Memories of Family Practice I

Introduction

A considerable number of medical practitioners have written of their experiences. I have never kept logs or journals of what occurred in my practice. Most of my career was in a setting where the records were not my property, so I do not have access to them now to pursue to perhaps obtain details to corroborate my memories. However, it could still be interesting and instructive, hopefully, to record these.

I want to make mention at the outset of my title. Many people speak of General Practice and General Practitioners or GPs. In the 1960s, with the population facing a shortage of family doctors as more specialties arose and attracted medical students, there was a move underway to provide more education for family doctors. sadly, GPs had to some extent even being looked down on by the increasing academic and specialized members of the medical profession.

It was felt by a number of family doctors though, that there were aspects of General Practice that were different and unique compared to those which specialists faced. One of the key differences was that whereas specialists tended to see individuals for a specific reason, family doctors saw their patients, at least initially, for everything and often looked after whole families. All of that gave them somewhat more of a tie – in to their communities, which was part of what attracted me to family medicine. 

I was particularly attracted to this in the rural setting where one could even then get to know more of the whole village or town and surrounding countryside in which one practiced. I could not conceive of this component becoming real in an urban environment. One difference between rural and urban physicians was that urban physicians had more specialties and more capable emergency facilities and surgical opportunities at the ready, whereas in the country, you were the first one to deal with everything and then refer on what you were unable to manage. This provided an opportunity for a wider scope of work, especially when it came to areas like trauma, minor surgery and obstetrics.

It was thus that in the 1960s departments of family practice with attendant residency training programs of a couple of years of extra training after graduation from medical school began to be formed in the medical colleges across the country. I added this to my education in the years 1976–1978.

From this I was recruited to a rural practice in a town I was entirely unfamiliar with, some 90 miles northwest of Winnipeg, Manitoba, named Gladstone, on the second major highway in the prairies, the Yellowhead or Number 16. It was a town of about 1200 inhabitants but had become somewhat of a centre for a number of communities around it, right up to the western shores of lake Manitoba. This area covered a community of settlers from Eng/Scottish, Icelandic, Ukrainian, German (Mennonite) and one large reserve on Lake Winnipeg, together with a smattering of other background such as Polish, Hungarian and Dutch. The only Asians at the time were the family running the typical small town Chinese restaurant.

All of this took place only 10 years after socialized medicine or Medicare had become uniform in the province of Manitoba. When I was completing my medical training, the New Democratic Party (NDP) who had brought this in under Premier Howard Pauley, was in power in Manitoba. An ad hoc group of medical students from a number of years of the school of medicine had gotten together and even gotten the ear of the deputy minister of health, Ted Kulchinsky, to help us reinstate a six week training in Family Medicine for all medical students in their fourth year. 

Influences in my college years and university had certainly led me into the more left wing side of society. Because of a shortage of rural family physicians, the NDP government was trying to start a program of rural health centres with salaried physicians and more structure, physicians being supported by more paramedical professionals such as public health nurses, social workers and community health representatives, as well as nurse practitioners. 

This was all new in the world of health and medicine. It was attractive to me as it portrayed a more holistic way of dealing with health and medical matters in the community. As such, my first practice was in one of these health centres which was located in Gladstone. Seven surrounding districts, some of them villages of their own, had led to it being called the 7 Regions Health Center. As such, I began with a salary, meaning I did not have to perhaps push patients through faster than what time they wanted to spend with me. As mentioned above though, it meant that the records were the property of the health centre and I did not have any special access to them. 

With that, I began my practice here in July 1978. The other physician at the health center, who had recruited me, Dr. Waldy Loewen, originally from Steinbach, Manitoba and Mennonite background like myself had also hired me to cover him and the other physician in the town for weekend call several times during the last year of my residency when I was able to obtain a license to do this. The pay was good for this and it gave me a little outing from the city and a taste of what this community was like.