The lived experience of working with chronic conditions in rural and remote areas: emerging results around changing identities

In August 2008 I started PhD fieldwork in rural Tasmania, investigating role and identity for rural and remote health professionals given rising expectations of chronic conditions work. The research aims to understand what is involved in giving chronic conditions care to rural and remote people, and how being rural/remote affects chronic conditions work. By making explicit transitions, tensions, issues, and changes within rural clinician roles and identities, this research will contribute to workforce understanding; thereby improving ‘fit’ of rural roles and work conditions to health professionals at different personal and professional stages of life. Method A qualitative multi-method project, this research involves observation, filmwork and semi-structured interviews with 20-30 rural clinicians representative of workforce profile. A subset of participants is videoed working with people with chronic conditions, with filmed consultations becoming triggers for collaboratively directed interviews. The observations and novel filmwork component verify, problematise and extend on the ‘reporting of self-experience’ normal to qualitative interviewing. My outsider status (naivety to chronic conditions work) and video ‘confrontation’ make explicit normally unasked questions and unstated positions of invisible community health work. Video-based interviews add further opportunity for health professionals to reflect more deeply on ‘what they do’. Results From work-life balance to role incompatibilities, asking about chronic conditions work raises many questions. Early findings suggest individual interest, professional pathways, peer expectations, and system capacity are important in enabling working with chronic conditions. Emerging hypotheses include that unless a rural clinician is in a designated chronic conditions role (eg diabetes educator), they appear reluctantly dissuaded from holistic chronic care by system constraints as much as access and availability. It also appears that just as patients experience cycles or chronic condition trajectories, professionals experience chronic conditions management trajectories. Intersecting with career trajectories are cycles of engagement/disengagement with chronic conditions work. Conclusions Rural health professionals really live with chronic conditions. Given ageing populations and sea/tree-changers, rural clinicians increasingly not only ‘manage’ people with chronic conditions, but have chronic conditions themselves and care for family members with chronic conditions. Living where they service, they are constantly confronted by their own and community expectations of chronic condition responsibilities, needs and wants. In a context where chronic conditions discourse is dominated by biomedical and (rightly) patient-centred processes, this research adds thick description of the ‘experience of chronic conditions work’. Early findings suggest a need to empower professional as well as patient chronic condition trajectories.