I roll out of bed at six am trying not to disturb my dreaming partner. After throwing on a hoodie from the pile of clean clothes I haven`t had time to put away, I fix myself a cup of tea and a bite to eat. As soon as that first drop of caffeine enters my bloodstream, I open my computer to review patient charts in preparation for my upcoming clinic. My inbox has about twenty messages from the day before, including one from a secretary stating that my patient -a single mother of two, recently diagnosed with breast cancer- was in distress as her insurance refused to cover her salary while she is off work undergoing chemotherapy treatments. I request that the patient be booked during yet another lunch break to see what can be done to help her out. Next, I print out a slew of drivers license renewal forms and insurance forms to complete as soon as possible. Each sip of tea is a guilty reminder that I meant to complete these days ago. After a brief good morning exchange with my partner, I drive to work to start my day of seeing patients.
Bzz..bzzz...bzzz.... I silence my phone apologetically, ignoring the never-ending stream of emails about pandemic precautions, equipment shortage updates, and which personnel are out on sick leave as a young eighteen year old sobs in my office. She is struggling to return back to school after being raped. Her appointment runs into part of my lunch break as I support her through the decision making process of whether or not she should take legal action against the perpetrator. The remainder of my lunch break is spent calling back patients with urgent lab results and speaking to the nurse from the rehab center I work at twice a week, trying to manage hyperglycemias and headaches at a distance.
While the last patient walks out my door at about five pm, my work day is far from over. I have a new pile of insurance forms, prescription renewals, and specialist referrals to complete. I spend the next two hours trying to finish charting all patient interactions. I spend extra time thoughtfully re-working yet another rejected insurance form so my patient with crippling depression after his son's suicide will continue to be paid while on work leave. I receive a result from a CT scan showing a brain tumor and ask around trying to figure out the fastest way to send the patient to neurosurgery and organize an appointment to discuss the result. After a brief dinner and an hour spent catching up with my partner at home, I skim through all the blood test results that accumulated throughout the day through fluttering sleepy eyelids to make sure there is nothing urgent before I roll into bed to do the whole thing over the next day. And the next, and the next. By the time the weekend rolls around (and I am not scheduled to work) I stumble into bed and sleep for about 12 hours.
I wish I could say that this scenario was unique to me, yet this reflects the reality of most family doctors in Quebec. Vacation and time off in our profession is hard to come by as family doctors in Quebec are considered entrepreneurs. This means that we pay rent to work in our family medicine clinics. We don't have paid sick days or paid vacation days, or pension. Any days of respite are unpaid. Inasmuch, we are only paid for patient interactions and next to none of the administrative tasks that take place after seeing patients. So we work and work until we burn out or leave the field all together because we simply can no longer bear the weight of our overburdened health care system. To make matters worse medical students and residents see our struggles and fewer are choosing to enter our specialty.
Family medicine is an incredible specialty and I feel privileged to do the work that I do. Yet it stings every time I see news headlines stating "family doctors don't work hard enough". There is so much hidden labor that goes unacknowledged and simply asking family physicians to take on more patients won't necessarily improve access to and quality of care. The solution is far more complicated. Thus, the next time you feel frustrated as to why your family doctor has no availability, remember it's because we are working day in day out behind the scenes to fill out your forms, refer you to specialists, follow up your lab results, and manage emergencies when they come up. We are working for you even when we don't see you.
