I am pleased that there has been so much positive comment on the March issue of Canadian Family Physician and on my paper “Hard to know. What is hard knowledge?” The thoughtful letters of Pimlott, Hardacre, Leyton, and others add much to the discussion of the essence of family medicine.
Pimlott rightly points out that the ability to manage uncertainty is an essential attribute of a good family physician. I agree that teaching this to our residents is vital. Hardacre makes a further addition: the importance of the narrative in distinction to the obvious weakness of medicine that is based only on facts, science, or “evidence.” Knowing the patient’s story and our own story are critical in medicine, particularly in a relationship-based discipline such as ours. Leyton raises the intriguing conundrum of the duality of particle and wave in quantum physics. He takes tolerance of uncertainty to a new level, and that is awareness of the mysterious in life. For many who think of themselves as modern, an encounter with the mysterious results in free-floating anxiety followed by denial or liturgies of pseudocontrol. This is particularly evident in our responses to childbirth and to dying. Leyton notes that disease or illness is not a fixed point but is constantly changing. I agree.
The uniqueness of family medicine has been highlighted by these letters. Family medicine is relationship based and the narrative is core. Family doctors must be expert in managing uncertainty and, yes, allowing for the mysterious. Our traditional specialist colleagues derive most of their benefit from analysis, a method that breaks things down into smaller and smaller pieces. We are called to see the big picture, to integrate and to put the pieces of life together for our patients and for ourselves.
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