What's in a name?

On being a doctor in today’s world of primary care

What’s in a name? That which we call a rose by any other name would smell as sweet? — William Shakespeare

While this may apply to roses, I am not certain it applies to healthcare providers. Much has been discussed recently about the various titles we assign to care givers in our medical system. Specialist Physicians, Family Physicians, Family Physicians with Added Competency, Hospitalists, Nurse Practitioners, Nurses, Licensed Practical Nurses, Home Care Providers, Midwives, Psychologists, Family Therapists, Counsellors, the list is endless. Is it no wonder then that patients are sometimes confused about where to seek care and wonder if the care they are receiving is the most appropriate?

I recently asked a young pregnant woman in our local maternity clinic if she had a primary care provider. She heartily said “yes” and “he is great.” When I did not recognize the name, I assured her I would simply look them up and ensure they received copies of all the reports. What I discovered was that their primary care provider was in fact a Naturopath, a fact not volunteered by the patient. Was she aware that Naturopaths, in fact, have a completely different training and skill set than Family Physicians? Maybe not.

Who is a primary care provider, and how do we tell the difference? 

Don’t get me wrong. I am a firm believer in team-based care – health care professionals working together, each to their scope of practice, can provide better care to more patients and ease the professional burdens of each member of the team, when done right.  Every health care professional has important skills they contribute to the world of primary care.  I work closely with a Registered Nurse in both my community office and the Primary Care Obstetrical Clinic and truly appreciate their skill set and the opportunity for collaborative care. 

But how do we find a way to ensure that the public understands the scope of each role, particularly when everyone is referred to as a “Primary Care Provider”? How do they know that they are getting the care they want and need? Whose task is it to ensure patients can easily recognize the different training and strengths we bring to the job?

The value of family doctors

It is true that Family Medicine is a tough, often underpaid and thankless job relative to other physician careers. The rewards come from building those long-term relationships that allow Family Physicians to better guide care and optimize outcomes and prevention. It is medicine across the life span, from birth through childhood, adolescence, adulthood, elder care, palliative care and end of life care. Study after study demonstrates that health systems with solid primary care foundations are more sustainable and provide better outcomes on all measures. Family Medicine residency requires a broad range of university courses, community and facility-based training, clinical research, and an ability to be both personable and comfortable working in the “grey zone” for the majority of your day. Family Physicians stand as the first line of defence for a broad range of medical concerns and need to be prepared to address those issues based on the clinical exam, a limited set of investigations, and limited access to treatment options, particularly in rural areas across Canada. Although many are increasingly working in teams to help to provide essential, additional supports to patients with complex needs, the majority of care coordination and navigation through our complicated healthcare system rests with Family Physicians. 

The way forward

I believe the time is now for our profession to agree that there is a sophisticated, specialized skill set required to work as a Family Physician. We need to clearly set Family Physicians apart from other primary care providers. We need to be clear that while there are many other options in the pool of healthcare providers, Family Physicians are truly the specialists in primary care. That’s why I and other physicians were so pleased to attend an event recently for the launch of the new name of the Society of General Practitioners, now BC Family Doctors, which has incorporated the phrase “specialists in primary care” within its branding.   

So, what’s in a name? A name does not lessen respect for, or in any away diminish others with specialized, focused skill sets. A name provides clarity of role and responsibility. A name communicates the level of sophistication and quality of care the public should expect. A name shows respect for the difficult work conducted by front line physicians working in the “grey,” often alone and with limited resources. A name can contribute to unity and empowerment in our medical profession. 

In my humble opinion, it is now time to dispense with the term “GP” and identify these colleagues with the most appropriate name, Family Doctors – specialists in primary care. This rose is simply not the same as the other roses. 
 

- Dr Kathleen Ross