The pride of being a family physician

A day in the life of a family physician ….

That morning, when the local physician went into the office, he expected to find a small, slow-paced practice. A few appointments, a few time slots for walk-ins treating one-off problems, and some follow-ups for chronic conditions.

At 8:00 AM, his receptionist tells him, “There is a patient in the waiting room who does not have an appointment but says it’s important.” How could he say no? When a young man arrives at the doctor’s office without an appointment and without having been in an accident, it must be urgent. Forty years old, in distress, with a beautiful little family, a beautiful new home … a couple evidently in crisis, a profoundly depressed man. The man is crying.

At 9:00 AM, his receptionist tells him, “Ms X., who was supposed to come in next week, is here with her daughter. She says it’s important.” How could he say no? The problem is very likely a recurrence of lung cancer. The diagnosis is not definitive but the scan is very clear and her clinical state is obvious—weight loss, cachexia, shortness of breath. A respirologist has repeatedly prescribed antibiotics and cortisone, which are visibly ineffective, but has not ordered a bronchoscopy or biopsy.

And then another, a young woman who is a social worker. She is also depressed. She went through a breakup a year ago. Left alone, she felt an existential emptiness. To fill the void, she spent a lot of money and went on wild shopping sprees. Now she is asking herself what happened. She does not understand. It is as if she was a different woman. The doctor is uncertain but suspects bipolar disorder. Should he prescribe a mood stabilizer without confirmation? The wait time for a psychiatric consultation will be several months, maybe even years.

In the afternoon, there is a request from a pharmacy to renew a vancomycin prescription for a patient the physician has not seen in 3 years! As far as he knows, vancomycin is primarily used to treat Clostridium difficile colitis. What colitis? When did this happen? Why is a renewal being requested? He checks the Québec Health Record. Calls the patient. The physician finds out that the microbiologist who prescribed the medication closed the file without ensuring follow-up. The pharmacy did not have any other option but to contact the family physician.

When the physician goes home, he is exhausted. He lies on the couch and immediately falls asleep.

In an open letter to members on June 22, 2022, the the CFPC confirmed that family medicine is in crisis:

More physicians are retiring and fewer medical students are choosing a career in family practice. Patients’ needs are becoming more complex, the costs of running practices are higher, and an increasing number of patients cannot access the care and support they require in a timely way.¹

Even in the most challenging of times family physicians have continued to serve as the only practitioners who care for every person, of every age and condition, from cradle to grave. But we are not being heard by key decision makers.¹

How do we restore the reputation of family medicine? Certainly, various measures can be envisioned. Recognize the true value of the profession. Compensate family physicians better. Distribute their work better. Do not make them the only access point for health care services. Do not consult them on “everything and anything.” Ensure that specialists follow up with patients they have assessed and treated, in the same way that other health care professionals do.

But most importantly, could we not simply return a sense of purpose to family medicine? There was a time when the College stated that family physicians are a resource for a defined patient population, and that the patient-physician relationship is central to the role of the family physician.² These principles defined the purpose of the profession.

At the end of his day, the physician is certainly exhausted, but he does not doubt the meaning or value of his work. He is a family physician and he is proud of it.

We should all show our pride in being family physicians.

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