Why you need a family doctor. By a surgeon.

Everybody needs a family doctor. I am a surgeon, but I have a family doctor, and so do my husband and kids.  I do not try to diagnose and treat my own family.  Ok, ok, sometimes I do for a little while, until they can get an appointment with their real family doctor.  Ideally your family doctor should be relatively close to where you live, and be someone you like and respect.  They should be available to see you, ideally on short notice, and be someone you trust.  This would be the holy grail though, and finding it is going to increasingly difficult with the cuts the government has currently imposed.

A man was referred to me by a hospital emergency department (ED). He presented there on a Friday night with a complaint. For those of you who are fortunate enough to have never needed to use an emergency room, weekend evenings are the worst time to have to use an ED.  Now all the people who don’t have a family doctor, PLUS all the people who do have one but they aren’t open, PLUS all the people who are too sick to go to their family doctor or have been to their GPs already and been sent on to the hospital, are there waiting to be assessed and treated.  This is Canada, so if you show up at an ED and want to be assessed, we have to assess you.  It’s your right.  So this guy shows up on a Friday night and waits. And waits. And waits some more.  He is seen, discharged, and a referral sent to me to ask for an assessment of his condition, which I do in a few days.  I’m not going to say what his condition was, but it was not life threatening, was not surgical, and did not require any management or testing  other than reassurance that nothing was going on here.  After I assessed him, I asked for the name of his family doctor, to send a note so they are kept informed as to what is going on with him.  It’s standard practice, but unfortunately a lot of the time I am writing letters to myself, as there is no family doctor.  “I’m healthy.” he promptly replies “I don’t need a family doctor.”  I looked at him.  I didn’t get mad, but it was a little frustrating.  “You just PROVED you need a family doctor.”  I said.  “You had to go to an ED on a Friday night to get a referral for something that could have been easily dealt with by a family doctor.”  He looked a little sheepish.  I offered to refer him on to a GP colleague who was accepting new patients, an offer he accepted.  I understand a lot of other conditions have now been uncovered and are being treated in this fellow.

Second story.  I am walking out through the hospital lobby after a day in the operating room.  The lady at the volunteer desk calls out “Excuse me, Dr. Barron, could you help this man?”  He knew he had a hernia (he had had one years before, but his family doctor had died and he had not been able to find a replacement). Basically knew he needed surgery and just wanted to get it fixed. No problem, that’s my job!  But it was a bit sad , and random, for him to be wandering around the lobby of the hospital, just to try and get someone to fix a hernia.  Happy ending though- hernia fixed and I did get him a family doctor.

Family doctors are indispensable.  They are the backbone of the healthcare system.  While you may be healthy, a family doctor is your entry point to, among other things,  referrals when you do become sick or develop symptoms, preventative care, keeping you vaccinations up to date, and a myriad of other services.   And of course they can diagnose and treat a lot of stuff themselves. Most people are not going to be healthy their entire lives and then drop dead.  It’s just not done that way anymore.  Let’s say you develop some symptoms, possibly related to mental illness.  You really want to be going for diagnosis, treatment and follow up in an ED or a walkin clinic?  It is safer, faster, cheaper, better care to be assessed by someone who knows you, and/or has your file to refer back to.  Most family doctors are smart people who know their patients pretty well, refer appropriately, and manage to keep up to date with ever changing guidelines for hundreds of medical conditions.  I share my office with four family doctors and they are amazing.  They look after their patients very well, and while I love the operating room, I admire what they do.

Which brings me to Ontario.  The process for acquiring a family doctor here is RANDOM.  Usually if one of your parents has a family doctor, that doctor will take you on when you are born.  Otherwise, it’s kind of a crap shoot.  If you move, there are some websites and public health resources to help you find a family doctor, but usually these are out of date and not helpful. Otherwise, it’s a word of mouth, phoning around, completely arbitrary process.  I have seen hundreds of patients without a family doctor. In follow up appointments after patients have had emergency surgery, I often get asked if I am accepting new patients into my practice.   No, just because I operated on you, does not mean I want to look at that rash that’s been bothering you for a few months, renew your blood pressure medication, and help you with your cholesterol.  It’s just not something I am trained to do and a family doctor is.  Keeping a family doctor you have seen in the past but now live a 2 1/2 hour drive from, is also not helpful.  It blocks that doctor from using that spot for someone who may be able to use it for more than a history and physical every couple of years.  Seriously, a 5 hour round trip when you are sick? I don’t think so, and yet this is what people do.  We both know when illness strikes, you are going to end up in the local walkin or ED, where you will wait (maybe a long time) and then a new doctor who has never laid eyes on you before, will start from scratch assessing you, with zero knowledge of your past medical history.  I’m not sure how to fix this, but maybe someone reading this blog will have some good suggestions.  I’m just trying to educate here.  As usual in our ever more complex society, there aren’t going to be  easy answers to complex problems.  If you live in Ontario though, you deserve a family doctor.  And if you are one of the 900 000 people who don’t have one, you should be asking, why not?

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4 thoughts on “Why you need a family doctor. By a surgeon.

  1. This is so apropos given the current health care climate in ON. We moved last July and have been trying to find a family dr or some form of primary care since then. Registered with HealthConnect. Phoned dr offices and NPLC’s regularly. No luck. Only 1 FHT office could put us on a waiting list – 1 to 2 yrs. before they could add us to the practice and advised us to keep looking in the meantime. A few wks ago we were contacted by a NPLC I had approached a while ago. They are a little over an hour away. Go for group intake mtg later this month. We are both seniors. For the most part we are in better health than many others, but we do take meds, me for blood pressure, husband for prostate, high cholesterol. Both of us for arthritis. With no primary care provider, these conditions and meds are not being monitored. Not a good thing. I need a knee replacement – determined by ortho surgeon prior to our move. But I can’t get referral to ortho surgeon here because no family dr. Seems to me last election we were promised better access to various models of primary care. I see no evidence of it. And I suspect the other 900,000 “unattached” patients don’t either.

    Walk-in clinics are not ideal. There is no continuity. They don’t know you or your family. And where we live now, their hours are extremely limited. Going to emergency departments for something a family doctor should be addressing is a huge waste of health care resources.

    Family doctors should be valued as an important part of our well-being and we need to support them in their efforts to be fairly and appropriately compensated rather than nickel and dimed to death with 128 pages (yes 128) of billing codes if viewed online. Many of the codes have unrealistic “rules” or limitations attached to them and many necessary, even critical, aspects of a family doctor’s role are not compensated at all.

    Patients cannot afford to underestimate the value of a good, caring, committed family doctor and I hope they stand up, speak out, and demand that primary care availability become a priority of this gov’t.

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    1. You are so correct in all your points. I feel your frustration. An hour’s drive is too long in my opinion to get to a family doctor, unless you live in an extremely remote area. Imagine if you were suffering from mental illness, had an addiction issue or transport problems, it would be even harder. I think it’s time the government stepped in and stopped letting patients and doctors sort this out in this unstructured way with no help or resources.

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  2. I am an insulin dependent diabetic (on a pump). I have had no family doctor for the past 6 years because the doctor I did have was very rude to me and that relationship ended abruptly. I live in a relatively large community but I have been seeing the ED for all medication renewals and anything else that comes up in my unhealthy life……………….no other choice. Unfortunately there are not enough family doctors to go around. I think that given the circumstances the ED doctors are doing an excellent job and I commend them. I have been on the system with health care connect for the past 6 years and am still waiting.

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    1. That is frustrating for you (and for me to hear). I hope you find a doctor soon to work with on your diabetes- the ED is not a great place for you to be having to go for prescription renewals.

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