Essays October 2016
David J. Price
As a family physician, I’m used to hearing intimate details of a patient’s life experience and after thirty years in this profession, there aren’t too many things that surprise me. And while I know that it shouldn’t surprise me, it still does when someone I’ve just met at a social function, on realizing that I’m a physician, proceeds to tell me the most intimate details of their recent medical ailment.
Lately however, I often hear more about their medical journey within the healthcare system. Although many include comments about how wonderful their own family physician is, too often I hear tales of frustration about the system within which their family doctors works. It often amazes me what patients will put up with. Anecdotes such as: “When I phone my doctor’s office I’m on hold for twenty minutes before I can speak with a receptionist”, “I seem to be asked the same question over and over again” or “when I phoned to have my sick baby seen, I was told that the next available appointment is in 10 days” are not uncommon. It’s amazing what we all will put up with from a system that hasn’t kept pace with advances in knowledge and technology, [all of which has enabled us to live longer, albeit often with multiple chronic diseases.]
The world of family medicine is changing; when I started practice, I was generally more knowledgeable about a patient’s particular medical problem than the majority of them were. I spent years at university, on hospital wards and in family medicine clinics, studying clinical medicine and became both a source of information and expertise for my patients about their particular ailment. Today, however, many of my patients know more about their own particular medical affliction than I do. While the wonder of the internet has created an incredibly informed population, I am able to put that information in context, interpret risks/benefits for the individual patient and help develop a plan for next steps.
Family physicians care deeply for their patients and often talk about “my patients” in “my practice,” but now need to learn a new language and speak about “our patients, within our practice, within our community.” The old structure of family medicine [solo family physician] is evolving into care by an interprofessional team which may include allied healthcare professionals such as nurse practitioners, registered nurses, pharmacists, dietitians, social workers, occupational and physiotherapists, with the family physician being the linchpin of the team. I still consider our profession to be somewhat of a “calling” which means some personal sacrifices (as a colleague pointed out “it’s not about work-life balance when you choose to become a physician; you’ve chosen work satisfaction, which doesn’t happen from 9-5”).
Our Canadian primary healthcare system is not evolving quickly enough to keep up with this changing environment. Systems and organizations that don’t change run the risk of falling behind and becoming either obsolete or extinct. Our precious primary healthcare system is the centre of our overall healthcare systems, and we cannot let it become obsolete. Like any system change, it needs a “nudge.” That is where you, the Canadian public, are going to play a critical role over the next few years. Family medicine/primary care is going to, I hope, undergo a period of “disruptive evolution.” The shakeup needed is not quite as dramatic as what happened to Blackberry with the introduction of the iPhone [disruptive innovation], but we certainly can’t wait the “generations” that Darwin’s evolution by Natural Selection requires. Our system needs to change now, but a revolution is not needed. We need to be disruptive not explosive!
To truly respond to the needs of Canadians, family physicians and other healthcare providers need to work more closely with local government, service agencies, and perhaps most critically, patients/citizens to prioritize resources within communities, coordinate and organize care, and respond to specific community needs. Each of us, as a patient, has our own role to play, partnering with our healthcare provider to make informed choices, avoiding duplications of service and tests etc.
Canadian universities family medicine training programs are generally training residents to provide comprehensive family medicine within a team-based context.
Recent graduates, no longer want to work in solo, fee-for-service paper-based practices, recognize that to provide optimal care [while achieving a somewhat balanced lifestyle], their practice must be different than it was for family physicians a generation ago. To achieve this disruptive evolution, governments, family physicians, and medical professional organizations, need your engagement, ideas and prodding to help the system evolve.
The Patient Care Group document (http://www.oma.org/resources/documents/primary_care_price_report.pdf) that I co-authored in 2015 contributed to the conversation, but the next time you see me at a social function/conference, tell me how you think we can make our system more responsive, not only to you as a patient but to your family and the community within which you live. Or send me an email – I’d love to hear your ideas.
About the Author
David J. Price is Professor and Chair of, Department of Family Medicine, Faculty of Health Sciences, McMaster University, and Chief, Department of Family Medicine of Hamilton Health Sciences