From the President - August 2017

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Greetings for what in many countries is a vacation period. My only overseas trip since the last news was to the excellent WONCA Europe conference in Prague, and I am about to make trips to Africa – to Tanzania, and to the regional conference in South Africa. In Tanzania, I shall be the guest of one of our ‘organisations in collaboration’, the International Federation of Medical Students Association (IFMSA), with whom we want to work closely to promote the profile of family medicine – which is still not a strong presence in some countries’ medical schools. I look forward to meeting their worldwide membership, and also to meeting some of the Tanzanian ‘pioneers’ of family medicine to whom our regional President Henry Lawson has introduced me. I shall write more about this in the next letter. In South Africa I look forward to meeting many colleagues from the region, including the young doctors of Afriwon, and to seeing the first award winners of the Atai Omoruto scholarship.

In Prague, I talked about the role of family doctors in building relationships and reducing social conflict. Globally, separatist forces operating across our world today are a source of anxiety, threat and conflict. Concepts of tribe and nation can be a source of pride but also division. Professional groups such as WONCA face the challenge of trying to find shared values and means of improving our professional standing and impact, while respecting the diverse settings and backgrounds of our members and patients. I believe, as did our esteemed colleague Iona Heath who I quote here, that “family medicine is a force for good”. Almost all our members will be working with people from different ethnicities, cultures, and social settings, both as their patients and colleagues: also external stakeholders from community leaders to politicians. This is actually a great privilege and often a pleasure but their worlds, experiences and priorities may be very different from our own, and we need to become skilful in working with others: also, sometimes, needing to stand up against some issues. There is always the risk of power and powerlessness – who holds the resources, makes the decisions: do we have a voice in that room, or is it beyond our control? In the face of these risks, our values can bring us together, enable us to be resilient and to persist in overcoming all the challenges – but there may be times when they can also drive us apart.

An important way that family doctors can overcome conflict and act as role models for an inclusive society, is by making our practices open and acceptable to all patients from all different backgrounds. A patient asks to be greeted by their new name, even though the records hold the old name: patients using English as a second language may have difficulty using a telephone based booking system: a lady may have a strong cultural preference for a female doctor. A community riven by social conflicts may be brought together in the waiting room, a patient participation group, or a community leaders’ meeting called by a local family doctor to try to reduce local fights and damage. This all takes interpersonal skills, is driven by deep professional values, and must be delivered across the team.

And this of course is also reflected within the consultation – how sensitive I am to the backgrounds of my patients, how much I am prepared to engage with sometimes very difficult personal issues that can profoundly challenge my own value system, and how I can help with healing - or indeed challenge their beliefs and customs if I think these may be harmful to them or others – these are the intrapersonal as well as interpersonal skills, which are particularly sophisticated parts of our residency training and ongoing professional development, and our discipline has put a lot of its intellectual energy into such areas. Even more ambitious is the kind of community development attempted by some innovative practices and health care system, where the work of family medicine is extended into interventions that address the social determinants of health.

If you want to influence someone else’s value system to focus on the patient as a person, and to be alert to equity issues and the needs of the poor and marginalised, then a very important role for family doctors and their communities is to be educators. I know that many of you will be hosting undergraduates and postgraduates to allow them to learn medicine outside hospital – to meet the people behind the diseases, and to see the ways in which their lives interact with their health and wellbeing. All that I have said about role modelling of patient centred care, regardless of the wealth or background or class of the patient, is a really important gift to a future doctor – and may also encourage them to make the choice to go into family medicine, perhaps to choose rural practice, or to work with vulnerable communities in different settings… So thank you to all those of you who are educators, playing these different roles - and please everyone try to add that role into your daily busy lives, because it can transform how learners think about patients and their own role as future doctors.

Ultimately, we have to return to values that unite rather than divide people, and create these inclusive approaches through our work and training, and indeed through our actions as citizens as well as doctors. In healthcare, and particularly in family practice, we have great opportunities to change the way people think. We have to stand together for the right of everyone to have good accessible affordable care that they can rely on – to have doctors they trust, and to be professionally worthy of their trust. We have to face up to our own prejudices and make good judgements about the right actions, informed both by facts and feelings. We can also show the right values in the face of stigma, prejudice, and indeed overt racism. And through our actions I hope we may bring some healing to our troubled world.

Professor Amanda Howe,
President WONCA