Today, I saw 25 of my patients - disclosed a new diagnosis of breast cancer, injected a shoulder, reviewed options for knee osteoarthritis, deprescribed a tricyclic, helped someone yet again try to quit smoking, made a new diagnosis of asthma and initiated a treatment plan, assessed someone's ability to return to work, reviewed the growth of a baby and discussed a new mom's adjustments to breastfeeding, reassured someone that the spot on his back was not cancer, initiated a seizure treatment plan in consultation with a neurologist for a patient who cannot travel ... well you get the message. Sound familiar?
A day in the life of a family physician addresses a huge scope of clinical issues - prevention, diagnosis, treatment across the full spectrum disease. Our patients are from cradle to grave, or as a colleague said - from sperm to worm. We deal with multimorbidity with medical regimes that are increasingly complex. More than one-quarter our seniors are being prescribed 10 or more different drug classes! They see specialists who each apply their disease specific medication regimes and then return to us for ongoing management of symptoms that are non-specific. Is it a new illness? Is it their medication regime? Is it an expression of anxiety? As we consider our advice, we take into consideration their ability to execute that advice - can they afford the fruits and vegetables, the medications, is there a counselor who can take more time to help them through this episode? How can we connect them with community supports?
What an expert; what a stimulating challenge!
And we get to apply this expert generalist skill to our group of patients that we see continuously, who we have known and will know for years. This continuity saves lives - did you know that? Studies have shown (don't groan!) that family physicians provide a higher level of continuity of care, which is associated with lower mortality rates, improved patient satisfaction, and fewer hospitalizations and emergency room visits. This wonderful video from the Nova Scotia chapter of Family Physicians (http://www.wespecializeinyou.ca) speaks to the fact that we apply our medical knowledge to the person in front of us. One size does not fit all and guidelines (flawed as so many of them are - but that is another blog!) are just that - guidelines to be applied to the person in front of us. We put that all together - the clinical knowledge and the patient's context and values.
Continuity of care, with the patient at the centre.
In my community, family physician colleagues are looking after patients in the emergency room, the hospital, in the operating room, obstetrics or neonatal resuscitation. Others are helping us with our palliative and end-of-life patients in addition to their family practice. Their skills have been acquired in many ways - through courses, an extra year of training, through years of practice. In the last 20 years that I have been in Collingwood, family physicians have led the way in the evolution of our local health care, trying to make an improved system to better serve their patients' full spectrum of needs. What these family physicians have done is respond to a need in their community.
Indeed, it's the expert generalist who has a view across the health system because we hold the patient's story. This gives the family doctor the unique skills and perspective to know what changes are needed in our communities. This is why our role is essential to any health reforms.
Community adaptive; community responsive.
I am proud to be a part of this profession - complex, challenging, patient-centred, community-based. It makes such a difference to the health of the individual and to the health of the community.
Thank you for embracing this in your day to day practice, and may the OCFP help you in this journey!
Jennifer
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