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126

Canadian Family PhysicianLe Médecin de famille canadien

|

Vol 57: January • JanVIEr 2011

President’s Message | College

Collège

Cet article se trouve aussi en français à la page 127.

Epiphanies in family medicine

Rob Boulay

MD CCFP

Gratitude bestows reverence, allowing us to encounter everyday epiphanies, those transcendent moments of awe that change forever how we experience life and the world.

John Milton

L

ast May, I had the incredible good fortune of being able to attend the WONCA (World Organization of Family Doctors) meeting held in Cancun, Mexico.

It was an inspiring experience—family physicians from around the world meeting with the common goal of improving the care they deliver to their patients. But it was a series of events that occurred on a side trip to Belize that provided me with fodder for reflection about the day-to-day lives of family doctors in Canada.

Unfamiliar waters

It began innocently enough. After the meeting, 3 couples, including my wife, Bernadette, and me, had planned to go to Belize, kayak out to a small island approximately 20 km from shore, and do some snorkeling and sight- seeing. What could possibly go wrong? We arrived in Placencia after a grueling trip by van, then got a good night’s rest. Things did not look good the next morning.

The weather had changed overnight and the sky was dark and somewhat ominous. We set out nonetheless, our guide leading the way in his motorboat. At about the 9-km mark, just after Bernadette exclaimed how much fun she was having, we zigged when we should have zagged and were capsized when a wave struck us broadside! At that moment, as we submerged and were ejected from our kayak, I was utterly thankful that we had a guide. The analogy struck me immediately. Having a guide while kayaking through unfamiliar waters was a lot like having a family doctor help you navigate through an unfamiliar health care experience. Our guide was able to pluck us out of the water and bring us to safety—

not unlike what family doctors do for their patients each and every day. This was my first epiphany!

Bumps in the road

My next epiphany occurred as I pondered on our drive to and from Belize. It seems that the Belizean govern- ment has decided to control vehicular speed on all their roads by using speed bumps—and lots of them. Driving in Belize consists of a repetitive cycle of speeding up

after you go over a speed bump, then slowing down as you approach the next one, usually located about 500 m away. I thought to myself that this was akin to how our governments try to control health care spending, some- thing I now refer to as the speed bump model of cost con- tainment. There are many things that can be considered bumps in our health care highways; for example, bill- ing numbers have been used in this way as an attempt to slow down increases in physician numbers and thus decrease escalating costs. Indeed, maybe I am just a speed bump myself, something a patient has to navigate to access health care. Or maybe we look at access to more specialized care as the biggest speed bump of all, where our patients must queue for what seems like ages before crawling through the system.

Safe passage

My final epiphany occurred just before we left for the airport to return home from Cancun. We had traveled back from Belize the day before, and, like a good trav- eler, I put our rather soggy passports (don’t forget our capsize) in the safe in our room. About an hour before the cab was to pick us up to go to the airport, I went to retrieve our passports and, lo and behold, the safe would not open. I could tell I was entering the correct code, as the mechanism seemed to go through its paces, but the lock would not release. After 40 or 50 tries, it became clear to me that I would have to call for help.

(I never said I was quick!) The security guard who was dispatched to our room shrugged when I asked if he could open it, and I was eventually made to understand that maintenance had been called. Shortly thereafter, 4 rather large men equipped with crowbars, drills, sledge- hammers, and chisels proceeded to decimate the poor wall safe. Forty-five minutes later, they proudly handed me our passports, and we had all of 5 minutes to spare before the cab picked us up.

And what did this teach me about family medicine?

Well, it demonstrated that it often takes teamwork to get the job done, and that health care does not always go as planned; we have to be ready for the unexpected and be prepared to work together with the ultimate goal of making sure our patients get the care and access they need.

Life is full of moments that can change how you see the world. I can hardly wait for our next trip!

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