Is there any doubt left that the model of family medicine in our province is broken? The signs are everywhere. Older GPs can鈥檛 find replacements when they retire. Patients frequently spend months, even years, trying to locate a family physician who will see them.
Hospital emergency wards are inundated with minor complaints, because family doctors aren鈥檛 available in the evening or on weekends. That鈥檚 why we often end up waiting for hours to see an emergency physician.
Traditionally, GPs were expected to visit their patients in hospital and supervise treatment. They also arranged follow-up care. Like much else that family medicine once stood for, that obligation has largely been abandoned. Home visits are now also, by and large, a thing of the past.
None of this makes any sense. GPs are supposed to be the central gatekeepers for the health-care system.
That means having a personal relationship with patients, knowing their drug history, their family circumstances, allergies, chronic ailments and the like. It means walking patients through the maze of specialists, social workers and home-care providers. It means seeing them when they call for help, not days or weeks later.
But none of this can happen if family physicians withdraw into an insular form of practice that becomes less accessible by the day.
The cause isn鈥檛 money. GPs in Canada make far more than their counterparts in most European countries.
Nor is it government indifference. The provincial Health Ministry offers financial inducements to family physicians who maintain their traditional role.
Part of the problem is the growing complexity of modern medicine. General practice has lost some of its stature, as specialists take on the more difficult work.
Part of the problem is all the paperwork that comes with running an office. Increasingly, young GPs entering the profession prefer to work at walk-in clinics or in hospitals.
That shifts the administrative burden onto someone else鈥檚 shoulders. But it also severs the personal link with patients.
And GPs today work fewer hours. That depletes an already understaffed workforce.
The question is what can be done. One answer is: nothing.
Medicine is not alone in this shift to assembly-line methods. How many of us buy hand-fitted clothes any more? Not many. We buy off the rack.
Ever meet your neighbourhood postie? Not likely. There鈥檚 a community letter box at the end of the road. And forget about knowing the local bank manager.
But it鈥檚 not just industrial models that have changed. We鈥檝e changed, too.
We get our entertainment sitting in front of a computer in the privacy (and isolation) of our home.
The trend is unmistakable. Our world is becoming more terse, more hurried and impersonal. Why should medicine be different?
Except that鈥檚 a lousy answer. Medicine is different, or at least we want it to be. We鈥檙e not widgets, we need personal care, and that need will grow, not diminish, as time goes on.
With challenging ailments such as cancer, the route patients must follow, from diagnosis to treatment to post-hospital care, is already dauntingly complex.
Part of the solution involves government and health authorities. Ways must be found to reduce the burden of red tape. We pay doctors to spend their time with patients, not filing cabinets.
A health system without GPs might still treat our ailments. But it will not provide personal care.
