Dr. Celestine Esume
In the different countries where I have practiced, family physician do a lot to help their patients. We are the first point of contact, we know our patients’ histories and we provide continuity of care. If you take family doctors out of the system, healthcare collapses. That’s true in Canada, too.
Family doctors build trust and connection with their patients. In Nigeria, the UK, and now in Canada, I’ve seen how people confide in their family doctor—not just about their health, but also about their work, finances, and personal lives. This is what makes family medicine so unique. Instead of focusing on one aspect of care, family medicine focuses on the whole person throughout their life. This is how I knew family medicine was where I belonged.
I now practice in Kelowna, and being part of my community is a big responsibility. People look up to you, and you want to do your best every single day. I have young adult children, colleagues I mentor and patients who rely on me. That helps me stay committed despite the challenges.
The referral system is broken
One of the biggest challenges is the referral system. In the UK, there is a “two-week wait” rule for suspected cancer cases—if a doctor thinks a patient might have cancer, they are seen within two weeks. Here, even when I know it’s cancer, I send a referral and often hear nothing back. I have to chase the referral, meanwhile, the patient waits, worried.
It’s frustrating for doctors, but even worse for patients. Many assume their family doctor has control over the timeline. They don’t realize that once we send the referral, it’s out of our hands. Some even question whether you have sent it. I’ve had to show patients timestamps and fax confirmations to confirm to them that referral has been sent. My medical office assistant and I waste precious time chasing referrals, re-sending paperwork and calling specialists – time that could be spent on patient care. The most frustrating part? After all that effort, months later, I might finally get a response—just to say the referral was declined.
A centralized referral system would fix a lot of this. Right now, referrals are sent to individual specialists. If that specialist retires, goes on leave or is too busy, the referral can sit for months before being rejected. If there was a central system, referrals could be automatically redirected to an available provider. We need a system that triages and assigns referrals in a way that makes sense, so patients don’t fall through the cracks.=
The need for timely care
Once, a patient came to see me for something unrelated, but I immediately noticed a large growth on the top of his left hand. When I asked about it, he said it had been there for months. No one had looked at it. He had been waiting to be referred to a skin specialist.
I told him, “That’s skin cancer. We need to remove it.” He hesitated—he wasn’t sure if a family doctor could handle something like that. Many patients think they need a specialist for everything. But family doctors are trained to do much more than people realize.
I explained that if I sent a referral, he could be waiting even longer. If he was comfortable, I could remove it in my office right away. He agreed. The lump was large—about five centimeters—and his skin was thin, which made the procedure challenging. But we got it out completely. A biopsy confirmed it was fully removed. He was referred to wound care clinic for follow-up. It healed beautifully. No skin graft, no major scarring. But what stands out most is how quickly he got the care he needed. If he had waited for a specialist, it could have been months before the cancer was removed. This case reinforced the need for timely treatment.
We also need better support for high-demand areas like maternity care and obstetrics, where medical and litigation risks drive many doctors away. Better compensation, practice support and referral networks will make a difference, increasing the number of maternity providers and reducing wait times.One case that highlights the urgency of this issue involved a patient who had undergone assisted reproduction and was finally pregnant after years of trying. This was an extremely important and long-awaited pregnancy. I sent referrals to multiple providers, only to receive responses saying they weren’t taking new patients.When a patient is pregnant, especially after an IVF journey—every delay adds stress. Each declined referral meant more time searching for a provider, checking availability, and re-sending paperwork. If there had been a centralized referral system in place, the patient’s case could have been prioritized and directed to an available provider.
The future of healthcare
There’s hope. There is talk of better systems in the works, which I believe will improve care. Despite the frustrations, I keep going because my patients need me. I have a panel of about 2,000 people, many elderly and vulnerable. Their appreciation reminds me why I do this work. I won’t stop fighting for them, for my colleagues and for the future of family medicine.
Dr. Celestine Esume is a family doctor in Kelowna, B.C.