Book Title: Family Doctors Say Goodbye: Shifting Grounds and Relationships
Editors: Lucy M. Candib, William L. Miller
Publication Details: Springer, 2023, 162 pp., $64.99, hardcover
Family medicine thrives on developing relationships with our patients over time, learning to see them as individuals with hopes and dreams, quirks and fears, and each with a unique story. How do we say goodbye to such relationships when the time comes? Family Doctors Say Goodbye, edited by Lucy M. Candib and William L. Miller, is a collection of essays reflecting on the experiences of leave-taking of eight family physicians, including the editors, in a variety of circumstances. Some left due to retirement or change in health, others to pursue something new, and still others due to disillusionment with changes in the health care system. With family medicine’s cradle-to-grave imagery, “the doctor’s ending of the relationship is the antithesis of this sometimes mythical version of family medicine” (p. 72). These essays provide insight into the special vulnerability that family physicians feel as they end the relationships that once defined their careers.
The group of essays opens with the reflections of Ann Reichsman as she looks back at more than 40 years of practice and leadership in a community health center. She had taken a year to say goodbyes to her patients, assisting them with transition to a new physician through a schedule-sharing process; she describes some of her most poignant and meaningful interactions. Other essayist physicians honestly explore their shifting roles and goals, openly admitting their uncertainty. Aptly, the collection of essays ends with the musings of Cynthia Carmichael after she recognized in herself early signs of Alzheimer’s and was forced to face difficult choices. She concludes by stating, “I wish I could practice family medicine again; I feel lost without my work” (p. 153).
Family Doctors Say Goodbye includes a chapter by John Frey, who has interviewed family physicians for 35 years, and provides a historical perspective on leaving practice. Previously, retirement was not a consideration for most physicians. Whether due to concerns about inadequate financial resources or psychological concerns regarding identity and the need to fulfill obligations, physicians would avoid retirement and instead slowly limit the scope of their practice. Sometimes they would bring on a new physician to groom to take over. Now, with retirement planning becoming the norm and with more and more family physicians employed by medical groups or hospitals, family physicians are contemplating how and when to leave practice rather than just fading away. The memoir-like essays explore these issues.
The editors of Family Doctors Say Goodbye have assembled a well-written collection of essays from a broad array of perspectives. Their introduction to each physician writer makes the essay that follows all the richer. I did struggle with the book’s organization of topics and would have preferred the historical and contextual chapters to have preceded the memoir-like essays rather than being mixed in among them.
This book’s publication is timely. As noted in its Preface, the first wave of Baby-Boomer family physicians, who were also the first to have completed a 3-year residency, are contemplating retirement after 35, 40, or even 50 years of patient care. I am one of those family physicians. While providing no blueprint as to how to make this decision or how to negotiate the minefield of taking leave, the book provides much to consider as I contemplate the end of this chapter of my life and make plans for the future. I recommend this book to any considering retirement or even just a change in practice location. The text will help us all to honor those special patient relationships that have made us love being family physicians.
