I can’t help but write a few lines about this whole debate around family physicians. Or general practitioners. Or… I don’t know what to call them anymore, because their field of practice is so vast!
I meet many of them every day at the hospital here in Montreal. The “family doctor” has been made into an accounting entity that is supposedly comparable with any other family doctor. However, nothing is more wrong !
There are those who do a full-time practice in the emergency room. From twelve to fourteen guards per month, recognized by all associations as full time. Because it involves guards distributed during the day, evening, night, weekend or on a public holiday. Difficult to do another medical activity if you do not get full rest before or after a ” shift »In the emergency room, without putting oneself at risk of a thoughtlessness, a distraction, a moment of deep mental fatigue.
There are also several who work at the hospital. Usually for a week, they are on call, 24 hours a day, seven days a week, they take care of their “floor” in general medicine, geriatrics, palliative care, and so on. They take care of patients with all kinds of serious pathologies, who need a lot of care. Either they practice independently or they do so with a team of doctors-in-training that they supervise. They are called at any time of the day for every abnormal detail, for every complication. Their nights are interrupted by their vibrating pager, and they have to put on their boots and go, once better awake, to the hospital. Most do this about ten weeks a year. Obviously, during that week, it is difficult, even risky, to spend a lot of time in the office, given the workload of such a doctor.
There are also those who do home care, geriatrics or CHSLDs, who visit the most vulnerable patients in an attempt to keep them out of the hospital at all costs. The volume of patients they see may be less because our elders take longer to listen, understand, comfort or care for. As an emergency physician, I know this too well, I who like to thread a series of questions in 120 seconds to my young and coherent patients. And I may have to wait two minutes to get the answer to a simple question from a citizen with even moderate dementia. I love my geriatric doctors who take their time with this fragile population.
There are those who do obstetrics, who follow and give birth to patients throughout the year. There are those who deal with mental health or drug addiction (God knows we need it in Montreal!), Another psychically very draining field of practice.
In many of our hospitals, especially so-called “community” hospitals, that is to say all those that are not large university centers such as the CHUM, the MUHC, the Jewish General Hospital or Maisonneuve-Rosemont, it is often them. , “family doctors”, who for the most part hold the hospital system at arm’s length.
Recently, it has been said a lot that if we could take family doctors out of hospitals and if specialists took more care of patients in hospital, it would free up time for follow-ups and care in the office. However, 20 years ago, didn’t we say that, if a “general practitioner” took charge of a hospitalized patient, we would probably have a more global vision of the patient, a more integrated vision? The specialist is sometimes too focused on “his organ”, on his system. Can we blame him? After all, that’s why we want an expert! But he sometimes comes to forget or ignore a lot of small details which honestly are not his responsibility. I don’t care, that my cardiologist does not understand anything about my digestion!
It takes a conductor to coordinate all the solo musicians! AMPs were designed precisely to address this shortage of caregivers in acute or long-term hospitals.
Family medicine has been made a specialty, with good reason. But we have forgotten that, while cardiologists, for example, deal almost exclusively with cardiac patients, not all family physicians take care of … families, because the practice of the latter is not at all comparable!
If we force these family doctors, with such a diverse profile, to take on more patients for office follow-up, I don’t know who will do the emergency call, the weeks in the hospital, who will accompany the patients. patients at the end of their life or assess and keep at home our elders, who will give birth to our future mothers, etc. Yes, many patients go to the emergency room as a last resort. But most are not these patients who really clog our system – except for a few waiting rooms where, yes, it takes a long time to be seen. The real congestion is caused by the lack of hospital beds. It is the patients lying on stretchers who require a lot of time and care.
The hospital system is already holding up thanks to a lot of “Duck Tape”. There should be no need to add more …