The family physician of the future

June is the 60th anniversary of the College of Family Physicians of Canada. As well as providing impetus to take stock, milestone anniversaries are a time for looking to the future. Others have imagined the future of family medicine through interesting lenses. For example, Petrany explored the subject by looking at what the doctors of Star Trek could tell us about what the family doctor of the future would be.¹ Smith characterized the possible futures of general practice as the “wood age,” the “iron age,” and the “titanium age.”²

Most current family physicians will recognize themselves in the crusty Dr Leonard “Bones” McCoy of the original Star Trek series. He is, as Petrany writes, a deeply caring man who repeatedly ... place[s] his patient’s life and interests ahead of his own, even if the patient belongs to a completely different species. Dr McCoy’s occasional crankiness cannot hide his caring spirit. We believe he is one of us and approachable .… He is capable of handling advanced technologies, yet shines as an unflinching patient advocate ... the man of heart that resists and balances the Vulcan Spock’s calculated logic. He is the ultimate space family doctor.¹

Dr Phlox, the physician from the recent series Enterprise, is an alien Denobulan who only needs 6 nights of sleep per year, ideal for maximum availability for patient care. He is exceptionally considerate and thoughtful, excited by diversity and new cultures and always projects a cheery disposition. He manages a biological garden and zoo that often serve as sources of medicinal therapies for his patients. Thus he is the prototype of the multicultural homeopathic physician of the future, comfortable with technology but knowledgeable regarding more natural means of healing. Dr Phlox reflects the swelling backlash against failed technologies that presently lead so many to experiment with non-traditional or natural remedies. But ... it takes an alien to bring back some balance between heart and technology to the profession.¹

We also have the extraordinary competence of Dr Beverly Crusher of The Next Generation, the complex and brilliant Dr Julian Bashir of Deep Space Nine, and the highly advanced holographic “The Doctor” of the Voyager series.

Smith’s visions of the future of the family doctor are shaped by the worlds in which we might live. In the “wood age” people react against technology; legislation restricts technological innovation; Internet access is a community resource, not a private one, but privacy is highly valued. The “wood age” family doctor is a sage in a long robe, central to the community, and the person who alone has access to the Internet and its information. The “wood age” family physician is the shaman of the Internet era.

The “iron age” of medicine is top-down and regulated. People are overwhelmed with information. The public interest is more important than privacy. The “iron age” family doctor is tightly regulated but trusted, important to the community and the state, and the purveyor of evidence-based information in a world where rationing is accepted. Call this vision of family medicine’s future the Orwellian one.

In the “titanium age” information technology develops fast in a global marketplace, governments have minimal control, people have a huge choice of technology and information sources, and they are suspicious of government-sponsored services like Medicare. In such a world patients shop around; family physicians compete with specialists, complementary practitioners, “cyberdocs,” and other healers; patients know more than you do, and most consultations are e-consultations. This might be the Blade Runner version of our future (and the one that seems imminent).

For Petrany, family medicine as a discipline began in the era of “Bones” McCoy and now finds itself in the era of Dr Phlox in an increasingly impersonal and technological system. Smith grapples with the powerful drivers of change in modern health care: the Internet and the information age, the rise of sophisticated consumers, increasing public accountability, the aging of society, more chronic disease, cost containment, globalization, the collapse of socialism, and the growing gap between rich and poor.² Both seek not to predict the future, but to prepare for and influence it.

Smith asks, “What will survive as the world changes completely?” His answers include having clear ethical values, being clear about what we are trying to do, putting patients first, listening, striving to keep improving, remaining therapeutic when others seek to persecute, accepting limitations, basing what we do on evidence, learning, and valuing leadership and teamwork.² Petrany is reassured that despite the increasing technological focus of the various iterations of the USS Enterprise’s doctors, each is a generalist with broad healing skills, who deals with a variety of ailments in patients of all ages, sexes, and even species. They are “uncompromising in their commitment to their patients.”¹ Smith’s answers appeal to my head, but Petrany speaks to my heart and soul as a family physician.

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