A Comparison of the practices of A Super Specialist and and average GP

I would not trade my community based family practice for a hospital based practice for anything.  I’ll tell you what happened to my wife and me this week to illustrate why that is.

I met my wife in medical school and we married during out internships.  We’ve been married for 30 years.  That is about all we have in common in our careers.  Lori is a well-known specialist in Respirology and is the Regional Director of the TB clinic.  She was program director for a decade at McMaster University and has risen to the rank of Clinical Professor.  She is Chair of Respirology at the Royal College.

She is also well liked by her patients and colleagues.  She cares about them and it shows.

I’m an average family doctor.  I’ve never risen above the rank of Assistant Clinical Professor and I never will.  Clinically I’m average and although I too care about my patients, I don’t come across as a likeable old curmudgeon, just an old curmudgeon.  I’ve had some medical political success but mostly because as one colleague told me, “you’re a big enough asshole to get along with the government.”

Despite my wife’s glittering clinical reputation and my averageness, my eyes were opened this week when both of us had to cancel patient appointments.  We both were ill with an influenza-like illness and had to take time off.

My patients were very understanding.  The most common reaction was “tell Dr. Wooder to take care of himself” or “I hope he’s OK”.  These people were genuinely concerned about me and didn’t mind that they were being inconvenienced.

Now I do see almost everyone on their day of choice.  It’s easy to get in the same day or the next day of a call.  If their appointment is for 11 they are generally out of the office by 1130.  My appointment times mean something.  And even when I was away, we did prescription renewals, looked after minor complaints over the phone or through a primary care nurse and had a covering family doctor available for serious complaints.

Most importantly these are people with whom I’ve had an ongoing relationship with for years, decades and sometimes for generations.  I’ve earned a little slack after years of good service.

My wife’s patients were not nearly so understanding.  People complained and they complained loudly.  “I booked a day off work you know” or “When will I get seen?”  They were all told that she was ill and not one person expressed any concern or hoped she would get better.

Lori does not see people quickly.  Her waiting list is months long.  People who are waiting to see her are generally quite sick and need to be accompanied by friends or family.  Some of them are complete strangers and she has no pre-existing relationship with them.  Sometimes hospital patients get real sick, real fast so an 11 o’clock appointment may mean 1 o’clock.

And that is the difference.  I know my patients.  I know their parents or their children.  I know their neighbours and they all know me.  Hospital based physicians don’t usually have all of that going for them and their patients are not as quick to forgive.  They are terrific doctors but they don’t have an ongoing relationship that acts as a buffer.

I respect my colleagues who work in hospital, but I feel bad for them too.

Scott Douglas Wooder, MD

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