Mentorship in Medicine

Dr. Leslie Lappalainen on building capacity in rural communities

More than six million Canadians will develop a substance use disorder in their lifetime, yet substance use typically features briefly in medical and nursing school curricula. As a result, only 15% of Canadian primary care physicians feel well prepared to treat substance use cases, and many Canadians don’t receive the best available care. This is an even bigger concern in rural and remote communities, where access to health care is already limited in comparison to urban centres.

Peer mentorship is an important approach to help address this longstanding gap in addiction training. For Dr. Leslie Lappalainen, Medical Lead for Addiction Medicine, Mental Health and Substance Use (MHSU) at Interior Health, mentorship can help build capacity and expertise across the health system to better support people with substance use disorders.

While working at the addictions consult service at St. Paul’s Hospital in Vancouver, Dr. Lappalainen helped train medical students, residents, and addiction medicine fellows.

“I was motivated to try and convey to students that substance use disorders are treatable and the outcomes can be really good when we offer people evidence-based treatment,” she says.

Lappalainen first became interested in addictions during an HIV elective in her residency.

“I [worked] with a wonderful family physician in Ottawa. He described how, when [treating] individuals’ substance use disorders, their overall care, including their HIV, generally [improved significantly].”

She was later inspired by the evidence-based, compassionate approach to addictions care embodied by her preceptors during an enhanced skills program at UBC.

She carried that inspiration into her clinical practice in Kelowna and her work across the interior, where offering evidence-based treatment isn’t always straightforward. She describes particular challenges for rural areas, including difficulty establishing overdose prevention sites, and stigma which prevents people accessing care for fear of being recognized. As a result, she encourages clinicians working in rural contexts to be creative when providing care.

“My experience is that clinicians working in rural and remote settings are often ready to roll up their sleeves and do some ‘out of the box’ thinking on how to best support patients with relatively few resources.”

Lappalainen describes some such initiatives in Interior Health, including ‘episodic overdose prevention services’ (eOPS), run out of existing care settings, and virtual addiction treatment options to increase access and allow for more discreet service provision.

But for Lappalainen, the work doesn’t stop there. She notes innovative solutions such as these should be published so that others can improve care in their own areas. She also highlights the potential for the BC ECHO on Substance Use to share resources and knowledge, particularly for those working in rural and remote contexts.

For Dr. Leslie Lappalainen, knowledge is power, and clinicians have a crucial role to play in sharing what works and learning from each other’s success.