VOL 47: AUGUST • AOÛT 2001❖Canadian Family Physician•Le Médecin de famille canadien 1531
Editorials
I
am honoured to receive the W. Victor Johnston award because it recognizes the extraordinary contribution made by Dr Johnston, as a family doctor, to Canada and because it comes from my College. Thank you, Victor Johnston and thank you, members of the College.V ictor Johnston was the first Executive Director of the College. He was a leader in devel- oping the vision of the College and in ensuring that that vision was disseminated to College mem- bers and to Canadians. When I review the history of the College, I am impressed with how applica- ble the ideas developed in those formative days are for today.
We have had three other Executive Directors since Dr Johnston: Donald Rice helped the med- ical schools across the country realize that general practice, family practice, and family medicine had to be full participants in the academic world. Reg Perkin firmly established the relationships of our College with our fellow professional organizations in medicine: the Canadian Medical Association, the Royal College of Physicians and Surgeons, the Association of Canadian Medical Colleges, and the Medical Council of Canada. Cal Gutkin, our cur- rent Executive Director, has led us to this largest ever national meeting, which combines our educa- tion and research sections with the Ontario College chapter. I also see him leading our Research and Education Foundation to its rightful prominence as a major resource for family doctors.
These four family doctors, each having come from strong practice bases, were prepared to make that dif ficult step of giving up the more immediate rewards of patient care in order to pro- vide leadership and direction at an organizational level for our profession. These are rare individuals to whom we remain indebted.
Our destiny
To those of you who are receiving Certification of the College of Family Physicians of Canada and Cer tification of Special Competence in Emergency Medicine, you are our destiny.
Beginning your practices at the dawn of this new century, you will determine how family doctors in Canada provide continuing, personal, first-line medical services to all Canadians.
The restructuring and refinancing of our health care services during the last years of the 20th cen- tur y have been an exercise in rearranging sec- ondar y and ter tiar y care (hospital-based, technologically enhanced medical care), from local to regional management, with a goal of cost restraint. Even Duncan Sinclair, the architect of Ontario’s hospital restructuring, acknowledged that they had to start where most of the money was being spent. According to Sinclair, he would rather have star ted with primar y care reform because he knew that, if fundamental change to improve health care in Canada was going to be truly meaningful, it had to start in the community.
Recent federal-provincial meetings have identified primary care reform as a priority. When I asked our Professor of Surger y, Luis Oppenheimer, to name the biggest problems facing his surgical col- leagues, his answer was “an insufficient number of nurses” and “an inadequate primary care system.”
Medical challenges for graduates
So what is the challenge for each of you as you develop your family medicine practice, wherever it might be?
First, family practice is an ef fective ser vice because it depends on personal relationships between physicians and patients and patients’ fami- lies. The trust that is central to good communication
Destiny of service
The W. Victor Johnston oration to the
College of Family Physicians of Canada, October 2000
Brian Hennen, MD, CCFP, FCFP, FRCGP
1532 Canadian Family Physician•Le Médecin de famille canadien❖VOL 47: AUGUST • AOÛT 2001
Editorials
results in better health. Moira Stewart and her research team at the University of Western Ontario in London have the evidence: better outcomes and fewer tests required for one additional minute per interview.1 The World Health Organization and the World Organization of Family Doctors are challeng- ing all countries of the world to find for their people family doctors who know them by name.
Johnston wrote, “By necessity, we could not treat our patients for specific complaints alone—
we knew them and their problems too intimately.
We had to see them whole.” Later on he writes,
“As time went by I became more and more con- cerned about ill people and relatively less about their illnesses. The patient gradually took prece- dence over his ailments.”2
Second, get to know the characteristics of your practice population and its community resources.
Two of the four principles of family medicine are that family practice is community based and that the family doctor is a resource to the community.
You know better than I what that involves in today’s world of computer-based record systems, multiple data sets, and webpage information. But also join a service club, coach soccer, linger after Temple, go to parent-teacher meetings, drive home from the office a different route each night, and get to know your local politicians.
Third, and I think most importantly, contribute to a system of family practice ser vices for your community. Except for smaller communities that have enough doctors and the single city with a medical school that has begun to do this (Sherbrooke, Que), family doctors have failed to organize themselves into effective systems of fam- ily practice and primary care services that encom- pass all family doctors and that present to their community an integrated, comprehensive, acces- sible service.
