The Phantom Menace
Dramatis Personae (in order of appearance)
Dr. Darren Cargill: Palliative Care physician, advocate, award winner
Bartender, or Wuher: bartender, doesn't serve droids
C-3PO: human-cyborg relations
Generalist Doctor #1: doctor, anthropomorphic walrus
Doctor Evazan, or Generalist #2: doctor, badly scarred, speaks with a Cockney accent
Obi-Wan Kenobi: Legendary Jedi hero, crazy old wizard
Dexter Holland: lead singer of The Offspring, with the word "singer" used loosely [ed: The Offspring? Really?]
Wade Wilson: a.k.a. Deadpool, the Merc with the Mouth
Han Solo: captain of the Millennium Falcon, scoundrel...SCOUNDREL!
The following is a piece of satirical fiction. If you don’t know what that is, consider repeating high school English. All of it.
This conversation never happened. But if it did, it would have happened in a sleazy cantina on a desert planet with two suns. You will never find a more wretched hive of scum and villainy.
An intrepid focused-practice doctor walks into a bar…
Darren: Can I get a drink please?
Bartender: We don’t serve yer kind here!
C-3PO: I was just leaving.
Bartender: Not you. HIM!
Darren: Oh, I see. What kind are you are referring to, exactly?
The bartender points to a sign behind the counter that reads, “Focused Practice will be the DEATH of Generalism in Family Medicine”, then walks away in disgust. Two well-dressed family doctors get up from their table and approach the bar.
Generalist Doctor #1: Rrrrrrrr…(a walrus-like noise)
Darren: Pardon?
Dr. Evazan: He doesn’t like you.
Darren: Alright then. I’ve just finished work. It’s been a long day. I’m just grabbing a quick drink and I’ll be on my way shortly.
Dr. Evazan: I don’t like you either!
Darren: Hmm. I get that. Can you explain why?
Dr. Evazan stomps his foot and points definitively at the sign.
Darren: Oh. Not this again. Listen, focused practice is a value-added part of family medicine. While many family doctors choose to practice comprehensive family medicine, some of us provide service to patients through a focused practice such as palliative medicine, sports medicine, addiction medicine or emergency medicine, just to name a few. We help to fill gaps in the system and provide expertise to our colleagues.
Dr. Evazan continues to point at the sign over the bar. Angrily. Repeatedly.
Darren: Okay, take me for example. I’m a full-time focused-practice community-based palliative care physician. Did you know that 70% of patients say they would rather receive palliative care at home and, when needed, receive end of life care in the home as well? But a recent ICES report showed that only 1 in 5 patients requiring a home visit in the last year of life actually received one. And over half of those visits were provided by focused-practice family doctors. Furthermore, those home visits reduce the relative risk of a death in hospital by 50-60%. So there is both a gap in the services our patients currently receive, and a clear benefit to the system if that gap is closed. Focused practice simply aims to provide great patient care, meet patient needs, and plug the holes in our health care system.
Dr. Evazan gets flustered, stomps his feet petulantly and points even more animatedly at the sign. [ed: Animatedly? A splashingly uncommon adverb!]
Darren: Focused practice doesn’t pose a threat to comprehensive family medicine. We admire our colleagues who provide a full range of health care services to their patients. Focused practice compliments that. This isn’t a competition. In fact, let me buy the next round of drinks and we can talk about this.
Bartender: Well, in that case! (rushes back and flips over the sign, which now reads “Certificates of Added Competency Welcomed Here”)
Just then, a lanky surgeon runs through the kafetaria yelling “GENERALISM IS DYING! Weesa all doomed!” before crashing through the front window, never to be heard from again.
Generalist Doctor #1: Rrrrrr!
Dr. Evazan: We're wanted doctors. We practice comprehensive family medicine! I have licensure in 10 provinces and 3 territories. As well as a death sentence in 12 systems! You should be careful.
Darren: I hardly see how that last part is even relevant to this conversation. But I promise you, focused-practice doctors are careful and practice high quality patient care.
