In every disadvantage there is an advantage

In challenging times, I look for inspiration and advice about my work from many sources, frequently non-medical ones. Legendary Dutch footballer Johan Cruyff¹ was a brilliant player, but he was also famous for his aphorisms and insights, many of which can be applied to life in general. One of my favourite “Cruyffian” aphorisms is the source of the title of this article.

One of the recent disadvantages that family physicians in Canada have had to contend with has been shortages of medications ranging from commonly prescribed pain medication¹ to the “blockbuster” drug semaglutide, developed for the treatment of type 2 diabetes mellitus but widely used off label for weight loss.² In the autumn and winter of 2022—peak season for conditions like acute otitis media, streptococcal tonsillitis, and pneumonia—the antibiotic amoxicillin was in short supply.³ But is the shortage of commonly prescribed drugs new, and is it primarily due to supply issues caused by the COVID-19 pandemic? Recent research by Lau and colleagues reveals that the problem has been around for much longer, across multiple drug classes, and is not exclusively owing to the impact of COVID-19.⁴

In response to these drug shortages and to support physicians and patients in managing them, the federal government⁵ and many provincial governments⁶ have established easily accessible online monitoring and reporting systems.

In this month’s issue of Canadian Family Physician, a commentary by pharmacist Huyghebaert and colleagues (page 85) focuses on the “advantage of the disadvantage” of these medication shortages, seeing in them the opportunity to consider deprescribing, to consider less expensive but equally effective alternatives, or to reduce doses.⁷ Their practice tips are timely and practical.

Much other content in this issue focuses on challenges in rural and remote health care, including a clinical review on burn care by Tremblay and colleagues from NOSM University⁸ (page 95), and 2 research articles—the first on the use of point-of-care ultrasound imaging by family doctors in rural and remote British Columbia⁹ (page 109) and the second, from Sioux Lookout, Ont, a rich qualitative exploration of the healing journey of First Nations individuals dealing with opioid use disorders (page 117).¹⁰

For those both living and practising family medicine in rural and remote communities, there is a tendency to think of the challenges as mainly disadvantages. The problems of recruiting and retaining family physicians in such communities are real and long-standing, but there are also opportunities to practise to the fullest scope and to make a meaningful difference in people’s lives. Poorer health outcomes and lack of access to certain types of care in rural and remote communities are similarly real and long-standing, but the advantages of living closer to family, community, and the natural world may outweigh the disadvantages for some.

As family physicians, wherever we live and practise, we are used to living in that duality, and it is that ability to see both the disadvantage and the advantage in many situations that allows us to look at problems differently and that can inspire creativity and growth.

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