Celebrating 50 years of Family Medicine

Although it has been decades since Dr. John Sangster, MD’67, and his mother provided care for his ailing grandmother, the memories are still fresh. He clearly remembers the thoughtful, patient and caring approach of his family doctor.

“He supported us and gave us the comfort we needed to know that we were doing the right thing for her,” Sangster said.

Years later, that same doctor invited Sangster to join his group practice, Wharncliffe Family Doctors, and delivered all of Sangster’s children.

It’s this opportunity for longitudinal relationships Sangster believes to be the essence of family medicine.

“I was a family physician for 43 years, and have cared for multiple generations of families, and had the privilege to live through unique experiences with many of them,” he said.

A graduate of Family Medicine residency and master’s programs at Western, Sangster is proud to have been associated with the department for all of its 50 years. He served as a professor, medical director of the Byron Family Medical Centre and director of the graduate program. He is looking forward to the celebrations as the department recognizes its golden anniversary this year.

Specialized family medicine training became available at Western in 1966, as one of only two such programs in Canada. At that time, medical graduates had the option to pursue training, with one year serving as an internship, followed by two optional additional years of specific family medicine training. Sangster was one of three individuals who chose to continue their internship in 1967.

As he began his full first year of family medicine training, Dr. Ian McWhinney was recruited to Western to become the founding chair of the first academic Department of Family Medicine in Canada.

McWhinney, known as the ‘father’ of Family Medicine in Canada, is considered one of the foremost writers and academic leaders in the discipline of family medicine in the world. He was responsible for developing and promoting the patient-centred, clinical method, which at the time, was an insightful way of understanding effective doctor-patient communication. He also conceived of the Master of Clinical Science Program, which prepares family physicians for academic family medicine roles.

It took McWhinney five years to pass the graduate program through Senate, which has grown exponentially. Having celebrated its 40th anniversary in 2016, the program has trained 103 graduates, from 17 countries, across six continents. Collectively, the graduates have generated 1,953 papers that have been cited more than 27,000 times. Since 1997, the program has been offered online in a distance education format.

The Department of Family Medicine now also offers a PhD program, providing family physicians the opportunity to pursue research at the highest levels. Dr. Stephen Wetmore, chair and chief of the department, believes Family Medicine at Western distinguishes itself from other programs across the country through its significant clinical training opportunities, by serving as the intellectual centre for family medicine in Canada and as the source of many influential books, papers and presentations.

Many of those contributions come through the Centre for Studies in Family Medicine (CSFM), which brings together an interdisciplinary group of researchers working collaboratively on topics important to family practice and primary care. There are several disciplines involved, including epidemiologists, family physicians, social scientists, nurses, social workers and psychologists. The researchers support one another in their endeavors and are truly collaborative.

The work of CSFM has led to at least seven new models of care during the past four decades, including the patient-centered clinical method; an integrated model of home care combining family physicians and case managers; models of improved practice through enhanced information technology; care for children with mental-health problems; care for Indigenous people with diabetes; interdisciplinary care for patients with multimorbidity; and the promotion of exercise in the aging population.

CSFM has also made original contributions to research methods such as pragmatic trials design, methods related to measuring patient-centeredness; measurement of the natural history of symptoms and illnesses.

Dr. Barbara Lent, who teaches in Family Medicine, is proud to define herself as a family physician and to be joining in the anniversary celebrations.

“I’m really pleased to have been part of many of the department’s initiatives, including the research program on family physicians’ role in addressing woman abuse and in various educational endeavours at all levels of medical education,” Lent said.

Dr. Tom Freeman, Professor and former Chair/Chief, feels fortunate to be part of, and to work with, individuals who make the department a vibrant centre of intellectual work and the application of that work to the daily practice of family medicine.

“Ian McWhinney set out to show a generalist discipline such as family medicine is not just a collection of parts of various medical specialties, but an academic discipline in its own right, with its own methods of practice, unique questions and methods of inquiry and is capable of making a unique contribution to medical practice,” said Freeman. “I think the department he founded has made great strides in this direction and will continue to do so in the next 50 years and beyond.”

The department’s anniversary celebrations include a special lecture featuring Western alumna Dr. Danielle Martin, as well as the annual McWhinney Lecture.

With more than 1,000 family physicians trained in the past 50 years, Wetmore is proud of the strides the department has made.

“When you consider our history, the comprehensive training we provide, the fact our training is based on solid research being generated in the CSFM, we are a premier family medicine training program serving the residents of southwestern Ontario, and indeed, the world,” he said.

The past 50 years have been critical in the development of family medicine and Sangster is excited to watch the next few decades unfold.

He encourages young medical students considering family medicine as a career to explore the true meaning of the doctor-patient relationship, experience a variety of clinical disciplines, as well as urban and rural family medicine opportunities, and to consider what lifestyle they want. If the longitudinal relationship with patients appeals to students, Sangster believes they will have a rewarding career in family medicine and in so doing, will continue the legacy of the Department of Family Medicine at Western.