Lessons on team-based care from the military

Each year on November 11 in Canada we observe Remembrance Day. As a former member of the Canadian Armed Forces (CAF), I learned and experienced so much during my time in uniform, including receiving additional training in diving and aviation medicine, but 1 thing in particular stayed with me. In the late 1990s when I started practising medicine, I was struck by how the military supported team-based primary care. For example, our urgent care clinic in the CAF involved medical assistants (starting visits), physician assistants (managing some patient visits), nurses (recording patient histories, managing intravenous therapies), and more. A few years later, physiotherapists were added to the team. As the physician leading the team, I reviewed cases, provided medical advice, and saw patients with complex, undifferentiated, or more severe illnesses. It was great work.

When the College of Family Physicians of Canada began building the Best Advice Guide: Team-Based Care in the Patient’s Medical Home,¹ I wondered if they looked at the CAF’s model. I later learned they included members of the military on their advisory committee.

At sea, the CAF medical team changed but was core to the work. Not every ship had a physician, but we were only a radio call away if needed. Once, I was on a ship in the middle of the Pacific Ocean and got a call from a physician assistant on an accompanying ship requesting assistance with a challenging medical situation. It was the middle of the night. The least terrifying way to transfer between ships in pitch-black rough seas, 1000 km from land, is by using a rigid hull inflatable boat (RIB). Loaded with a duffle bag of personal belongings on my back in case I needed to stay on the other ship, I rode over 10-foot swells to distant lights that quickly became a wall of steel. A rope ladder dropped from the ship above as I bobbed alongside to the revolutions of the RIB’s outboard motor, layered over the low, deep roar of the frigate’s diesel engines.

I jumped on the ladder and started climbing as it swung and bounced against the ship’s hull. After a burst of climbing, I paused to reorient myself. In what felt like less than a second, I was suddenly, shockingly, laying in the bottom of the RIB, still holding the rope ladder. I had started climbing in a wave trough and when the wave crest lifted the RIB over 10 feet into the air, I ended up back in the RIB (thank goodness they waited to watch my ascent). My team saved me that day.

The CAF build primary care medical teams around a family doctor. Within primary care, family doctors are the experts. We have the training, the broadest scope, and deepest medical experience. Our training prepares us, as clinical leaders, to guide a busy team working to capacity and managing many more patients than any clinician alone. There is no doubt we need more family physicians, but enhancing teams with family physician clinical leadership will help us address the desperate need for comprehensive primary care services.

Notes

Spotlight

Dr Marc Bilodeau is the President and Chief Executive Officer of the Outaouais Region Integrated Health and Social Services Network in Gatineau, Que. Before stepping into this role, he served as Surgeon General of the Canadian Armed Forces, capping a remarkable military career. A family and emergency medicine specialist, Dr Bilodeau has always balanced hands-on care with leadership in shaping health systems. He is deeply committed to mentorship, improving patient care, and currently chairs the Board of Directors for the Canadian College of Health Leaders.

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