A number of features make general practice a distinctive part of the medical profession. General practitioners (GPs) usually enter into a long-term relationship with their patients which enables the physician to treat illness with a full knowledge of a patient's life history, medical history, social and family relationships, and personal values or preferences. GPs see each of their patients on the average 4 times a year. These visits provide excellent opportunities for health education and the early detection of disease. The majority of illness episodes are managed entirely by the GP.
When specialized help is needed, the GP arranges a consultation with or a referral to the appropriate specialist. The growth of specialization and the technological development of medicine have added greatly to the complexity of medical care; GPs are often instrumental in co-ordinating the patient's care and in explaining the implications of diagnostic investigations to patients and their families.
When GPs live in the communities in which they practise, particularly rural communities, they can gain valuable knowledge of the working and living environments of their patients. Some GPs still visit their patients at home and the great majority of general practitioners in Canada admit and care for their own patients in hospital. Prenatal, postnatal and well-baby care are important parts of this kind of medicine.
The Development of General Practice
In the 19th and early 20th centuries, virtually all doctors were GPs. Since the 1930s there has been an enormous growth in the number of major medical specialties, and since the 1950s, a great deal of fragmentation into subspecialties. As a result, certain procedures (eg, major surgery) which were formerly the responsibility of GPs have increasingly become the province of full-time specialists. At the same time, many specialists, by limiting their practice to narrower fields, can no longer provide primary care. In some specialties, however (notably pediatrics and obstetrics), there are practitioners who offer primary and continuing care to certain age groups.
The rapid growth of specialization after WWII was followed by a decline in the numbers of GPs, a decline paralleled in other countries and in other professions, where the relationship between generalists and specialists became an issue. Since that time, however, a number of factors have contributed to a renaissance of general practice, including the founding in 1954 of the College of General Practitioners, renamed in 1967 the College of Family Physicians. The college has provided the intellectual and academic leadership that has enabled GPs to redefine their role in a more complex society. Instead of seeing themselves as "jacks of all trades," GPs are now members of a well-defined medical discipline, based on an integrated knowledge of clinical medicine and human behaviour, with special skills in the prevention and early diagnosis of disease and the complex long-term care of patients.
The college has encouraged the emergence of general practice as an academic discipline in the universities and the development of postgraduate training programs in family medicine. The first chair of family medicine was established at University of Western Ontario in 1968; today all 16 medical schools in Canada have academic units of general practice and postgraduate training programs. Several hundred trainees graduate from these programs each year. The College of Family Physicians, which was founded in 1954, has approximately 13 000 members, each of whom also has compulsory membership in their provincial colleges.
In 1997 there were 28 108 GPs and 27 135 specialists in Canada. A historic problem with insufficient training positions for all graduates entering general practice generally has been overcome and there is increased awareness of the GP's role in the large urban hospital. General practice has become a popular career choice for medical graduates, especially women graduates.
The growing proportion of elderly people in the population has made the care of the aged an increasingly important aspect of general practice, and the high cost of hospital care and the complexity and fragmentation of medicine has made it essential to have a well-trained and highly skilled body of generalists.
Author IAN R. MCWHINNEY
Links to Other Sites
Canadian Academy of Sports Medicine
The Canadian Academy of Sport Medicine (CASM) is an organization of physicians committed to excellence in the practice of medicine as it applies to all aspects of physical activity.
Canadian Medical Association
The official website of the Canadian Medical Association. An extensive source of information about hundreds of health issues.
Check out the colourful AboutKidsHealth website for online articles on hundreds of childhood ailments, medications, behavioural issues, and medical procedures. Also offers an animated "How the Body Works" feature, and much more. From the Hospital for Sick Children (SickKids) in Toronto.
Take an interactive multimedia tour of past and present health care practices in Canadian hospitals. From the Virtual Museum of Canada.
Canadian Public Health
The Canadian Public Health Association (CPHA) is a national, independent, not-for-profit, voluntary association representing public health in Canada with links to the international public health community.
Community and Hospital Infection Control Association of Canada
An informative website about effective practices for the prevention and control of infectious diseases for health care professionals and the general public. Check out the contact information for local chapters in your region.
Canadian Bioethics Society
The website for the Canadian Bioethics Society, an organization concerned with ethical issues relating to human life and health, biology, and the environment. Click on "Bioethics Community" to access their blog and other online resources.
Canadian Journal of Rural Medicine
The official journal of the Society of Rural Physicians of Canada. Provides full text academic articles about rural health issues.
Centre for Rural and Northern Health Research
A great resource for academic information about rural health issues in Canada. From Laurentian University.
About children's rights in British Columbia. Topics include choosing which parent to live with, medical treatment and hospitalization issues, and children's input in child protection cases. From the Canadian Bar Association, British Columbia.
Public Health Agency of Canada
Check this site for the latest news about current health issues. Covers chronic disease prevention, public health emergencies, infectious disease outbreaks, and other topics related to health hazards.
Canadian Institute of Child Health
CICH is a national charitable organization dedicated to improving the health of children and youth in Canada. Check out the informative CICH Communiqués and other resources about children’s health.
Open Medicine is a peer-reviewed, independent, open-access general medical journal. The Journal examines issues relevant to health and clinical medicine both in Canada and internationally.
Dr. Mary Jackson
The eventful life story of Dr. Mary Jackson, a pioneering family doctor in rural Alberta. Check this site for additional family histories.
Museum of Health Care
The website for the Museum of Health Care. Features an overview of the museum and online exhibits about the history of health and health care in Canada.
Pharmacare program would save billions: report
A CTV News story about a report that recommends the adoption of a national drug plan for Canada.
The Cochrane Collaboration
The website for the Cochrane Collaboration. Patients and other healthcare consumers can assess the potential risks and benefits of their treatment.
Association of Faculties of Medicine of Canada
The website for the Association of Faculties of Medicine of Canada, a good information source for students interested in pursuing medical studies. Provides links to websites of medical faculties, details about admission requirements, online publications about medical education and research, awards for innovative teaching initiatives, and more.
Canadian Pharmacists Association Survey Reveals Drug Shortages a Serious Concern
A summary of a report that examines the impact of drug shortages on Canadian health care. Click on the link to access the full report. From the Canadian Pharmacists Association.