Not a day goes by without people repeating in every forum that too many Quebecers do not have access to a family doctor. This is indeed the case, and it is deplorable.
However, this unfortunate situation had been predictable for decades. There have been political decisions taken to restrict the number of entries into medicine. We cannot ignore the Barrette era and its denigration of family doctors, which had a catastrophic effect, the most visible consequence of which is that, for ten years now, there have been dozens of positions in family medicine residency which are not filled, with residents preferring to move towards a specialty. Results: almost 600 fewer potential family doctors over ten years.
In addition, the aging of doctors follows the demographic curve of the entire population, another piece of data that should have been taken into account upstream. There is currently a shortage of more than 1,000 doctors in Quebec out of a total of approximately 10,000 family doctors. It takes six to seven years of university to train a family doctor. In light of this data, it is clear that it will be impossible to resolve the problem in the coming years if we continue with the same premises.
The boat is sinking and it seems that the captain and his lieutenants are still bailing it out one glass at a time while tons of water rush into the holds. The Ministry of Health must act quickly and effectively. Major reforms are needed. We must revalue family medicine, stop its denigration and, to do this, we must understand the very essence of the work of the family doctor.
Change paradigm
The family doctor is there to listen to the concerns expressed by his patient about his physical and psychological health, to understand the context in which he lives, to examine him, to make diagnoses, to define the necessary investigations, the treatments to begin or to continue. adapt, ensure overall monitoring of the care given by specialists, including checking all prescribed medications, answer questions from patients, many of whom are vulnerable due to multiple physical pathologies or a mental health problem.
We need energetic measures to support family doctors: reduce bureaucracy, standardize the pan-Quebec electronic medical record, because, currently, there are multiple different medical records that are incompatible with each other. Contrary to what many patients think, this means that we do not have access to their entire health check-up, because the notes and many examinations carried out in other clinics or hospitals are inaccessible to us.
We must allow for versatility of practice (mental health, drug addiction, sports medicine, etc.). Currently, mental health is the poor relation of our health network, and family doctors interested in this cumbersome practice are disadvantaged by the obligation of objectives to be respected regarding the number of registered patients. We must increase the number of professionals in GMF: nutritionists, physiotherapists, occupational therapists, nurses, psychologists, social workers, pharmacists, etc.
We must allow doctors who have 30, 40, 50 years of medical practice to reduce their workload by reducing their patient base, which is not currently permitted and which, as a result, contributes to the retirement of hundreds and hundreds of doctors. Insurers must review their needs regarding family doctors and stop unduly asking patients to obtain annual requests from their doctors for physiotherapy, osteopathy, massage therapy, etc. ‘acupuncture.
Employers must not require sick leave forms from their employees for a common cold or gastroenteritis. We must prevent patients from having to obtain a new consultation request to see their specialist doctor again. It should be considered that patients with a chronic illness, such as unstable heart disease, acute inflammatory bowel disease, cancer, poorly controlled diabetes, severe depression, etc., can be followed by their specialists as much as possible. that their medical condition is not stabilized and referred to their family doctor for joint follow-up.
We must encourage programs on social networks, on television or on the radio advocating educational advice on health. Pharmaceutical companies’ advertising agencies must be made aware of the importance of not overusing the “Talk to your doctor!” » for many new drugs. This type of message generates unnecessary consultations.
We must facilitate the training of a greater number of psychologists and ensure the free care offered. Many professionals, social workers, psychologists, physiotherapists, occupational therapists, dietitians, pharmacists, etc., must become the front line and patients can consult them before seeing their family doctor.
We may need to rethink the current model of registering a patient with a family doctor, because, according to this model, the doctor can only meet patients registered with him, no longer giving others the opportunity unregistered patients to consult him for serious and priority conditions. The family doctor would then become the professional to consult when the first line – which could be held by IPS, psychologists, physiotherapists, pharmacists, etc. — would require medical expertise.
We must strive towards a real desire, first of all to understand what family medicine services consist of, in order to make informed changes. It is not by continually deploring the lack of family doctors and blaming the dysfunction of the health network on their shoulders that things will improve. There is a way to ensure that Quebecers can have access to a family doctor if we change the paradigm, if we seek to innovate rather than stubbornly continuing to rely on an approach that is far from proven. .