Conversation with Ian McWhinney

A people that values its privileges above its principles soon loses both.

Dwight D. Eisenhower

Life is divided into three terms—that which was, which is, and which will be. Let us learn from the past to profit by the present, and from the present, to live better in the future.

William Wordsworth

In an important and provocative editorial, Dr Roger Ladouceur, my colleague at Canadian Family Physician, lamented the decline of generalism among family physicians, including many recent graduates.¹ In response to this editorial, Thomas Freeman and Stephen Wetmore challenged our discipline and our national College² to confront this emerging identity crisis in family medicine.³

In the great tradition of the Royal College of General Practice in the United Kingdom—which established and supports the William Pickles, James Mackenzie, and John Hunt lectures that are published annually in the British Journal of General Practice—the Department of Family Medicine at Western University in London, Ont, established the Dr Ian McWhinney Lectures in 2015.⁴ Canadian Family Physician is proud to be able to share these lectures annually with our readers in the December issue of the journal.

Dr Michael Kidd, then president of WONCA, the World Organization of Family Doctors, was the inaugural lecturer.⁵ Dr Kidd was affected and influenced by Dr McWhinney’s 1996 William Pickles Lecture, “The Importance of Being Different,” in which McWhinney described 4 powerful ways that generalist medicine differed from specialist medicine.⁶ Using this lens and the 9 principles of family medicine described in Textbook of Family Medicine,⁷ Dr Kidd told his audience a series of global stories bringing to life these principles in countries as diverse as Canada, Cuba, Japan, Australia, and Uganda. If the theme of Dr Kidd’s lecture could be summed up in a single sentence it might be that, armed with the principles of family medicine and a deep understanding of the ways in which committed generalist physicians understand health and illness, family medicine can be a force for greater health and social equity in the world.

In the 2016 lecture, “The Perils and the Promise of Proximity,” Dr Marie-Dominique Beaulieu explored the concept of proximity medicine, which goes beyond our understanding of patient-centred care into the realm of true partnerships with patients (page 964).⁸ Dr Beaulieu describes how the practice of proximity medicine—a concept that Ian McWhinney would not only recognize, but also embrace—can empower family physicians to lead change in our health care system to address the social determinants of health, the challenges of access, transitions in care, and what she describes as “maximally disruptive medicine.”⁸

Both lecturers had, as their starting point, commented on the fact that neither had met Dr McWhinney personally, but had come to a deep relationship with him through his writing. In each case, they chose a different work of Dr McWhinney’s as a lens through which to examine the challenges that face family medicine as we seek to achieve greater health and social equity, not just in Canada, but also around the world. In the case of Michael Kidd, it was the 1996 William Pickles Lecture; in the case of Marie-Dominqiue Beaulieu, it was The Early Signs of Illness⁹ and the memoir A Call to Heal.¹⁰

Ian McWhinney understood and clearly articulated that the practice of family medicine is an ongoing, daily, and lifelong series of acts of moral imagination—to understand our patients, our communities, and the wider world and how these affect the health and well-being of people. The McWhinney lectures provide Canadian family medicine with an ongoing conversation with Dr McWhinney and his ideas—a conversation that reminds us, as the first 2 lecturers have, that the key to our identity—and our identity crisis^1–3—is embracing the principles of generalism and the ways in which family medicine is different.

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