In it for profit?

Your article “Stand and Declare”1 made me sit up with pride and feel more hopeful about the future of family medicine in Canada. It takes vision, critical thought, and courage to go forth on the path that you have laid out in your article, and I commend you and others involved in this mission.

As a practitioner, I continue to watch industry and the drive for profit erode the practice of family medicine. I hear from allied health care providers and patients alike that “the medical model” is mostly a recipe book of algorithms and pharmaceuticals being dished out in 5- to 10-minute increments known as “office visits.” Practices such as these have replaced compassionate, reflective practice styles, which involved more time and more meaningful human contact. I believe we have lost our perspective on what is indeed normal and normative about the development of human beings. We have grown reliant on technology and taxonomy (eg, DSM-IV) to pigeonhole patients to the extent that they have been dehumanized. In this process we ourselves have grown more desensitized and more distant and detached from ourselves, our families, and our patients.

Clinical guidelines quickly become the expected standard of care. This occurs without any analysis of economic effects, population health, or disease prevalence in primary care, and without any meaningful discourse between specialists and primary care practitioners. Moreover, as pointed out by Dr Sanderson, a UK-based family doctor,2 there have been catastrophic results when these “standards” have been implemented along with pay incentives for family doctors to practise them (pay-for-performance practice). I understand that this is an exploration of incentive-based practice; however, I am unable to rid myself of the image of a donkey with a carrot just beyond its reach.

Critical appraisal skills are important as we evolve as practitioners and grow more knowledgeable about our collective effect on population health. The very evidence that we are critically appraising, however, is flawed from the outset, owing to research and publication-related practices that you describe so succinctly in your editorial.

This has to change! The profession has been corrupted by these insidious influences. I have read that if you throw a frog into a pot of boiling water, it will react by jumping out. In order to successfully boil the frog to death, you have to put it in a pot of cold water and slowly turn up the temperature so that it does not even notice that it is being boiled to death.

Thank you for pointing out how hot the water has become!

• Copyright© the College of Family Physicians of Canada