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?