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Please, please don’t ask me

I love being known. 

As I have written before, I get a narcissistic pleasure when people stop me on the street to show me their teenage children whom I delivered years ago, or when the librarian says “Oh I know who you are, everyone does.”  

This happens because while Montreal is a metropolis, English Montreal is a village, and Jewish Montreal is a shtetl. 

However in the last few years, people recognizing me has come with a cost that I am not willing to pay. Whenever I meet up with people, any people, the question inevitably arises, “Do you know where I can find a good family doctor?” Or even worse “Why can’t I come see you as my family doctor?”

In the last few weeks I have been asked by two or three former patients who I ran into at the café or the grocery store. My postpartum patients break down in tears begging me to take them, their children, their spouses, their parents. Even my esthetician is begging me for help. I have never seen such a breakdown of service for patients in my almost 40 years of practice. 

This week I got an email from the government asking me to be a part of a project where I review abnormal mammogram results for orphaned patients, and call them to give them the result and assure that next steps have been arranged and examine them if necessary. The fee for this service is $120 for every 10 reports read. My first reaction was incredulity, my second was outrage! I am all for pitching in but this fee is ridiculous! At first I thought this was a typo and that the fee is $120 per patient, little enough for conveying bad news to a patient with whom I have no relationship, but at $12 per patient this is less than minimum wage. This is something that used to be part of my job as a family doc but now there are not enough of us to do the most important job of a family physician, which is to follow patients over time and be their companions in care. All the policies of the past have served to undermine this role and it is poorly paid relative to other jobs family docs can do in emergency and as hospitalists. 

This weekend one of my patients almost had a C-section because of the nursing shortage. My patient was having an induction with signs of placental insufficiency. The overcrowding of L&D and the shortage of nurses delayed her almost 24 hours. When the new obstetrician came on that night she questioned whether we should do a section. I countered that the induction had been so half-hearted that she had not had a fair trial of labour. Three hours later she was fully dilated and delivered an hour after that. Unfortunately I had gone to sleep by then. One of the nurses explained to me that the shortage was because many of the new nurses they had trained found the government’s new requirement, that all nurses work full time, too grueling particularly for young women planning to start a family. Even though they loved the work, they opted to work for private agencies where they were better paid and had more control of their lives. 

So here I am, giving my version of the rant that has been so prominent in our publication, and then my attitude was changed by a conversation with my favorite geneticist. We were trying to figure out how to follow up on a baby with a mild genetic condition who should be cared for by a Pediatrician. “Remember”, he said, “we are lucky to be here. Not in Gaza, not in Ukraine. This stuff is annoying but at least we get to keep doing good work in relative safety.”

I took a deep breath and let a wave of gratitude for my security and safety, health and family come through me. So we will proceed to manipulate the system, as we do, doing our best for colleagues, students and most importantly for our patients. Then I thought, “F––– this, I just want my work life to work!