Christine Hanna is a family and emergency physician, the medical director/chief of the Division of emergency medicine at Quinte Health Care, and an assistant professor in the Department of Family Medicine at Queen’s University.
Whether you are a medical trainee, allied health professional or attending physician, you’ll at one time or another have heard someone say, “They’re just a family doctor.”
This phrase has survived time and, unfortunately, is still often spoken – in our hallways, our emergency departments, and even in family medicine clinics. I’ve heard variations of this phrase from attending physicians having worked both in Canada and abroad. I’ve heard it from colleagues – well-meaning acquaintances. I’ve even heard it from patients and their families. And chances are, so have you.
Family physicians and the discipline of family medicine are disparaged too often. Although we preach that primary and comprehensive care are the cornerstone of our health system and integral to its successful delivery, we still hear denigrating remarks about how it’s the easy, simple, straightforward medical career path.
Sometimes, it’s disguised as a compliment. I – and many of my colleagues in family medicine – have often been told we’re “too intelligent” or “too hardworking” for family practice. But saying things like this implies that family doctors are “less intelligent” and “less hardworking.”
Perhaps it is because the complex role of a family physician isn’t so well understood, or maybe some have just not been exposed to it in their training or even as a patient. But the truth is this: caring for the undifferentiated patient with increasing medical complexities is no small feat. Our practice extends well beyond an office setting. Family physicians are comprehensive care physicians. That’s… everything. Every system, every age, every level of acuity, every emotional state, every communication setting – everything. You cannot be anything less than intelligent and hardworking to be a family physician. Moreover, you need to be time-efficient yet comprehensive, a humble team player and a fierce advocate, an expert in communication, with a working knowledge of…well… a lot!
The Institute of Clinical and Evaluative Studies (IC/ES Ontario) has published work suggesting that when a person with a chronic disease has a family physician they visit the emergency department and get admitted to hospital less often. A 2019 population-based study looking at data from 2005 to 2015 showed that an increase in 10 family doctors per 100,000 people in the USA increased life expectancy by 51.5 days, and for every 10 more family doctors per 100,000 people there were 0.9% fewer cardiovascular deaths, 1% fewer cancer deaths, and 1.4% fewer deaths related to respiratory conditions. The importance of family doctors cannot be understated. They provide an exceptionally valuable service to patients, their families, and the wider community. And, often, they do so under difficult circumstances, amid increasing financial and time constraints.
The definition of ‘the hidden curriculum’ – what is learned but not necessarily explicitly taught – is simple and encompasses the nuances of socialization, experiential learning and knowledge transmission. The more we hear – and allow comments to be made about – our colleagues in family medicine as somehow less important physicians, the more we take away from the incredible work family doctors do for us all.
Changing the culture that still glorifies tertiary-care specialists and disparages family physicians will take time and effort from all. We are all cogs in the same wheel; none of us work if one is broken. When I speak to a patient in a setting that is not their own family doctor’s office or practice, I will often say positive things about the fact that they have a family physician and how lucky they are to have one. I make many positive comments about their family doctor and how hard they work – and I believe them.
I’ve heard allied health professionals and other attending physicians make throwaway comments. My strategy there is to gently correct, explaining some of the challenges faced by family doctors that the speaker may not have been aware of.
If I hear a medical student say they are interested in family medicine, I make encouraging comments and talk to them about how great their choice is.
I write this in the hope that others (and hopefully you!) will do the same. In this way, we can use the hidden curriculum and positive role modelling to challenge these incorrect views and replace them with ones that duly respect the work of our colleagues in family medicine.
When I worked, nearly a decade, in a Northern Town (with 3 excellent colleagues, a small hospital, a heliport & an AirStrip… prone to spells of weather that locked us in)… I was once in Toronto, describing to a layperson “where I worked”.
She asked, “And, are you a Specialist?”. I answered, spontaneously, “Oh, No, a Specialist would be of No Use to us, there!” And, I quite meant it. We were On-Call, one night a week, and one endless 72-hour weekend a month, for “everything”. (And, if we were known to be “in town & at home”, we were “always” an un-paid “second On-Call”, as we would never think to leave a friend and colleague un-aided in an overwhelming situation!). Brave and clear-thinking Generalists only, for that job! …MD’s who were not afraid to do something “they’d never done before” with only phone-advice from a Specialist, 2 & 1/2 hours away by road.
Every specialty other than family medicine ignores complexity, pretends uncertainty doesn’t exist and don’t follow patients long enough to be confronted by the diagnostic and other errors they make. Ignorance is bliss. Especially when accompanied by the illusion of superiority.
This article condemns the casting of aspersions on Family Doctors.
Doing the same of specialists does not redress the wrong.
As a specialist I face the reality of complexity and uncertainty on a daily basis, follow patients for weeks, months or years, confront my diagnostic and therapeutic errors, and have no illusions of superiority. I am simply a servant to my patients, and my referring physicians, both of whom I respect. I frequently tell my patients that “I don’t know”. I also tell my patients when I have made a mistake.
It was as recent as yesterday that I advised a patient that his/her family doctor made the correct diagnosis and prescribed the correct therapy which was why they had improved and that it needed to be continued longer to effect a complete resolution.
I agree – we are all working exceptionally hard in a tight system. But please know, I didn’t denigrate my specialist colleagues by advocating for respecting my family medicine colleagues. To advocate for one group, as I’m sure you are aware, does not imply insult to another/all others.
Well spoken, Dr. Hanna!
I was very aware of a somewhat contemptuous attitude toward family medicine from many quarters during my undergrad training back in the 80s. I encountered it to a lesser degree while in practice, but still caught echoes of it when I returned to do another residency in the late 90s. Ironically, the bias seemed particularly strong against rural family physicians – who I believe to be among the most skilled clinicians around! I am sorry to hear that this attitude persists. It is hard to overstate the value of comprehensive, continuous and compassionate care from a good family doctor.
Beverly Goodwin (Queen’s Meds ’87, Family Medicine ’89, Psychiatry ’01)
A very well articulated position Dr Hanna!
Your enthusiasm for Family Medicine is infectious!
Keep it up!
I am an 85 year old Board certified general and thoracic surgeon plus RCPSC. General practice is the most demanding medical speciality as you need to be able to deal with the widest range of unpredictable disorders and illnesses.
This is exactly what I needed to be reminded of today! Our profession is fortunate to have family docs (aka heroes) like you. Thanks for writing this!
Thanks for your thoughtful description of the reality of Family Medicine. Family physicians are heroes!
Dr. Susan Burgess
As an FRCP and CCFP emergency physician for 20 years than an FP for 29 years I could not agree more. We see everything and often early on at the difficult to diagnose stage. We don’t have the advantage of lab and imaging at our fingertips.
Patients with chronic diseases and chronic pain are sent back to us and we help them live with their incurable problems.
Specialists only see our failures, not our sucesses.