The March issue of Canadian Family Physician was an enjoyable and interesting read. It is timely that one of the themes explored should be the existential aspects of general practice, including the concept of uncertainty in practice, as well as the finding of joy in general practice.
I cannot recall any teacher discussing uncertainty as an important element of the discipline when I was a medical student and resident in family medicine in the early 1990s. Now, as a teacher of family medicine at the University of Toronto, I explicitly discuss recognizing and managing uncertainty with the resident physicians whom I supervise. An argument can be made that managing uncertainty is the “specialty” of general practice. The key to feeling comfortable and enjoying a career in family medicine might hinge upon how well students and residents learn to do this.
Uncertainty pervades family medicine. People present to family physicians with symptoms and not diseases, and it often takes time before the diagnosis becomes clear. Younger physicians are often uncomfortable with this and need to learn the skills to deal with it. The growth of evidence-based medicine has been an advance in clinical practice during the past 2 decades and, at least in theory, should help to reduce uncertainty in certain areas of practice, such as drug therapy. However, many studies of drug therapy include only younger patients or those with only 1 medical problem and, therefore, do not resemble the patients seen in a typical family practice. Nonetheless, even this type of uncertainty can be understood and managed.
The article by Pestiaux and Vanwelde, “Becoming a general practitioner” (Can Fam Physician 2007;53:387–8 [Eng], 391–2 [Fr]), addresses a common theme in today’s medical literature: the unhappiness of physicians. There is no doubt that in a world in which specialization of professionals is the norm, being a generalist is both unusual and very challenging. When the pleasures and rewards of the generalist life wear thin, I find the 1996 William Pickles Memorial Lecture by Dr Ian McWhinney to be reinspiring.1 It is perhaps the most succinct consideration of the things that distinguish generalist practice from specialty practice that I have read, as well as a touchstone to the things that are the most rewarding about being a family doctor. I recommend it to residents and practising physicians alike.
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