By Annamarie Fuchs, Creator. Partners in Health | Conversations
July 8, 2022
You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.
Hunter Patch Adams
I recently crossed paths with the son of a family physician from my community who had passed away in 2019. I was teaching a class on Zoom and immediately recognized his name. During a break, I texted him privately and asked “are you Dr. Smith’s (pseudonym) son? I hope you don’t mind but I had to ask.”
“Well, yes, I am!” He exclaimed. “Sadly, he died a few years ago. How did you know him?”
I went on to explain that we had worked together many years ago when I was a young clinical nurse. I had always admired the passion he had for his work and his unrelenting advocacy for his patients and his community. While he could be gruff at times, his focus was always on ensuring that his patients were receiving the best care possible. Over the years as I matured as a nurse, it became easier for me to gain a sense of the enormous burden of responsibility that family physicians carry on their shoulders. This is not a career that you leave at the office or in the field at the end of the day. The role of a family physician becomes a way of life, a vocation.
When I left the bedside, I was offered the opportunity to work in an administrative capacity where I labored alongside physicians to address issues associated with policy, access, and continuity of care. It was during those years that my appreciation for these original health care pioneers truly flourished.
At the end of the Zoom class, we remained online and talked about his father for awhile longer. “I’m a physician as you know. Dad was a huge influence on my life and on us all. It means a lot to hear from someone who knew him and to learn a bit more about how other people viewed him as a family physician.”
After that conversation, I reached out to a colleague who had known Dr. Smith for many years and asked her to offer some insights about the kind of physician and human being he had been.
I was so blessed to have him as my family physician for more than 25 years. My respect and appreciation for him remains strong to this day and I still miss him. To this day, I view his ‘old school’ approach to medicine as truly innovative because he treated both body and soul whenever I went to see him or took my children to see him. There wasn’t a time where I didn’t feel like he cared deeply for who I am as a person and what my issues were. He advocated strongly for me and my family and for the community and I would say that he actually became an activist. No matter what roadblocks or detours landed in front of him, he stood his ground.
He was often blunt and brutally honest with me, but I always knew that it was exactly what I needed to hear at the time. But at the same time, he was soft, gentle, and caring. He truly listened to me and to my children. In fact, he once said to me that “more children would have far less serious illnesses if more physicians would just listen to their mothers. Children don’t make things up and I am so proud of you for advocating for your children.”
Honestly, I think that with the change in how primary care is approached and delivered today, we’ve lost so much. Healthcare has become so incredibly impersonal in my opinion.
When he passed, Dr. Smith had been a family physician for more than 50 years. He had served in the Canadian Armed Forces, been President of the Medical Association, and supported numerous community organizations along with a range of charities. In every possible way, Dr. Smith was a patient advocate, a community advocate, an activist for health system change, and up until his retirement at nearly 80 years old, he was still caring for individuals and their family members – and still making house calls.
Today, physicians like Dr. Smith are rare and family medicine is largely delivered through various robust community oriented and team-based primary care networks, supplemented by walk-in clinics. Many provinces have either developed primary care models or are in the process of exploring them. In my province, The Primary Care Network model has 3.6 million Albertans enrolled. Approximately 84% of all primary care physicians in the province are registered with and work in clinics associated with one of the 40 Primary Care Networks that are scattered around the province. And while I believe in the Primary Network model to some degree, despite its value, we’ve lost much of the trust and the relationships that once were the hallmark of family medicine in this country.
In the days when Dr. Smith began his practice, family doctors carried medical bags and made house calls after many of their long clinic days. Patients who could travel to his office would do so, but others often waited into the evening for house calls. He cared for individual patients but often, those house calls included discussions with additional family members about other concerns. As a result, Dr. Smith, and others like him often became known as the physician for the entire family. In my opinion, today’s primary care and family medicine should attribute its values to the generations of pioneering family physicians who treated patients and families in the community and in their homes. Access to and use of emergency departments and hospitals was reserved for only the very ill or badly injured. Even in my lifetime when I was growing up, it would have been unheard of to visit an emergency department with a minor issue. Minor illnesses and injuries were treated at home by mom or dad or with a request for a house call from the local family physician who would visit, assess, treat, and leave instructions for ongoing care.
When I think about all the attempts the system has made to manage escalating healthcare costs and improve access to quality care, I am reminded about how healthcare was once delivered by people like Dr. Smith (pseudonym) and how we, the public, once viewed and made use of the health system. As costs mount and both access and quality of care continue to decline and we persist in adding more layers of service, perhaps we might consider what it once meant to be a family physician and whether the system adequately remunerates individuals who might want to resurrect traditional family practices. Today we have Nurse Practitioners, Physician Assistants, Paramedics with Primary Care certificates, Walk-In Clinics, and more. While each of these roles may indeed provide incredible contributions to people and communities across Canada, we would do well to look back and consider what we’ve lost along the way and whether traditional, pioneering practices like that of Dr. Smith’s may be exactly what the system needs to help solve our current healthcare crisis.