QUERY

I hear it in the hospitals, I hear it in ORs. I hear it in emergency departments, doctors' lounges, wards. Elevators make great enclosures for the phrase. I catch a faint echo when I approach any hospital, feel stronger vibrations beneath my feet when I walk through the main doors. I fear that my hospital, constructed in the late 1970s, has absorbed into its structure a new resonance beyond the wind-whipped lashings of its frame and the perpetual PA squawks of pages and alarm tests.

Figure. Photo by: Anson Liaw

Stupid family doctor.

Dumb GP.

I never would have done that.

What was he thinking?

The drone amounts to a constant hum, a buzz that has become a consensus in our institution. Mistakes are viewed, from the omniscient vantage of elapsed time, as inevitable by beings who have practised their mantra well: stupid family doctor. Missed upswings in electrocardiograms, the lost dots on x-rays: in review, these are less errors and more the product of systemic “poor management” by stupid family doctors.

The catchphrase is ubiquitous, perhaps a greater addition to this hospital than any of the other renovations: more important than the cardiac catheterization laboratory, the palliative care wing, the air-transport/helipad system, medical informatics, geriatric restorative care and ascendant diagnostic imaging. A hundred beds could be added to our numbers, a thousand! The single greatest change in the firmament of modern Canadian medicine will remain the death of the generalist.

I hear the ritual sacrifices to the many specialist blood gods and it saddens me to understand that the policy of making-stupid has become assimilated by patients themselves. I acquiesce to requests for second opinions, listen to complaints about prior care, and hear dumdum undertones in consult letters when my own patients return and criticize my care according to what they've been told by people I've asked for help.

During residency I heard it in the OR. I heard it in elevators, in the emergency room, and on the wards. The difference now is that the sound penetrates my own walls, that I hear it in my own office. Before it applied to others. Now it applies to me. The growth of knowledge has led to the growth of privilege, the ease of retrospective criticism. Though I never knew the era, I believe that physicians were better served by the rotating internship, when the undifferentiated masses arrived on the newly-minted doctor's doorstep fresh and unmanaged, ready for a general working-through. That way, one understood the difficulties of primary care and not just the deficiencies.

Broadcast from the hospital barricades, the harmonic of GP illegitimacy makes me hate this myth, the myth of Doctor Stupid.

— Dr. Ursus