Purpose, portent, and possibility

The first time I saw a baby delivered, I fainted. I was a pre-clinical medical student on my first overseas elective in Nepal, and my preceptor was nice about it. He blamed the monsoon heat and didn’t mention it in my evaluation, but I think he was secretly hoping I would choose obstetrics over family medicine as a specialty. My choice of family medicine came surprisingly late. The Nepal trip had a lot to do with it. There, for the first time, I realized how much I love children (I ended up gathering my wits and performing obstetric care for some time and now, 30 years later, I have 3 daughters of my own) and how a well-trained generalist can make a difference in an unjust world. With its clinical diversity and potential for community leadership and advocacy, family medicine was the natural choice.

In this issue, contributors to Canadian Family Physician (CFP) explore all these themes. The Rourke Baby Record (RBR) has helped family physicians since it was first published in 1985.¹ This year’s update (page 553)² is notable for a section on anti-racist, inclusive, and culturally safe care. The RBR incorporates many pages of resource links³ for health professionals and families. This is easy to forget if we approach the RBR as an exhaustive checklist, but Rourke and colleagues critically clarify that, “Despite its checklist framework, [the RBR] is intended to be a clinical tool to provide a basis for a personalized reciprocal interaction with the patient, the family and provider.”² This is a refreshing take for a discipline currently overwhelmed with paperwork.

A Praxis article on artificial intelligence medical scribes (page 569)⁴ and a Perspectives article on revisiting Dr Ian McWhinney’s holistic principles of patient care in the digital health age (page 543)⁵ are also helpful for busy practitioners trying to balance thoroughness and technology with maintaining a strong relationship with their patients. Thompson et al remind us digital transformation can serve as a catalyst for adopting McWhinney’s principles when thoughtfully implemented. We can feel comfort in prioritizing compassionate relationships as we adopt new tools.

Another Praxis article (page 567)⁶ discusses reproductive health and obstetric care. One guideline update in the article merits special mention. The delivery that made me faint in Nepal was, in retrospect, 1 of the most natural to which I attended. Operative delivery rates in Canada now approach 35%, a 3.5% increase from 2020.⁷ The American College of Obstetricians and Gynecologists’ recommendation to define active labour starting at 6 cm of cervical dilation is noteworthy. While conditional and based on moderate-quality evidence, the recommendation to allow longer second-stage labour (up to 3 hours for nulliparous and 2 hours for multiparous individuals if there is ongoing progress and no contraindications) is based on strong, high-quality evidence. Pregnant individuals living with human immunodeficiency virus with consistent antiretroviral therapy adherence and an undetectable viral load (<50 copies/mL) within the past 4 weeks should now also be offered vaginal delivery.⁶

I wanted to share some lessons I learned about CFP since becoming the journal’s Associate Editor this spring—a deeply meaningful evolution for me. As a member of the College of Family Physicians of Canada (CFPC), I appreciate our high impact factor, bilingual, open-access publication. Did you know articles listed under the issue highlights section on the CFP website (https://www.cfp.ca) are eligible for Mainpro+ credits? Or that CFPC members can download a digital version of each journal issue (either the full edition, French edition, or a research-focused edition)? About 25% of CFP readers are from outside Canada, and articles solicited from abroad can inform our primary care system and its current challenges.

Ten times a year, I witnessed the small but effective team at CFP work hard to deliver each high-quality issue. Sometimes, it’s a race to publish cutting-edge findings and updates, as the many articles in this issue illustrate. Other times, a special issue can take a year or more to plan, such as the June 2025 research-themed publication about the Canadian primary care crisis. It’s been amazing to witness—the team at your journal is always there, turning words into new ideas and renewed hope for our profession. It’s a labour full of purpose and portent, not unlike seeing a baby born for the first time.

• Copyright © 2025 the College of Family Physicians of Canada