The Department of Family Medicine at Queen’s University had a year of growth and success with important milestones. This year, we mark the 40th anniversary as a department at Queen’s. On July 1, 2012, we opened our fourth site for postgraduate “residency” education in Oshawa. On September 1, 2012, we became the home of our first Royal College program, Public Health and Preventive Medicine, a five-year specialty program with many synergies with Family Medicine.
This growth is against a backdrop of increasing austerity in our province and university. Yet, it is clear that Family Medicine and primary care are growing on their traditions and are being recognized as the cornerstone of the health care system. In a society with such a propensity for specialization, the benefits of generalist approaches to health care are receiving more attention and more resources.
Over the past 40 years, the Department – and Family Medicine as a discipline – has been aware that more could be done by generalist physicians taking a patient-centred approach to meet the needs of our populations and our individual patients. This recognition of our potential was never intended to distract from the incredible advances made by many of the specialist disciplines. New pharmacological approaches to many diseases, cutting-edge diagnostic techniques and ever-improving and precise surgery that is minimally invasive have been true miracles of human ingenuity and knowledge. But humans are not machines, and the “fixing of parts” does not necessarily result in a functioning whole. As each person interacts socially and biologically, he adapts to his environment in a different way. When the adaptive mechanisms break down, people feel unwell, ill-at-ease with their surroundings and their bodies. We all have patients who have “medical” problems but they are well. We also have patients who have no apparent problems with diseased organs but they are unwell. And this presents one of the ways that patient-centred family physicians can be so effective – working in a world where we embrace the complexity of individuals and work with them to achieve a healthy adaptation to their environment.
To achieve this, our Department has grown over the years. We have expanded the postgraduate program while taking more “ownership” for it. Most of the postgraduate program is now centred in Family Medicine, as opposed to the training being a series of experiences in different specialties. We are placing our residents in excellent community practices where there is modelling of the comprehensive nature of Family Medicine. The new curriculum at each of our sites emphasizes this centrality of the Family Medicine experience but also reflects what our research has consistently shown – that the continuity of the relationship between physician and patient is the key to success in helping our patients achieve wellness. We need to model this for our resident physicians and harness the power of continuity in the relationship between teachers and learners.
Our education programs need to be at the forefront of change. The needs of our population are changing – not just in regard to aging and the prevalence of chronic disease but also in regard to our changing environment. Global warming, nuclear reactor failures, toxic environments, political weakness, increasing socio-economic disparity, and social unrest are all challenges occurring against a backdrop of fiscal weakness and economic uncertainty. Our profession, and every profession, needs to step forward boldly to help find solutions that work to resolve population health issues, to address the social determinants of health, to achieve dignity for all, and to transcend the barriers of religion, race, gender and history to improve the life of everyone.
The Queen’s Department of Family Medicine will continue its work of the last 40 years and be a leader in educating the physicians of tomorrow and helping to transform the way care is delivered to our patients. We will continue our focus on important research that is appropriate to the primary care setting and for the environments in which our patients live. And we will continue to support a work environment that respects the contribution of every member of the Department. Every member of staff, every faculty member in the university centre and in the community, and every resident working with us is essential to our advances in achieving our mission.
As a department of caring people, we have the skills and synergies we need to be the change agent we envision for our patients and our broader community.
Glenn D. Brown
BSc, MD, CCFP (EM), FCFP, MPH
Head, Department of Family Medicine