Thursday, 15 February 2018

Mike and Family Medicine in Saskatchewan. Pt 2.

See previous posting for part 1.

   A week later I met Mike at the construction  site of the new hospital.  He was waiting for me, replete in his yellow hard hat with the rolled-up blueprints in one hand and a spare hard hat for me, dangling in the other.
   "Put this on," he said, passing me the hat.   "I'll take you on a quick trip around the hospital and we'll end up in the Department of Family Medicine.
   I looked around the huge empty spaces, naked apart from girders and dry wall and found it difficult to imagine it ever becoming anything, while Mike did his best to describe what a magnificent cathedral to health the structure would be.  Finally, we ended up at what was to become the Family  Medicine Department.  We stood in the corner of the unit with large windows on  both sides, looking out over the bald prairie.
   "This is going to be my office," Mike said proudly.
   "Not going to be ready for a long time," I answered.
   " That's okay, We are going to have to develop a two year family medicine training program and we are going to have to negotiate with the essential specialty departments and the community family physicians to put together a successful training program orientated to Family Medicine.  We can't do it by ourselves.  So we need to have it lined up to take in our first batch of residents a year from September.  It'll take a lot of work to have the program ready to go by that time."
   We went for lunch.

   Family medicine, or General Practice as we called it back then had fallen upon hard times.  The General Practitioner, was on the bottom rung on the ladder and by many regarded as the basic graduate in medicine who was unable to aspire and ascend to the heights of medical specialization.  The jack of all trades, master of none concept.  Many GPs accepted that role, either because they did not have the resources to continue their studies or because they lacked the confidence to feel they could fulfill the requirements for specialization.  Indeed, in those days, it was common to ask, 'Are you a specialist or just a GP?'.   But there was another group who regarded themselves in another light.  They regarded themselves not just as scientists in the health sciences, but as problem solvers in the broad spectrum of  health disorders, be they pure physical problems, mental ones, including relevant social issues.  Problem solving could mean anything from the practitioner dealing with the entire problem, to dealing with part of it and enlisting the help of those with more specialized knowledge and if necessary to transferring the patient to a specialist or group of specialists, while continuing to follow the patient and be aware of needs that fell outside specialty concerns.  In other words, being concerned with the greater picture of the patient as a functioning human being.  The problem was that the practitioners holding up the base of the pyramid did not receive training either in medical school or in in-hospital internship in how to do this.   Nobody even considered what sort of training would be necessary to achieve these goals, until a group of  generalists got together to form the College of General Practitioners in 1954, which became the Canadian College of Family Physicians in 1968.
   Patients were getting tired of being regarded as 'interesting cases', removed from  the realities of their existence.  They just wanted someone they could talk to and explain their problems to and get some sort of a reasonable answers. While some GPs were doing an admirable job, some weren't and since nobody knew exactly what it was that a family doctor was supposed to do, it was difficult to establish a standard curriculum.  The College of General Practitioners, later to become the College of Family Physicians of Canada, was there to establish that standard and to ensure that it was being met.  The University of British Columbia and the University of Western Ontario were the first centres to  wholeheartedly commit themselves to establishing a Department of Family Medicine and designing a program to meet the needs of future Family Doctors.  The University of Saskatchewan was not far behind and Doctor Mike Spooner was an undisputed leader in the development of the discipline of Family Medicine in Saskatchewan and in Canada.

   Despite the fact that I assured Mike that I was not considering moving out of the partnership that I enjoyed, Mike and I continued to meet for lunch on a weekly basis.
   "You are already involved with teaching and even if you are not considering an academic career, I need all the help I can get from community physicians, because as we both know much of family practice can't be learned in a hospital.  I did learn something about education in general and medical education in particular when I did my Master's Degree at Michigan State and I've visited the few established programs in Canada and the U.S. to see what they are doing.  In fact I think you would find it very interesting to have a look at a few of the programs.  Rochester, New York has a good program and so has Dalhousie in Halifax.  If you'd be interested in having a look at a few programs I think I could get the University to fund it," Mike said.  "Then when you get back we could discuss the best way to put together a really good two year residency training program in Family Medicine.  I have an embryonic plan but I need a good community based general practitioner who's had experience in the real world to help bring it to fruition.  It's a huge job, Stan and it has got to be ready to go by September, a year from now, because I am already recruiting a fantastic group of final year medical students who have expressed interest.  Think about it."
   How could I help thinking about it, a thirty-nine year old GP being offered a whole new career just in time for his fortieth birthday?

See the next posting in a week or two to see how family medicine developed in Saskatchewan and Canada.

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