Dr. Evazan: You’ll be dead!
Darren: That just seems excessive…
Both Generalist doctors lunge to attack. Suddenly a refined but reluctant English actor, in swirling brown robes, springs into action and uses a lightsaber to sever both of attackers’ arms and legs with a sweeping hum.
Darren: Wow, pretty gruesome. Nice hemostasis though.
Obi-Wan: Don’t worry, these guys won’t bother you anymore. They just feel threatened by you.
The two Generalists frown sheepishly while smoke wafts from their recently shortened limbs.
Obi-Wan: See, it’s normal for the practice of medicine to evolve, including family medicine. Change is inevitable. Years ago, family medicine felt threatened by the decline in labor and delivery provided by family doctors. Now, babies are primarily delivered by obstetricians and midwives*. Yet comprehensive family medicine still survives.
Dr. Evazan: But won’t encouraging or even supporting focused practice inevitably lead to the destruction of comprehensive family medicine? Kind of like Alderaan?
Obi-Wan: Only a Sith Lord deals in absolutes. [ed: but comprehensive practice has indeed been in decline for 20+ years]
Dr. Evazan: But I read so much on the Internet about this. And all those hashtags that lament the loss of #generalism. It must be true. It’s on the Internet after all.
Obi-Wan: You'll find that many of the truths we cling to depend greatly on our own point of view.
Darren: It seems to me that generalism has a bit of self-esteem issue. [ed: just a bit?] It seems like generalist doctors feel threatened by focused practice when all they want to do is help comprehensive family docs care for their patients.
Dexter Holland: Yeah, it’s like my girlfriend. We make plans to go out at night. I wait till two then I turn out the light. This rejection's got me so low. If she keeps it up I just might tell her so.
Darren: Dexter Holland? Lead singer for The Offspring? How random. [ed: The Offspring?!?]
Darren: Well, that certainly explains things. Anyways, I don’t know, maybe it's just me but it sounds like generalists and comprehensive family practice will always be an important part of primary care and the health care system. Maybe focused practice is just an evolutionary process and we are seeing some much needed adaptation to meet the needs of patients in a complex health care system. But this doesn’t have to be a zero sum game. Perhaps generalism and focused practice complement one another. Perhaps if both groups decided to cooperate and collaborate together, then maybe we might see even better patient outcomes than if they compete with one another. Maybe the sum is greater than the individual parts?
Wade Wilson: Like five mini lion-bots coming together to form one super bot? [ed: first thought that came to my mind was a Care Bears countdown]
Darren: Precisely. It will just take a bit of work and effort on both sides.
Wade Wilson: Maximum Effort!
The Generalist Doctors nod knowingly.
Darren: At some point we just need to end this ongoing myth that focused practice will be the death of comprehensive care and generalism in family medicine. It’s time to rewrite history regarding generalism and focused practice.
Just then, a single laser blast echoes in the bar. A green alien slumps forward in a nearby booth. A handsome rogue sits across from him with a smoking blaster.
Han Solo: He shot first. I swear.
Darren: If Geroge Lucas can re-write history, why can’t we?
Generalist #1 breaks down crying, sobbing uncontrollably.
Dr. Evazan: You’re right. We’re smart. We’re pretty. And gosh darn it, people like us. Maybe if we need a little confidence in ourselves. I think we need help.
Darren: Asking for help is the first step.
Generalist #1: Do you know someone that could help me?
Darren: I just happen to know a really great GP Psychotherapist…
The names of those involved in the conversation were changed to protect the innocent.
I would like to claim that no one was harmed in the telling of this story but that would be a lie. The Generalists were maimed terribly. Clearly Focused Practice had the high ground.
#DumbMoveAnakin
*except in northern, rural, and remote locations, a caveat which should be added to just about anything you say about medicine in Canada, at any time, for any reason, about any topic, with any audience, anytime, anywhere. Especially around medical students, those guys don’t miss a thing. Frankly, I would just tattoo this to your forehead to be safe.
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Friday, February 23, 2018
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