Anatomy of the elephant in Quebec family practice

Abstract

Background
 Whole person care has been a foundation of the modern practice of family medicine, and therefore one might expect that such an approach by family practitioners would evolve and mature over time. Some of these clinicians, however, currently question their ability to provide such holistic care because of external factors they perceive as negative, and over which they have little or no control.
 Objectives
 This presentation will explore perceived inhibiting factors affecting family doctors ability to provide whole person care within the publicly-funded health care system of the Canadian province of Quebec. 
 Method
 The presenter, an academic and clinician scientist with forty-four years of experience practicing family medicine, will present personal perspectives, along with those gathered informally from a broad cadre of colleagues working in different settings. Using the idiom of “elephant in the room” to identify problems or obstacles that may not be voiced, this talk will start with consideration of elephant anatomy as being comprised of thirteen distinct anatomical parts that contribute to a functional whole. An analogy will be developed in which thirteen distinct factors are presented as likely impeding or discouraging whole person care by family physicians. 
 Conclusion
 Some agendas and policies of health care planners and administrators, either alone or collectively, and intentionally or unintentionally, may decrease opportunity or ability of family physicians to provide whole person care.