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Guest Editorial: Maintaining the Patient-Physician Relationship in Family Practice

Jan Kasperski, RN, MHSc, CHE
Ontario College of Family Physicians
Network, Winter 2006

The father of family medicine in Canada, Dr. Ian McWhinney, reminds us that family doctors form a covenant, rather than a contract, with their patients. A contract means that the physician will do so much and no more. A covenant means that the physician will do everything and anything it takes to meet the needs of the patients.

On an operational level, the covenant between the patients and their family doctor is supported through a model of care known as “patient-centred care.” Patient-centred care involves the development of a partnership between the patient and the family physician based on trust and mutual respect. The patient brings to the clinic setting knowledge of self, of family and of the community in which the patient lives and works. The physician brings to the table knowledge of clinical medicine and the health-care system. Together, they work through the assessment and diagnosis of the problem and then together make decisions about the most appropriate treatment plan.

The trusting patient-physician relationship develops over time, over multiple visits, and is key to patient-centred care. Patient-centred care results in better health outcomes, fewer tests and fewer referrals to specialists and specialty services. It is effective and cost efficient. As we move towards increased organizational structure in primary care that demands new accountability contracts with government, we need to be careful that they do not overshadow the vitally important covenant between family doctors and their patients. As we develop interdisciplinary teams and shared care models of service delivery, we need to be mindful of the importance of patient-centred care practiced within the trusting patient-physician relationship.

Patients value the relationship they have established with their family doctors. Regardless of the problem but especially in the area of mental health, patients prefer to have their care delivered by their own family doctor. Family doctors have told us, time and time again, that it is almost impossible for them to gain access to mental health care for their patients in those instances when the patient is willing to be referred or is so ill that referral is almost mandatory. As a result of both patient choice and lack of access, the main providers of mental health care in Ontario are family doctors and they are asking for help.

The Collaborative Mental Health Care Network (CMHCN) was established by the Ontario College of Family Physicians to provide that help. CMHCN borrows from the concepts of shared mental health care, bringing together family doctors, GP psychotherapists and psychiatrists and their specialty team into an educational model of support for patients. However, it maintains the special relationship between family doctors and their patients while providing the guidance, advice and support that family doctors need to deal with the wide spectrum of emotional and mental illnesses that their patients experience.

The results have been very positive. Family doctors report that they feel much more confident in their ability to provide care for even the most complex mental illnesses. They are less likely to refer patients to specialists or send them to the emergency department, and they are looked upon in their own communities as “opinion leaders” who are willing to share their expertise with other family doctors and to advocate for positive changes in the mental health care system locally. The increased level of respect for family physician members of the network amongst the specialists has resulted in positive changes in their own practice. Mentoring, rather than providing hands-on care, has freed them up to deliver care to those most in need.

The Ministry of Health and Long-Term Care is to be commended for its support of this project and for providing the encouragement needed to truly make a difference in the delivery of excellent mental health care services in Ontario and serving as an excellent model of care nationally and internationally.

Jan Kasperski is the executive director and CEO of the Ontario College of Family Physicians.

» Return to Network, Winter 2006 – Contents