In defence of a “good-enough” family physician

Roger Ladouceur

I’m just an ordinary guy

Sometimes I just want to do nothing ...1

Being a family physician is not easy these days. This fact is coming out again in the results of surveys published this month in Canadian Family Physician. One by Miedema et al ( page 286) tells us that many family physicians are finding it difficult to reconcile their professional lives with their personal lives; they feel overwhelmed by the burden of work and are under the impression that they no longer have any personal or family lives. The other survey conducted by the same authors ( page 279) reports that some family physicians, particularly younger ones, women, and those who work in rural areas, say they are victims of harassment and abuse. They complain about the disrespectful behaviour and verbal threats uttered by certain patients or their families and sometimes by their own colleagues. These aggressive attitudes sometimes even escalate into taunts and physical altercations. The final survey of a representative sample of family physicians in Kitchener-Waterloo, Ont, speaks of the stress these physicians feel at work and the ways they have of dealing with it ( page 288).

Are family physicians’ situations worse than those of others?

Certainly, many other workers could interpret these perceptions as self-pity, thinking of their own situations. Specialist physicians, for example, could retort, “Do you think it’s easy being the medical experts, communicators, collaborators, managers, health advocates, scholars, and professionals that our key competencies require us to be? Do you think that one person can be all those things and more?”

And others will say, “Do you believe it would be easier to be a farmer, a housewife, or a bus driver? Do you think that the lot of a young single mother who works herself to the bone in a factory to feed her family on starvation wages is preferable to yours? And what about workers who find themselves at 50 unemployed, with no money, no education, and no future?”

Most professions and job situations have their share of difficulties and hard times. As the saying goes, “I complained because I had no shoes until I met a man who had no feet.”

Difficulties inherent in just being a family physician

When all is said and done, the profession of family medicine is fraught with difficulties, especially because the field of endeavour is so large, the spectrum of knowledge infinite, the range of skills immeasurable, and the expectations so high—no doubt too high. Simply consider the principles of family medicine: a family physician is a skilled clinician; family medicine is a community-based discipline; a family physician is a resource to a defined practice population; and the patient-physician relationship is central to the role of a family physician. You might as well say that people expect family physicians to know all, be all, and do all ... or almost. Few are the professions in which the expectations are so high and the needs so pressing.

And it’s not only society and individuals who make great demands on family physicians. These physicians make great demands on themselves. Most wish to be good family physicians, but also good parents, good husbands and wives, and good friends, and to succeed in all aspects of their lives.

A “good enough” family physician

Fortunately, authors like Ratnapalan and Batty ( page 239) are there to remind us that family physicians are above all human. That to be “good enough” is perhaps quite all right, maybe even preferable to trying to be perfect. For as everyone knows, perfection is not of this world!

In truth, most family physicians benefit from developing another skill, not a key competency, but a very fundamental skill: the capacity to recognize their limitations, whether professional, personal, or existential. And to be able to take to heart Charlebois’ words: “I’m just an ordinary guy ... I make music with my old pal.”1

My own old pal, whom I consulted when I was caught up in my professional, familial, marital, and societal responsibilities many years ago, suggested I look out over the cemetery located behind his office (he practised in a little village in Quebec). When I tried to understand his message, he said, “You know Roger, all those people thought they were indispensible too.” It shocked me to the core!

I’m just an ordinary guy ...