Doing it All with Family Medicine

It makes no difference whether Dr. Judy Maynard is speaking of a young resident trying to find his bearings, an elderly patient struggling with poverty and nearing the end of her life, or an established and highly regarded colleague in family medicine, a listener would notice the same level of respect and deference for the individual and his or her circumstances. No doubt, many readers will relate to this Family Physician of the Year’s enthusiasm for the diverse aspects of family medicine. 

Dr. Judy Maynard

When we spoke with Dr. Judy Maynard for this article she was just winding up an on-call weekend covering a roster of 91 patients who are part of the Brameast Family Physicians’ home-based palliative care program. Eighty per cent of those in the program – one of the largest in the province – can be expected to die at home, says Dr. Maynard, and on the weekend, three patients passed away.

“In general, I have a caseload of about 15 to 20 of the 91 that are mine,” says Dr. Maynard, who was preparing for an afternoon of house-calls across the city of Brampton, working with the program’s clinical nurse specialist to visit her “most sick patients in the community.” “It’s something I’m passionate about,” says Dr. Maynard. After 30 years of family practice obstetrics, she shifted her focus to palliative care nearly six years ago. “There are a lot of  new palliative care specialists but we’re basically all family doctors and we’ve been doing it for a long time.”

Dr. Maynard, who was named an OCFP Family Physician of the Year in 2016, joined Brameast in 1990, following locums in other parts of Ontario and in New Zealand. For roughly 15 years, the practice in then small-town Brampton served as a rural elective for University of Toronto medical students.

Then, in 2008, she undertook the role of site director, spearheading the creation of a satellite full-time residency program in Brampton as part of the McMaster University Department of Family Medicine. On this project, she worked with colleague Dr. Frank Martino, former OCFP President and current Chief of Medical Staff at William Osler Health System.  “It’s something I had never planned to do, but both our practices had been teaching with the University of Toronto and both of us wanted the commitment of full-time residents,” says McMaster graduate Dr. Maynard. “We figured we had an incredible, untapped group of teachers in Brampton.”

Four short months and a lot of hard work later, the program was up and running. Today, while Dr. Maynard has given up the Site Director role, the Brampton Family Medicine Teaching Centre through McMaster University continues to annually accept 10 fulltime family medicine residents for their full two years of residency. Her group accepts three of the 20, as well as teaching other medical students who participate specifically in palliative care and family medicine electives.

“We’re doing a lot of teaching – it’s rare for me to go out and do a half-day of house-calls without a learner being there,” she says. “[Home-based palliative care] is a very different experience to what you get in your office – where people book to see you and they’re coming into your office space.”

While it may be difficult for a physician to absorb all the information that comes with a house-call –individual circumstances, social situations, medical issues and family constraints all come into play – these details are especially important in the context of palliative care. “You can give folks suggestions and advice, but that may not be practical based on their social situation and what’s practical at home.”

She admits that, for residents, home visits can be especially overwhelming, even “mind-blowing”, at first. “But we also watch them very quickly get used to it, and blossom to become more independent,” says Dr. Maynard. “If they’re with us for two to four weeks, we can even get them doing some repeat visits on their own to get some confidence.”

For her part, she views her work in palliative care as somewhat an “extension” of her work in a homeless shelter providing much-needed ad hoc care. “They don’t have time to think about their healthcare, they don’t have time to commit to an appointment or even make an appointment.” This means doing whatever is needed when it’s needed, rather than scheduling tests and follow ups, says Dr. Maynard. “They were some of my most interesting patients and many of them ultimately joined my practice.”  

As in the residency program, Dr. Maynard’s enthusiasm for learners highlights a role she has relished since the start of her career in family medicine. “I’ve always loved teaching. Even in New Zealand, I was teaching medical students but I myself had barely graduated, so I didn’t feel that I had much to teach them,” she recalls with a laugh.

Teaching, obstetrics, palliative care and medical care for people in other difficult circumstances – Dr. Maynard attributes her achievements as a family physician to one thing. “The nice thing about family medicine is there’s such a breadth to what you can do, but you have to have the right group of people to back you up,” she says. “I’m with an unbelievably inspiring group of smart people and I think that is a huge key to success.”

To the benefit of patients and colleagues, this family physician has taken full advantage of family medicine’s breadth of care from the start. “At the beginning I kept trying to find a specialty – I thought I was going to be a psychiatrist, I thought I was going to be obstetrician, and by the end I realized that I just like it all and the best way to do it all is to go into family medicine.”