Almost ten years ago, I hesitated until the last second, literally. I finally “ranked” “med fam – Joliette” in front of four choices in anesthesia. I chose a medium and a specialty. I chose to return to my native region. I had my first choice.
I told myself that with family medicine, I could do “everything”. That was what I was promised. A choice of reason in the circumstances of the time, but, basically, I did not see myself mourning the children, nor that of the old, even less women or techniques. I wanted to do everything. I like to know about everything, to be able to answer everyone.
With two years of family medicine, a medical education fellowship and an Oxford certificate in evidence-based health care education under my belt, I am now working to launch a FMG-U with a powerful team eager for forward-looking care. ‘Outreach community, I do hospital call duty one week out of four in addition to being responsible for teaching for my home hospital, I am a medical consultant for the GAP of the CIUSSS-de-l’Est, I give conferences on overmedicalization and the judicious use of health care resources, I am a clinician teacher, I help humans die with dignity every week and I care for more than 700 patients, the majority of whom are members and residents of a community of the First Nations, where, every day, I revise that the most powerful medical instrument remains the relationship between a doctor and his patient.
On the last blows of 2020, I left my maternity leave early to go to the front because I felt I was particularly well equipped as a family doctor to go and fight COVID. No one forced me, no government coercion. I didn’t need the government to tell me what to do. I knew it. I wanted to be there, I wanted to treat, I never counted the hours. I deeply enjoy practicing medicine and interacting with patients.
In the hospital, in SNT, in RPA and in the community, I have been with my colleagues on the line to take care of patients and provide them with care in often difficult conditions. And I’m not alone. There are thousands of us across Quebec who have done it, without being forced to do so, without being asked to do so. We did it because we had to. Thousands of us have rolled up our sleeves to take care of our communities.
When I arrived in Montreal, I had no choice but to commit to taking on 250 additional patients in order to have the right to join the team of the future GMF-U Hochelaga-Maisonneuve. Nothing to do with the fact that it takes me 7 hours every week to see my patients in Manawan, nothing to do with it jeopardizing my ability to provide care to those I have been following for several years.
When one “signs” a new doctor on a territory, well-ordered charity requires that one start with oneself and that he pushes to the wheel to “empty the counter” local. I have about 100 days left to add 100 East GAMF patients to my caseload to respect this obligation (otherwise the RAMQ will cut my remuneration by 30%). For information, there are more than 57,000 names still pending on the GAMF de l’Est, as well as saying that there is no “small contribution”.
These 100 days are also already burdened with four weeks of hospitalization, where I cannot realistically add clinical care. Ah yes, that’s for sure, I can ask for an exemption on the deadline. It could be discussed at the parity committee… phew, all is not lost.
I work with absolutely extraordinary young doctors, who have additional training, subspecialties in cutting-edge areas of care […]. These young doctors find it difficult to promote their expertise because they are told: “outside of care, there is no salvation”. And that, too often, they find out the hard way once they practice because the academic world continues to cultivate a discourse of “possibles”, while the sum of government constraints on practice makes it possible less and less to value practices that serve communities and individuals in a way that is different from, but just as useful as, ‘care’.
“Executioner’s Medicine”
Through all of this, I say it without hesitation, “office” family medicine, the famous “care”, is certainly the most difficult thing in medicine. It’s also the most rewarding thing. From the cancer you help diagnose, to the parent you reassure, to the life you are told you saved not with heavy equipment, but just because you were there at the right time to listen, when the suicide note was written, this practice is full of small victories against the small trials of life and against death.
But it’s so heavy! Sometimes we laugh when we call it “executioner’s medicine”… there is the paperwork, the heaviness, the fact that there is often less and less medicine in the office and more and more administrative silliness… the constraints practices (AMP, PREM, RLS, GAMF, DRMG, MSSS, CIUSSS, etc.), systemic mutism with the second line, doctor bashingappointments given to patients to make sure they have not fallen into too many cracks in the system, working with burned and decimated teams, seeing a patient four times while he is waiting for its service, a system where technology wins are fax over email, a system that continues to prioritize the hospital over the community, politicians that undermine what has been proven for nearly 30 years to deliver ” the best bang for the buck “: first-line medicine.
Again in 2019, a study published in the JAMA concluded that adding “ten general practitioners has a 250% greater impact on life expectancy than an equivalent addition in specialist medicine”. It has also been shown that places with more family doctors have lower mortality rates. I’ll let you take stock of what it may represent knowing that, this year, again, 73 positions remain vacant.
Again this year, we are moved by the fact that dozens of positions remain to be filled. If I had “ranked” this year, I let you guess which choice I would have put first. It is not a fatality. There are decisions, actions, omissions and words that got us there… there are people responsible. There are solutions. Demand that they do better.
Let’s reinvest the front line: it pays off and it saves lives… but it shouldn’t be used to win elections.