What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Friday, March 24, 2006

Family Physicians, Healers or Educators.

One of my pet peeves, as some of you regular readers know, is when the medical profession refers to its-self as “educators”. Yes, yes, I know that we certainly have a responsibility to educate, but the truth is, we are healers and education is just a small part of what healing is about. This should be particularly true of family physicians.
I have often said that I, as a family physician, will be anything my patients need me to be, if it will facilitate their getting well. One dying very elderly lady often confused me with her previously departed husband and hugged me frequently. Although awkward at times, it certainly was an asset in getting her to cooperate with the nursing staff and my suggestions. When I was younger I often had the impression that some of my elderly patients had trouble keeping from pinching my cheek as grandmas often do as a sign of affection. When I retired one of my elderly female patients gave me a huge bear hug with tears in her eyes and said: “you can’t retire, I’ve given you the best years of my life”. For those patients that regarded me as an educator, I spent the time reviewing their situation as an educational event and for those that considered me a friend and asked me what I would do in their circumstance; I would answer their question honestly with the caveat that each circumstance was unique and specifically review their criteria for treatment.
Contrary to the modern concept of “partners” in health (although there certainly is a group of patients who need that relationship), I feel that one of the most important roles a family physician has today is to be the parent that a patient doesn’t have, or feels they don’t have. And there does seem to be a growing need for this. This role requires mutual respect, trust, and the feeling on the patient’s part that you are truly there for them “in the long haul”, but have a responsibility that you will live up to.
The following cases best demonstrate this point:
Some thirty years ago I had hospitalized a 14 year old girl for recurring abdominal pain. Unlike most patients this age, she seemed to welcome being hospitalized. Further, while in hospital, her father phoned me daily to enquire how she was doing. The mother never phoned. I had ruled out as best I could organic causes of pain and had proceeded with considering psychosomatic causes. We had developed a good rapport over the years and because of the peculiar “before mentioned circumstances” I enquired about abuse. Suddenly, the most horrific story of sexual abuse was revealed that quite frankly shocked me. This was long before sexual abuse was on everyone’s radar screen. The end result was that the father went to prison and the young lady suffered years of psychiatric care. She trusted no-one except me. She would come to the office when crises, would sit and wait as long as she needed to, would only be admitted to hospital if I drove her, would only stay in hospital if I took her to her room, introduced her to her nurse, and promised to visit her at a specific time each day. She eventually stabilized from her trauma and became a nurse. She moved away many years ago, but drops by for a short visit when she is in town. Her father had abused her, her mother had abdicated her responsibility, and I had become her sole parent.
2) Again this young fourteen year old female patient had come to the emergency department because of a presumed overdose of her epilepsy medicine. Her previous family doctor had “fired” her because of repeated “faked” overdoses. Unfortunately, on occasion she actually did overdose, so the situation was intense. I was the family physician responsible for admissions that day for the emergency so she was assigned to me. She had been under a child psychiatrist and a pediatric neurologist for years and after obtaining their perspectives I spent time with this new patient. It soon became apparent to me that her home was a pathologic environment. Her father had left and her mother had remarried. Her step father was fanatically religious and her mother worshipped him and ignored her. She denied being sexual molested but I had some concerns. It soon became apparent to me that this young lady was extremely bright. I proposed a plan that she and draw up a list of areas were we would each be responsible. We shook hands. Her number one responsibility was to always be honest with me and tell me the truth; mine was to always act in her best interests. After consulting with her child psychiatrist and her parents, we decided to have my new young patient committed to a psychiatric group home if she wouldn’t go voluntarily. In keeping with our agreement she agreed to go voluntarily provided I would visit her at the home every month. I also insisted she be brought to see me at my office once a month.
The therapists at the psychiatric group home viewed this relationship with some suspicion and insisted on sitting in on the first few visits, but as time went by welcomed my visits. After the first year in the home it was decided she should spend a second year. My visits became optional as she gained confidence and security. She became an honors student at university and last I heard went away to do a PhD in criminology. Her visits to me were always special and started with a big hug (in the waiting room). When she left at age twenty two, the tears on her cheeks were an expression of her gratitude.
A person on the hepatitis enquiry asked the question “when physicians become business men, who do we turn to for a doctor”? I would like to ask the question “ when family physicians become educators (teachers), who does the patient turn to for a family physician”?


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