As a family doctor, much of my work is invisible to patients.
This first-person article is the experience of Dr. Laura Sang, a family physician in the greater Montreal area. For more information on CBC’s First Person Stories, please see frequently asked questions.
WARNING: This article contains references to sexual assault and suicide.
I get out of bed at 6am trying not to disturb my sleeping partner. After pulling on a hoodie from the pile of clean clothes I haven’t had time to put away, I make myself a cup of tea and a bite to eat.
As soon as that first drop of caffeine enters my bloodstream, I open my laptop to review patient records in preparation for my next clinic.
My inbox contains about 20 messages needing attention from the previous day, including one from a secretary stating that my patient – a single mother recently diagnosed with breast cancer – was in distress because her insurance refused to cover her salary during discharged undergoing chemotherapy treatments. I am requesting that the patient be booked on one of my lunch breaks this week to see what can be done to help her.
Then I print a multitude of driver’s license renewal forms for my elderly patients and insurance forms for discharged patients. Every sip of tea is a guilty reminder that I wanted to end a few days ago. After a brief “good morning” exchange with my partner at 8:00 a.m., I head to work to start my day seeing patients.
At the clinic, I silence my buzzing phone, ignoring the endless stream of emails about pandemic precautions, updates on equipment shortages, and staff on sick leave as I try to give my full attention to the sobbing 18 year old. my office. She struggles to return to school after being raped.
His family does not know. I’m the second person she felt comfortable talking to after a teacher refused to give her an extension on her essay when she asked for help.
She looks helplessly into my eyes as she expresses her heart. I feel a growing weight on my shoulders – a sense of responsibility to make up for a system that let it down.
Her appointment lasts as long as I support her through her decision-making process of whether or not to take legal action against the abuser.
The rest of my break is spent calling back patients with urgent lab results and talking to the nurse at the rehab center where I work twice a week, trying to manage patients’ high blood sugar and headaches at distance.
The last patient leaves my house around 4 p.m. but my working day is far from over. I have a new stack of insurance forms, prescription refills and specialist referrals to fill out.
In my first year as a family physician, I’m still trying to figure out what business side of medicine we need to manage. With no sick or vacation days, we only get paid based on our interactions with patients. I spend the next two hours trying to finish plotting these interactions. All this administrative work — most of it invisible — is unpaid.
I spend more time carefully reworking another rejected insurance form so that my patient with crippling depression after his son’s suicide continues to be paid while on leave.
I receive a scan result showing a brain tumor and try to find the fastest way to send the patient to neurosurgery and arrange an appointment to discuss the result. After a brief dinner and an hour spent meeting my partner at home, I sift through all the blood test results that have piled up throughout the day. I struggle to keep my sleepy, floating eyes open as I make sure there’s nothing urgent before slipping into bed to start all over again the next day. And the next and the next.
By the time the weekend rolls around (luckily I’m not supposed to work) I fall into bed and sleep for about 12 hours.
This schedule reflects the reality of so many family physicians in Quebec. We work and work until we are exhausted, move into the private sector, or leave the field altogether because we simply cannot bear the weight of our overburdened healthcare system any longer.
I feel privileged to do this work. From celebrating remission from cancer to treating depression after a miscarriage, family physicians see patients go through many defining moments in their lives, times that many family members never are not even aware.
Although my work is incredibly rewarding, it is also exhausting. Interactions with patients can affect us deeply and it can be difficult to find the time to process much of the suffering we witness when we are overwhelmed with a high volume of patients and paperwork.
And there are often huge sacrifices in our personal lives to care for our patients – postponing dinner plans, missing birthday parties and family gatherings. I’ve had weeks where I haven’t seen my partner, because I’ve been out of the house before he woke up and home after he fell asleep.
That’s exactly why it stings every time I see The politicians saying family doctors don’t work hard enough. Ask us to take more patients as part of the reforms of the Quebec health system will not necessarily improve patient access or quality of care. The solution is much more complicated.
The next time you feel frustrated that your family doctor is late, remember that we’re probably helping someone through a crisis. When we’re only available two days a week, it’s because we often work at other locations or use unpaid hours to complete your forms, refer you to specialists, and follow up on your lab results.
Remember that we work for you, even when we don’t see you.
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If you or someone you know is having trouble, here’s where to get help:
Support is available for anyone who has experienced sexual assault. You can access crisis lines and local support services through this Government of Canada website or the Canadian Association for the Elimination of Violence Database. If you are in immediate danger or fear for your safety or the safety of those around you, please call 911.