Just one more question

Since starting my practice, I have had the privilege to know and care for many wonderful patients and their families. I have developed meaningful, trusted, and cherished relationships with them. I have celebrated their joyful moments of birth, growth, change, and recovery. I have walked alongside them through difficult times and cried with them through times of sorrow and suffering. 

There are so many things that I love about this work, so many moments every day, every week, that remind me why I chose to do this. In my most exuberant moments, I feel the satisfaction that I am providing value to the health and quality of life of my patients. I have the knowledge that my work makes a difference. I even think that having a family doctor should be everybody’s right. That’s how important some days I think my work is.

But in the same days and weeks, not a day goes by that I don’t reconsider the work I am doing. There’s the struggle I experience advocating for my patients in a system that is under-resourced. The feeling of isolation. We are where the buck stops. The endless piling up of forms. Going on vacation only to work every single day checking and following up results. Coming back from vacation and having a full schedule with requests to fit in yet another patient who can’t wait. Hours of charting at the end of the day at home, hours of missed time with my family. 

And here’s the hardest part. Being asked multiple times a day by my dear patients if they can ask just one more question at the end of their visit. I know what’s coming. I’m already running behind. But I can’t stop it. ”I just have a quick question. You see, my [insert family member or friend here]’s family doctor retired/disappeared/closed their practice. My [insert family member or friend here] really needs a family doctor for [insert compelling reason here]. Would you accept them to be your patient?”

In the fall of 2021, I was reaching exhaustion. I decided that I needed to set some boundaries so that I can find balance and make family medicine sustainable. So I did three things. First, I scheduled a lunch break. Enough said.

Second, I sought help. I launched into recruitment mode and found locums to work alongside me and my colleagues. (That I was able to sign on some wonderful locums is a miracle I am ever grateful for.) This was actually a very difficult process of letting go. We did not want to give up our patients to see another doctor even though we were overwhelmed. WE wanted to provide that care. WE wanted to be there for our patients in their moment of need. We felt like we were failing them in some way by having another doctor see them in our clinic. But we agreed that always being available is not sustainable. It has been an adjustment, but four months into this new arrangement, I can see that it has been for the better for all. Our locums have helped us manage our overflowing volumes so our patients have timely access to care and we can keep our appointment waiting times to a minimum. 

Third, I decided not to accept any more new patients – no matter how gut wrenching the story was, no matter how much I wanted to help the patient sitting before me asking so genuinely. 

Of all the changes that I made in my practice, this is probably the hardest one. The reason why is because it pops up at me many times a day. It leaves me feeling guilty, helpless, and fumbling for answers. I am angry at the inequity in our system. It is so, so unfair that some patients have access to a family doctor and some do not. 

I feel for the family doctors leaving their work for retirement, illness, and many other legitimate reasons, knowing that their patients will not be able to find another doctor. And I understand why newly graduated family physicians would not choose this work. As strong an advocate as I am for family medicine – and I really am, you can ask my colleagues about this – I find it hard to sell family medicine to a new grad. It’s high responsibility work from which we can never get a break. We get paid for face-to-face time with patients and almost nothing else. If we are sick or go on vacation, we fund that ourselves – and we are responsible to find coverage ourselves. When I was sick with COVID, I did telehealth from home and then took two weeks unpaid leave to recover. Did you know the College of Physicians and Surgeons of BC now has a practice guideline requiring family doctors to have a death plan? That’s right – before I create a patient chart, I need to have a plan for continuity of my patient’s care in case of my sudden unexpected death. How do I convince someone to take on this kind of work?

A lot of the work we do is easy to not notice. Chronic disease management. Mental health support and treatment. Cancer screening. Immunizations. Preventative care. We are keeping our patients healthy. We don’t see the disease burden of these illnesses because we are managing them well, preventing exacerbations or even preventing them happening entirely! Some of the happiest moments are patients coming back to me telling me how proud they are to have made a change in their lifestyle. They’ve quit drinking. Their liver enzymes are normalized; they feel so much better; they’ve changed their job or their social circles; they are never going back. They’ve started running; they are training for a marathon; they are coming off their blood pressure pills; their blood sugars are normal now. Their mood is improved; their anxiety is way less than before; they are sleeping better and they are ready to go back to work.

We have UPCCs popping up that provide urgent care. But what about the kind of care which comprises the majority of what we do? This is the reason why I would want a family doctor for myself. Because for things like this, there is nowhere else to turn. Recently, my husband was experiencing some chronic symptoms. It was easy for me to suggest that he talk to our family doctor about it. He made an appointment, was assessed, had some investigations and follow up and has a good plan forward.

So when my husband and I got the letter, it was a sad moment, but I was not surprised. Our dear and trusted family doctor of 11 years is closing her practice. I understand. I am thankful for her care. I wish her all the best. But the loss I felt cut deep. The thing I thought we had, that would keep us afloat, was now severed and we are now adrift, like so many others, lost in a system that does not have the resources to provide for the overwhelming need.

Now when my patients ask me if they can ask just one more question, I feel more prepared.

“I’m sorry; my practice is full. I’m not accepting patients right now. I encourage your family member/friend/etc. to keep looking. No, I have no suggestions, ideas, or recommendations of where to start. But by the way, if you find a doctor, will you let me know? Because I’m looking for one too.” 

– A family doctor in Vancouver