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What do Family Doctors do?

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Family doctor with patient combo, Norman Rockwell painting and photoDr Carmen Eadie, Vancouver BC, Sep 4, 2022.

The biggest problem with being a Family Doctor is that no one knows exactly what we do. We are involved in so many aspects of a person’s life that the lens is not clear to other people.

When we are young doctors, we tend to have younger practices: we would deliver babies, treats sports injuries, help young parents navigate parenthood while trying to maintain a family and a career. We looked after middle-aged people and tried to help them prevent chronic disorders by discussing diet, exercise, and lifestyle changes. We worked with teenagers and their angst. We helped families with children with special needs and chronic childhood illness that needed extra support. All of this regardless of the limited remuneration.

As we got older, our practices got older and we started dealing with more cancers, chronic disease, geriatrics, as well as the middle-aged people that started with us when we were new in practice and then the young adults that we delivered and their families.

We look after people throughout their whole lives, and no one seems to understand this.

We don’t just write prescriptions for chronic illness (the pharmacists’ view), we don’t just look after kids with flus and colds, childhood illnesses, healthy baby checks and supporting young families (the NP point of view). We don’t just treat hypertension, diabetes according to the guidelines of the day (another NP point of view). We also look after people with mild to moderate mental health disorders, most of which resolve within 2 years i.e. mild to moderate depression, youth angst etc. (the social worker, counselor, psychologist, youth worker point of view.)

Through all this we have to sort out the worried and anxious from the seriously ill. Which baby is a true failure to thrive and which is a healthy child, just growing a bit slower or genetically smaller than their cousins? Which child has asthma, and isn’t just snuffly? Which anxious mom is truly just tired and a bit anxious and which has postpartum depression? Who is having coronary disease and who is having anxiety? This is our job.

How people see our role is based solely on the reason they come to see us. We wear many hats. The longer we are on the job the more experience we have. But the patient still only has their personal experience of what they need us for and don’t see the rest of it.

Our specialist colleagues, especially over the last 20 years of my practice, have similar blinders. Our experience is minimized, our roles misunderstood and our experience is ignored.

I have practiced medicine for 40 years and have worked in Obstetrics, ER, in hospital care and I have taught medical students. I have averaged 8,000 patient interactions a year from seeing 35 patients a day, 5 days a week, for 46 weeks of the year (allowing 4 weeks for holiday and 2 weeks education). After 5 years that’s 40,000 individual interactions.

In 40 years of practice, averaging 8,000 patient interactions a year, that is 320,000 individual patient interactions dealing with people throughout the timelines of their lives. I would say that is a hell of a lot of experience and contribution for one person/professional.

Not many people, other than FP’s can describe this level of interaction with society and yet, so many others feel that they can do our job or that we are lacking.

It’s time Family Doctors were recognized as the professionals they are, with a high level of education, a high level of experience and a high level of contribution to society.

Anyway, I don’t know any other profession that does this. If I am wrong, please let me know.

Family Doctors play a big role in medicine, but no one realizes it because very few people see all that we do. Few people are willing to admit that what I have just described is our reality, except other Family Doctors.



Family Doctors filter undifferentiated patients

I think what most people do not appreciate is that Family Doctors separate the seriously ill from those that are concerned and worried, but otherwise well. A Family Physician takes undifferentiated patients and filters them to the specialists, who receive pre-filtered consultations on ill patients. This is important work, and not appreciated at all or by anyone. And all for a pittance in FFS payment. It is heart-breaking.

A doctor’s dilemma by Dr Kristi Herrling

This is a very good article published in MacLean's magazine September 2022 issue.

A doctor’s dilemma

My job as a family physician in small-town British Columbia is a dream come true. It’s also nearly impossible to do.

By Kristi Herrling August 15, 2022

The Doctor's Dilemma

This article in Macleans is an example of excellent literary writing for several reasons. The first three words set up a scene which will be familiar to many readers: the conflict of boredom and anxiety in a hospital bed, where you have little to do but observe the mechanical process of maintaining blood volume, usually without any understanding of what that actually means (for most non-medical readers).

For those who have experienced the birth process, either personally of vicariously (as an attendant) she immediately heightens the tension, with allusions to the uncertainty of the imminent delivery; while reminding us of both our arrogance and of the limits to our intervention.

Then we are made to face the harsh consequences we face when things turn out unfavorably. “This is the reality of the human condition. Deal with it.”

Then comes a little familiarization of the human background and context. Followed by the most perfect description of what it means to be a family doctor, but especially in a rural community. Without saying so in as many words, she is telling us that this is a “specialty” like no other; and that it is incredibly rich and fulfilling.

But there is a fly in the ointment: the system to which she belongs is in a state of disintegration and collapse. Then she methodically begins to describe just why.

Of course money is the biggest part of the picture. But it's not just how much she is able to contribute to her family economy each month, although that is obviously far too little.

No, it’s more about the lack of money or else mal-distribution of money throughout the government run system. All patients, not just hers in Sooke, but throughout the province are hurting: “..our payment system, our government, does not prioritize spending time with patients;”. The arrogant, faceless bureaucrats and politicians, none of whom have the foggiest idea about the practice of medicine, are controlling every aspect of our profession. While at every turn they hobble the physician and surgeon with bureaucratic forms and other nonsense.

Then the tableaux is enriched by the image of the ‘doctor as a patient’. No one without our training can possibly imagine what it’s like to be in the ‘helpless’ situation of a doctor-patient, only too well aware of the multi-fold ramifications of every symptom and sign and test result. The burden of this knowledge may be overwhelming.

And finally she returns to being just an ordinary human being like the rest of us. A wife, a mum, a daughter, the lady in the house next door.

This is a brilliant piece of writing. God bless her; and may she continue to serve her very fortunate patients for very many years.


Cease fire banner, you don't speak for the people.