"Family doctors are also people": a qualitative analysis of how family physicians managed competing personal and professional responsibilities during the COVID-19 pandemic.

BACKGROUND: Family physicians (FPs) fill an essential role in public health emergencies yet have frequently been neglected in pandemic response plans. This exclusion harms FPs in their clinical roles and has unintended consequences in the management of concurrent personal responsibilities, many of which were amplified by the pandemic. The objective of our study was to explore the experiences of FPs during the first year of the COVID-19 pandemic to better understand how they managed their competing professional and personal priorities. METHODS: We conducted semi-structured interviews with FPs from four Canadian regions between October 2020 and June 2021. Employing a maximum variation sampling approach, we recruited participants until we achieved saturation. Interviews explored FPs' personal and professional roles and responsibilities during the pandemic, the facilitators and barriers that they encountered, and any gender-related experiences. Transcribed interviews were thematically analysed. RESULTS: We interviewed 68 FPs during the pandemic and identified four overarching themes in participants' discussion of their personal experiences: personal caregiving responsibilities, COVID-19 risk navigation to protect family members, personal health concerns, and available and desired personal supports for FPs to manage their competing responsibilities. While FPs expressed a variety of ways in which their personal experiences made their professional responsibilities more complicated, rarely did that affect the extent to which they participated in the pandemic response. CONCLUSIONS: For FPs to contribute fully to a pandemic response, they must be factored into pandemic plans. Failure to appreciate their unique role and circumstances often leaves FPs feeling unsupported in both their professional and personal lives. Comprehensive planning in anticipation of future pandemics must consider FPs' varied responsibilities, health concerns, and necessary precautions. Having adequate personal and practice supports in place will facilitate the essential role of FPs in responding to a pandemic crisis while continuing to support their patients' primary care needs.

Perspectives and experiences of the first geriatricians trained in Canada.

Many Canadian-trained geriatricians from the subspecialty's first decade of existence continue to practice today. The objective of this study was to examine the experiences and perspectives of the earliest cohort of geriatricians in Canada. Using qualitative description method, we conducted semi-structured interviews to explore participants' experiences in training and practice. We included geriatricians who trained in Canada between 1980-1989 and were in active clinical practice as of October 2021. Each transcript was coded independently by two investigators. Thematic analysis was used to develop key themes. Fourteen participants (43% female, mean years in practice 35.9) described their choice to enter geriatric medicine, their training process, the roles of a geriatrician, challenges facing the profession and advice for trainees. Two themes were developed from the data: (i) advocacy for the older adult and (ii) geriatrics as "the road less taken". Advocacy was described as the "core mission" of a geriatrician. Participants discussed the importance of advocacy in clinical practice, education, research and disseminating geriatric principles in the health system and society. "The road less taken" reflected the challenges participants faced during training, which led to relatively few geriatricians for the growing number of older adults in Canada. Despite these challenges, participants described rewarding careers and encouraged trainees to consider the profession.

Current biopsy practices for suspected melanoma: A survey of family physicians in Southwestern Ontario.

BACKGROUND: Family physicians (FPs) have an opportunity to diagnose pigmented lesions early with a timely biopsy. OBJECTIVE: To assess current biopsy practices used by FPs in diagnosing melanoma. METHODS: A computer-generated random sample of 200 practicing FPs from large and small communities in Southwestern Ontario was identified from the College of Physicians and Surgeons of Ontario physician directory. Paper-based surveys exploring practice setting, basic melanoma knowledge, biopsy practices and referral wait times were mailed using a modified Dillman protocol. RESULTS: The response rate was 50% and respondents reflected the demographic characteristics of FPs nationwide as per the National Physician Survey. Knowledge testing revealed reasonable mean (± SD) scores (3.2±1.03 of 5). Twenty percent of respondents would always perform an excisional biopsy of skin lesions suspicious for melanoma. The remaining 80% would avoid an excisional biopsy in an aesthetically sensitive area and if there was risk of failure to close the defect primarily, among other reasons. If an excisional biopsy were not performed, one-half of respondents would perform an incisional biopsy (eg, punch biopsy). In large communities, 24% of patients were not seen by a surgeon within six months when referred without a tissue biopsy, leading to delayed diagnosis. DISCUSSION: Educating and supporting FPs to perform incisional biopsies in cases for which excisional biopsies are inappropriate should result in earlier diagnosis of melanoma. CONCLUSION: FPs appropriately recognize that excisional biopsies are ideal in melanoma management and one-half will move on to an incisional biopsy when excision is not appropriate.

HISTORIQUE: Les médecins de famille (M) peuvent diagnostiquer des lésions pigmentées rapidement grâce à une biopsie. OBJECTIF: Évaluer les pratiques de biopsie actuelles des MF pour diagnostiquer un mélanome. MÉTHODOLOGIE: Un échantillon aléatoire créé par ordinateur de 200 MF en exercice de grandes et petites collectivités du sud-ouest de l'Ontario a été extrait du répertoire de l'Ordre des médecins et chirurgiens de l'Ontario. On leur a posté des sondages papier au sujet de leur lieu de pratique, de leurs connaissances de base sur les mélanomes, de leurs pratiques de biopsie et des temps d'attente avant l'aiguillage, selon un protocole de Dillman modifié. RÉSULTATS: Le taux de réponse s'élevait à 50 % et les répondants reflétaient les caractéristiques démographiques des MF au pays, conformément au Sondage national des médecins. Les tests sur les connaissances ont révélé des indices moyens (± ÉT) raisonnables (3,2±1,03 sur 5). Vingt pour cent des répondants effectueraient toujours une biopsie-exérèse des lésions cutanées en cas de présomption de mélanome. Les 80 % restants éviteraient une biopsie-exérèse dans une zone esthétiquement fragile et en présence d'un risque de ne pas fermer l'anomalie primaire, entre autres. S'ils rejetaient la biopsie-exérèse, la moitié des répondants effectueraient une biopsie incisionnelle (p. ex., biopsie à l'emporte-pièce). Dans les grandes collectivités, 24 % des patients n'étaient pas vus par un chirurgien dans les six mois s'ils étaient aiguillés sans biopsie des tissus, ce qui s'associait à un retard de diagnostic. EXPOSÉ: L'enseignement et le soutien des MF à effectuer une biopsie incisionnelle lorsque la biopsie-exérèse ne convient pas devraient favoriser un diagnostic plus rapide des mélanomes. CONCLUSION: Le MF indiquait correctement que les biopsies-exérèses sont idéales pour prendre en charge les mélanomes et la moitié opterait pour une biopsie incisionnelle lorsque l'excision ne convient pas.