Johnston noted that, in the 1920s and 1930s, Canadian doctors had not begun to experiment with working together in partnerships or groups.
He knew that family doctors were not solo opera- tors. “I learned early in my practice that nurses were the doctor’s best friends,… both practical and registered nurses, including midwives.”2 But I’m talking about more than call groups or acknowledging the value of nurses and other health professionals. I’m talking about a system of services that involves all family doctors in a col- laboration to assure the public that, if they walk into any family practice office or clinic, they can expect certain things: personal attention, contin- ued access for all health problems and resolution
of most of them, appropriate referral to whatever health care resources are needed, and continued follow up.
The College Summit report3sets out the blue- print. We must move on it quickly if we are to achieve necessar y reform of the whole health care system without sacrificing the principles of the Canada Health Act. I urge you to contribute your skills and commitment as family doctors to such a system of family practice services for your community.
What about medical organizations?
Johnston also commented on professional medical organizations. Whereas “most people thought their own family doctor was satisfactor y,” there was “trustworthy evidence that medical organiza- tions were getting farther away from the people.”2 It was such failing public support in the late 1980s that prompted the Educating Future Physicians of Ontario Project (EFPO), supported by the five medical schools, the government, and Associated Medical Ser vices. The EFPO undertook a com- prehensive review of what the public really expected of doctors. The Royal College validated and endorsed the study, and the Canadian Medical Association embedded it in its new vision statement. What the public expects of doctors is clinical exper tise, good communication, public advocacy, collaborative behaviour, keeping up-to- date, and responsible management of health care resources. The profession adds to these six points a scientific approach to medicine and attention to the personal lives of its doctors. We can respond to this public challenge only if every family doctor contributes to an integrated system of family prac- tice ser vices. Johnston wrote, “I became con- vinced that the medical profession would be saved not by its organizations but by the sum total of the common sense and humanity of its individual practising members.”2
Common sense and humanity: what about humanity? Let me urge you to respond to the needs of the most disadvantaged in your com- munity: the homeless, the poor, those with developmental disabilities, the lonely, and the refugees. If you can provide appropriate care to such as these, in all their complexity, providing care to those who are not so disadvantaged will be much easier.
I encourage you to look after yourself. I cannot imagine a more satisfying vocation than family practice where the job is to connect with patients, the community, and resources. But it is demanding
Editorials
and can be a hard taskmaster. Johnston wrote “excessive devotion to interesting work can come to have all the elements of an addiction;… a physician can build a complete world around patient activities and shut out family and personal ade- quate health care.”2
I close with one mor e Johnston stor y. We often take ourselves ver y seriously, as we should, for our work is impor tant. But when Johnson did his first locum tenens for a Dr Richardson in Spr ucedale in Muskoka, Dr Richardson admonished him with, “I br ought you up her e to make my patients feel better. Smile! Look as though you’re interested and pleased.
Cheer fulness is as impor tant as pill and potion.” My good friend, Ed Belzer, from Middle Musquodoboit, NS, quotes a favourite poet Wendell Berr y: “Laugh. Laughter is immeasur- able. Be joyful though you have consid- ered all the facts.”4
We really do have much to be joyful about.
I dedicate this piece to the memory of Dr H.C. “Curly” Still, College founder, Family Physician of the Year, Dalhousie University Professor, Victor Johnston Orator, husband, father, and grandfather.
Dr Hennen is Dean of the Faculty of Medicine at the University of Manitoba in Winnipeg.
Correspondence to: Dr Brian K.E.
Hennen, University of Manitoba, A101-753 McDermot Ave, Winnipeg, MB R3E 0W2
References
1. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient-centered care on out- comes. J Fam Pract 2000;9:799.
2. Johnston WV. Before the age of miracles: the memoirs of a country doctor.Toronto, Ont: Fitzhenry and Whiteside Ltd;
1972. pp. 43, 70, 72, 107, 201, 202.
3. College of Family Physicians of Canada. Summit 2000. The future of family medicine in Canada. May 11-14 2000.Mississauga, Ont:
College of Family Physicians of Canada; 2000.
4. Berry W. Manifesto: the mad farmer liberation front. In:
Collected poems, 1957-1982.San Francisco, Calif: North Point Press; 1985.
