Mr. H, in his late fifties, a truck driver without a family doctor, arrives at the walk-in to have an SAAQ medical certificate filled out attesting to his ability to drive a non-articulated heavy vehicle. So I assess his eyes and ears, his brain, his mental state, his heart, his lungs, his glands, his skeleton, his social habits relating to alcohol and tobacco and his driving skills like any good doctor.
I discovered he had high blood pressure, a tobacco addiction and erectile dysfunction. His neurocognitive skills are sufficient for me to sign his certificate of aptitude. I’m a bit of a perfectionist, but mostly a family doctor, so I lend him a pressure machine to validate his hypertension at home, I ask him to do a blood test to check his sugar and cholesterol levels, to do a screening cancer of the prostate, as well as that of the colon, I give him advice for quitting smoking and judicious information as to possible inadequate consumption of alcohol, in order to improve his erectile performance.
The results come to me: high blood pressure, high cholesterol, prediabetic condition, positive stool blood test, smoking-related erectile dysfunction, and overweight. I prescribe her blood pressure medication and advise her on various strategies to quit smoking.
The medical record is easy to write in an arithmetic sentence: “This patient is a ticking time bomb. » I would like to prevent him from becoming diabetic and invite him to reduce his cholesterol with the help of a nutritionist, suggest physical activity and reduce his weight with a kinesiologist, to control his arterial hypertension well with help from a nurse, all to prevent him from having a heart attack or a vascular accident in the next five years, or even to avoid lung, throat, stomach or bladder cancer with the support of a respiratory therapist.
This will not be the case, because the professionals needed to accompany him on this journey are non-existent in the Quebec health network since the massive disinvestment by the State in front-line public health services. The responsibility for population health historically attributed to CLSCs has been shoveled into the backyards of Family Medicine Groups (GMF) for many years, kinds of doctors’ CLSCs, so it’s the family doctors who are at fault case it goes wrong.
Services in hospitals only treat hospital cases, cases that are already fairly desperate, and local CLSCs are dead: empty shells torn apart with all their vitality for lack of means and non-partisan political vision. As for the GMF in which I hang out, it “patches” the holes in the walk-in and tinkers to save life time without incapacity.
Thus, this patient will have a heart attack in six years rather than five and will develop bladder cancer in ten years. My doctor’s intervention will save him two years of disability-free life expectancy. Yeah. I’m breaking my braces. I think I’m going to change careers. Thank you, Gaétan Barrette, Danielle McCann and Christian Dubé for your incompetence. After dismantling frontline public services, the three of you will have the honorable privilege of appearing in the history book… uh, the Guinness World Records, sorry ! of the disintegration of family medicine in Quebec.
Signed, a sick doctor of his imaginary public service.