Bringing health to the community

When Merrick Zwarenstein graduated from a South African medical school in the early 1970s, he left with the scientific training required to be a doctor. But he felt as though the institution of medicine had been ignoring the most crucial part of medical care for generations – the patient.

This perceived shortcoming inspired him to begin his pursuit of changing primary health care in Canada. His approach of patient-centred care – making each person’s individual needs and concerns into a priority – is one that he continues to this day as the director of the Centre for Studies in Family Medicine.

“Often, if you come out of a medical school, you leave with a very technical idea of disease,” said Zwarenstein, who joined the centre in May. “That idea is important and necessary, but it doesn’t mean you are well equipped to adapt the care you provide.


“The needs of an individual can differ from one who may live in a very different context to a patient who has the same disease.”

The late Ian McWhinney, the father of family medicine in Canada, founded the centre in 1989. Its primary goal is to enhance family medicine and primary health care through research designed to have a positive impact on the health system, as well as patient well-being.

The centre operates under the Department of Family Medicine in the Schulich School of Medicine & Dentistry and consists of 11 faculty members and upwards of 30 staff.

One of the newest and most innovative programs underway is Western’s Primary Health Care program. With a focus on community-based care, the research project involves streamlining the communication between family doctors and specialists to decrease patient wait times.

The process will mainly involve using email between family physicians and specialists. It works to ensure patients are being sent to the correct type of specialist, whether more tests are required, and to speed up on communication between parties, according to Cathy Thorpe, research associate and manager at the centre.

Wait times in Canada have become a serious issue. The average wait time actually increased in the past few years, according to an annual report released by the Wait Time Alliance, a group consisting of doctors from a wide range of specialties.

Other recent activities at the centre include a $2.5 million program funded by the Canadian Institutes of Health Research called Patient Centred Innovations for Persons with Multimorbidity.

“There is an assumption that people with chronic conditions often deal with only one condition at a time,” Thorpe said. “But it’s usually the case that there are multiple.”

The Canadian health-care system operates under this false assumption, according to Thorpe. The goal of this program is to make the system address the needs of patients dealing with multiple afflictions simultaneously.

While there is a medical and scientific approach to this, the health-care system should focus not only on the disease, but the patient’s context as well, said Zwarenstein.

“Patients are more than their cancer, and they’re more than their injury,” he said.

When projects like these are a success, the data is brought to policy-makers at the Ministry of Health and Long-Term Care in hopes of making province and nationwide changes to improve the health care system.

The centre’s activities benefit Canadians. They often work alongside family physicians and patients at the same time to improve the ability of doctors to serve patient needs. Their breast cancer study is one such example.

“Patients helped us to train oncologists, surgeons and family physicians in how to care better for breast cancer patients. They were very much involved in designing the training,” Thorpe said.

The data was turned into an online training program for physicians aimed to improve communication with breast cancer patients. Both have found the program highly beneficial.

The organization creates a physical space in which practicing family physicians can do their own research to better their knowledge and understanding in treating patients.

Joshua Shadd is a physician who joined in 2009. He uses the centre’s resources and space to conduct research to improve his specialty in palliative care.

The data gathered by the centre are invaluable to not only his patients, but also thousands of patients in the London area. While most in the general public may have never heard of the centre, they have definitely benefited from it, said Shadd.

One of the most important aspects of the centre is that they act as a bridge between the frontlines of community health — family physicians — and policy makers in the Ministry of Health and Long-Term Care.

“There are few opportunities for front line care providers to have direct input with the Ministry of Health. It would be a loss for a centre like this not to exist. It is an important connecting node of the broad system that looks after the health of the community,” Shadd said.