Following my university and post-graduate training in family medicine in the mid 60s, I finally achieved my goal of becoming a family physician and establishing my practice in a small community where a general practitioner was needed. It was a time at which there was no significant shortage of family doctors − especially in larger communities − and I wanted to be where there was a need. As the only doctor for 40 miles, my practice was a 24-hour tour of duty, especially in the summer when thousands of tourists flooded the lake area. Appointments were encouraged but, if someone came to the office because of an urgent need, they were seen. The office served as the regional emergency room site; the more serious patients were stabilized and sent on to the hospital 40 miles away. Between my efforts and those of my wife − an experienced registered nurse − we covered a good part of the needs of the local area, including all of those summer visitors. I dispensedmy own drugs, since there was no local pharmacy. All children were closely monitored for their necessary vaccinations. Regular patients with chronic medical conditions were always booked for followup visits. Annual physical examinations were routinely booked for many adults, especially seniors, at which time I would review their immunization status and order any screening tests according to my findings and their particular medical conditions. I made many house calls to a small number of housebound invalid patients and to families with small children who had a feverish sick child in bed at home. After several years in that solo practice, another young practitioner took over. I established my new practice in the nearby city, where I joined four other young GPs and we built a modern family practice clinic. Although I was welcomed to the city by other doctors, I had not been encouraged in any way to make the move as it was perceived by many that there were already enough family doctors. Throughout my 15 years at that practice I, along withmy partners, always accepted new patients in need of a family doctor. Not only were we maintaining our practices at reasonable levels, family doctors felt a moral responsibility to be available for residents who had no family physician… including those who had recently moved to the area. All family doctors were required (as part of their hospital privileges) to serve regular hours in the emergency department of the hospital. There were no walk-in clinics and any phone advice to patients was an unpaid service. When we signed out for the day or weekend, one of us was always on call for all of our patients’ needs and, if necessary, would see them in the emergency room. On weekends, one of us would be responsible for the Saturday morning walk-in services at our clinic for any necessary medical attention. Health The Changing Face of Family Practice by Dr. Robert MacMillan MD 34 | www.snowbirds.org
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