The Paradox(es) of Primary Care - Part 1
I have a week off and I am writing from the cottage. It’s been a long time since I have had a week off—I cannot remember the last time I wrote using plain pen and paper. And after a season of deadlines in front of the computer and rushed visits in front of the EMR, it feels good.
During one of those rushed visits, one of my patients commented that it was funny that I printed my prescriptions with a computer but signed them with a fountain pen. I said that it helped keep the computer in check, but it got me thinking.
Our discipline is full of paradoxes. Computers help us, but can also hinder our relationships with patients. We both use and discount guidelines and evidence, depending on the circumstances. And we are both advocates for our patients, but also stewards of the broader system--we try to be patient-centered, but there are times where we feel overly-personalized medicine is not a positive trend. (1)
Another paradox was recently pointed out to me by a brave medical student at the end of a forum on social accountability and global health. He asked: how could I justify greater (or lesser) degrees of overseas heroism when so many are suffering back home? Or something to that effect. The room fell silent, but it’s a good question.
As family doctors, we like to pride ourselves in being in touch with vulnerable patients and community needs. But in a world with potentially limitless needs, where do we draw the line? Do we focus on our practices or look beyond to those forgotten patients in our communities? And if we look beyond, how far do we look? As privileged physicians in a privileged country, in a world with great degrees of human suffering, I would argue that we should look quite far. But if all of us do that - back to the medical student’s point - suffering back home will increase as well.
Attitudes towards this conundrum, it turns out, are shifting (2). Although the younger generation of physicians are more likely to see social accountability as an interest rather than a duty, they are also more likely to reflect on local needs than their teachers are. Local, it turns out, is the new global.
More than paradox, it may be instead that our discipline is rather full of complexity and nuance. Something that works for one patient may not work for another. The substitution of one word can make a world of difference. Incredibly, asking “is there something else I can help you with today?” rather than is there anything else I can help you with today?” makes the patient feel much more heard (3). And perhaps we can apply global health lessons locally, and vice versa. Maybe, we can do both.
Maybe we can embrace modernity without letting go of tradition.
As Hippocrates said, life is short, but the craft is long. The rest of his Aphorisms, by the way, make for great reading (4). Many of them are still true. Or could be, in the right circumstance. It turns out old may be the new young again. In fact, as family doctors, perhaps we understand that often, there is little difference.
As, the great Syrian poet Adonis penned (before the age of computers):
“The seasons are not four.
A week is not seven days.
A year is more than it is,
And less.”
I’d like to wish readers of CFP a very happy new year.
References
1. http://www.cfp.ca/content/54/2/255.long
2. https://journalhosting.ucalgary.ca/index.php/cmej/article/view/36867/pdf
3. https://www.ncbi.nlm.nih.gov/pubmed/17674111
4. https://en.wikisource.org/wiki/Aphorisms
Photo Credit: Couvrette/Ottawa
