Translating gossip into respectful dialogue

Vanessa Brcic; Nicholas Pimlott

doi:10.46747/cfp.6708559

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A view from the pasture
Henny Rappaport

Published on: 09 September 2021

Published on: (9 September 2021)
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A view from the pasture
Henny Rappaport, family physician retired, retired
I am a recently retired family physician who ran her own practice for 42 years, and also had the privilege of training medical students and family medicine residents in my community-based office . In addition, I had numerous leadership roles in both my hospital and in the move to reform primary care which provide me with yet another level of context. I read with great interest the 2 articles, “Family Medicine is not a Business” (1) and “Translating Gossip into Respectful Dialogue” (2), and believe they are both pivotal editorial opinions for our profession. However, I am troubled by the divergent nature of theses papers. .
Dr. Ladouceur’s article resonated greatly with me and I salute his courage in bringing difficult key issues forward for scrutiny. I would like to add some perspective from a societal lens. In 1968 in Ontario, medicare was fully implemented and within a relatively short period of time guaranteed physician income became a factor in the self selection of candidates going into medicine. Previously altruism was a primary driver as most physicians provided some care pro bono or with very limited payment. This made it a much less desirable profession in the pre medicare times for those who had a more entrepreneurial bent. Altruism is a necessary underpinning that allows medicine to be well practiced.

“Translating Gossip into Respectful Dialogue” also carries weight in my mind. However, much of this paper seemed to both rationalize and j...
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I am a recently retired family physician who ran her own practice for 42 years, and also had the privilege of training medical students and family medicine residents in my community-based office . In addition, I had numerous leadership roles in both my hospital and in the move to reform primary care which provide me with yet another level of context. I read with great interest the 2 articles, “Family Medicine is not a Business” (1) and “Translating Gossip into Respectful Dialogue” (2), and believe they are both pivotal editorial opinions for our profession. However, I am troubled by the divergent nature of theses papers. .
Dr. Ladouceur’s article resonated greatly with me and I salute his courage in bringing difficult key issues forward for scrutiny. I would like to add some perspective from a societal lens. In 1968 in Ontario, medicare was fully implemented and within a relatively short period of time guaranteed physician income became a factor in the self selection of candidates going into medicine. Previously altruism was a primary driver as most physicians provided some care pro bono or with very limited payment. This made it a much less desirable profession in the pre medicare times for those who had a more entrepreneurial bent. Altruism is a necessary underpinning that allows medicine to be well practiced.

“Translating Gossip into Respectful Dialogue” also carries weight in my mind. However, much of this paper seemed to both rationalize and justify systemic issues as the root of problematic behaviours. There is no doubt that our discipline is facing difficult times. Over the years family medicine as a discipline has needed to provide much broader and complex care to the patients we serve as a result of many wonderful advances in medicine. Our training programs unfortunately have not kept pace with this need. This adds to the stress already experienced by trainees and newer graduates, increases the demands on their time and drives some of the shortage of broadly based longitudinal family medicine providers. I do know that work is ongoing to address this issue. But other factors are also at play. The funding mechanisms in Ontario often do not reflect the work involved nor the value of the services family physicians provide. There is also the reality in which the youngest generation of our peers have been raised. I believe many of our youth, both inside and outside of medicine, expect the world to fit their needs. When expectations are not met, frustration is the result.

In order to resolve the tension between professional behaviours and systemic issues, change must take place. I am optimistic that this understanding will assist in addressing the issues raised in both articles. The future of our discipline depends on it. Hopefully the balance found will be appropriate for a profession where service to others is a core value.

Henny Rappaport MD CCFP FCFP (retired)
Toronto ON
Competing Interests: none
References:
1. Ladouceur R. Family medicine is not a business [Editorial], Can Fam Physician 2021; 67:396 (Eng), 397 (Fr).
2. Brcic, V. and Pimlott, N. Translating gossip into respectful dialogue [Editorial], Can Fam Physician 2021; 67: 559 (Eng) 561 (Fr).
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Competing Interests: None declared.