Family medicine has become, over the course of various reforms, one of the most important places for access to health care in Quebec. We regularly hear the various political parties promising that each will soon have his or her family doctor. Health ministers alternate between financial incentives, blame and negotiations to make these more accessible to the population.
The first line of public services is no longer the hospital or the CLSC in its area. It now goes through family medicine groups (GMF) with the establishment of a lasting link with this family doctor promised to every citizen. Family physicians are thus placed in a position of access to care defined as unavoidable and essential. The citizen who does not have his own is, therefore, deprived of a large part of the public care of our health system.
The official regulatory bodies in medicine (College of Physicians, Federation of General Practitioners of Quebec, etc.) seem, at first glance, to fully approve of this broad mission of accessibility to care entrusted to family physicians. They define the role of physicians as “pillars”, “conductors” and “integrating care leaders” on which patients can rely. In medical schools, the family doctor is presented as the person who uses his medical expertise to meet the needs of patients in “all the complexity of humans and their environment” who treats them in their “global” to all. the stages of their life and who is the “defender of equity” in relation to all the determinants of health (physical, social, and environmental).
These official descriptions of the role entrusted to family medicine have everything to convince us that we cannot do without a family doctor. Ideally, it is always to him that we should turn when we have health problems.
But what health are we talking about, exactly?
Today, family medicine is part of a definition of health that has evolved a lot. The World Health Organization (WHO) defines it as “a state of complete physical, mental and social well-being, and does not consist only of the absence of disease”. Understood in this way, health tends towards a humanist philosophical ideal of the common good which goes well beyond the traditional field of medicine.
The challenge of humanist thought, it should be remembered, supposes that in order to consider the human experience in all its complexity, it is necessary to rely on a plurality of knowledge and perspectives. The plurality of knowledge is the only ethical path that makes it possible to humanize care. Simply put, it is a plurality of care that we need to be healthy.
If family physicians follow this definition of health, it must be admitted that it is impossible for them to embody on their own a plurality of perspectives and knowledge on health. Like most caregivers, doctors have a privileged angle and this one directs them more towards a biomedical perspective of health. This is considerable and very important knowledge. But it certainly does not provide an answer to all the health problems of citizens. By making the family doctor the guardian holding the keys to access to care, do not all forms of suffering run the risk of knocking on his door to seek asylum? Expectations can then be endless, and this is what can be observed in the field. In addition, the old adage warns us against the over-medicalization that such a discourse entails: when you only have a hammer, everything looks like a nail.
In our opinion, there is a misconception here of accessibility to care which, in any case, cannot be based on a single approach, a single stakeholder, as is the case in the current proposal of a family doctor. for everyone. Of course, we will be objected to the fact that specialized nurse practitioners, nurses, social workers, pharmacists, nutritionists and psychologists also offer care in the current structure of FMGs. But are we not completely losing sight of them in the current debate on accessibility to family physicians? Just as we actually lose the possibility of consulting them if we lose our family doctor.
The “failure” of family physicians to assume the function of accessibility to public care should open our eyes. The political choice of our society to base the main access to public care on biomedical expertise – while affirming that the approach is global and plural – inevitably leads to confusion, blind spots and undesirable effects.
We are told that the problem is that too many patients are still waiting for their family doctor. Rather, we have the impression that the problem is not posed correctly. By dint of waiting for Godot, we seem to have forgotten who he was, and even why we were waiting for him. The promise, by dint of being repeated, relieves us of responsibility and depoliticizes us, preventing us from seeing that it is up to us collectively to define accessibility to care.
Health choices are, first and foremost, political and democratic choices. Care is at the heart of living together and when it is threatened, society as a whole suffers. The choice of places to host Quebecers ‘health problems can certainly not be defined in a vacuum between the doctors’ unions and the government. It is not a simple administrative issue, much less a lever for negotiation or a threat to be exerted on caregivers. Health, the financing of which occupies more than 50% of the state budget, is, like education, a place of solidarity and equality, one of the foundations of our rule of law. It is everyone’s responsibility to outline it.
We believe that it is important that citizens and experts from various horizons can help to shed light on the nature of what is currently entrusted to family medicine and help to identify new forms in this function of welcoming suffering. patients. Above all, to see how to better share its mission between all those who are committed to providing care, both healthcare professionals and patients who are partners in their own care. It is a plural, imaginative and truly humanist look at the care we most desperately need. Health is our common good, it belongs to us.
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