From the President: Know hope

October, 2010

These are the rare days when I question the wisdom of my career choice. Instead of a family doctor, would I have been better off as a lawyer? More content as a farmer? Happier as a rock star? And then, at the end of that long day, the clang of the mobile ruptures my reflective moment. Yet, one more intrusion.

The caller begins, “He’s having a lot of pain. What can we do about his pain?” She makes no apology for the late night call. She offers no reason for phoning me rather than the doctor on duty for the night. She does Some days drag me down. Patients expect too much. Team members make more, not less, work for me. Students and trainees disrupt the usual work flow. The health care system and its bureaucracy frustrate at every turn. Jumping from one task to another; interrupted each step of the way. There is too much to do, too little time to do it, too few resources to get it done.

not even identify herself or who “he” is. She assumes I know.

She assumes I know that his newly diagnosed lung cancer with bone metastases has him in distress. She assumes that I know that he has always been the one to reassure her through her frequent moments of anxiety, and that now he is the one that needs reassurance. She assumes that I know his pain magnifies her psychic suffering. She assumes that I know – and she’s right. I do know.

I know that I have no magic answers. I can only patiently answer each of her questions. I can only try to explain the symptoms, to make sense of the suffering. I can only suggest adjustments to the pain and anxiety regimen. I can only offer hope that we can get the pain under control and that something better lies ahead.

Fifteen minutes later, she says good bye and hangs up. No “thank you for your help.” No, “I’m grateful we have you as our family doctor.” Yet, I know. I know I have eased her suffering, and his. I know I have given them enough hope to manage one more night. I know because I know them.

Then, I consider the future of family doctoring. I wonder whether tomorrow’s family doctors will value and preserve the tradition of the personal physician. The person who knows – us. I hope they can know the satisfaction, and the therapeutic power, of that special relationship.

Recently, I had the chance to put my hope to the test. I was asked to speak at the 59th General Assembly of the International Federation of Medical Student Associations (IFMSA) in Montreal. More than 700 student leaders from 95 nations attended. IFMSA represents 1.2 million medical students, with about 11,000 students actively involved in leadership, local projects, and student exchanges between countries.

They kept me busy, with six presentations in 48 hours. They kept themselves even busier, with education and committee sessions during the day, intensely debated policy discussions in the evening, and social festivities until late into the night.

They asked tough questions, challenging me about the future, pay, prestige, and science of family medicine. Their questions reflected that they have a lot to learn and some things to unlearn. Their comments also suggested that they perceived a great deal. They sensed the misdirected priorities that can drive medical schools and health care systems. They shared the belief that health care was an important way to make the world a better place. They voiced the hope that they could make a difference.
One final thing I should mention. IFMSA first came to us, asking to learn more about family medicine and to seek our help developing exchanges in family medicine. They want to know more – about us.

Through our Working Party on Education, WONCA will partner with IFMSA to establish medical student exchanges in family medicine and primary care around the world. IFMSA has considerable experience and success with such exchanges, including the development of a formal curriculum for gynecology exchanges they developed with FIGO (International Federation of Obstetricians and Gynecologists).

I would urge you to reach out to medical students. Be a mentor, serve as a supervisor for an exchange student, and share your wisdom and passion. You can help shape the number and nature of tomorrow’s family doctors. While you can do much for them, they will do much for you. They will remind you once again that you can know hope.

Professor Richard Roberts