Purpose of a family medicine journal

What is the purpose of a medical journal? While literature exists on the topic,¹ it is not specific to family medicine. September’s issue of Canadian Family Physician (CFP), which includes articles about social accountability and clinical content, has led us to reflect upon our purpose.

Family medicine journals around the world take a variety of approaches. American Family Physician no longer publishes research articles; instead, it focuses on short, easily digestible clinical content.² The British Journal of General Practice has a greater focus on research.³ The Australian Journal of General Practice mirrors our structure in terms of publishing a combination of research, shorter clinical content, and essays.⁴

How do we determine CFP’s content? It is in part based on your feedback. Each year, we distribute our Medical Readership Information survey. Respondents, composed of College of Family Physicians of Canada members, provide their opinions on the content of the journal. In the most recent survey, readers were in agreement about their enjoyment of our clinical content. Yet there were also striking differences in opinion: some commented that we focus too much on social topics, while others found our attention to social issues insufficient.

This issue includes clinical content, but there are several articles on social accountability, as well. A commentary (page 599) reviews the barrier of cost when it comes to accessing medications and provides a potential solution.⁵ Anawati et al (pages 594 and 630) address social accountability in health care, discussing the need for family doctors to be antiracist both in our practices and in the systems within which we work.^6,7

While socially themed articles may be met with resistance by some, social accountability is recognized to be an essential component of medical education and practice, as discussed in a landmark report published by the World Health Organization in 1995.⁸ Social accountability has now become a standard to which medical schools must adhere for accreditation,⁹ and the current multiyear update of the CanMEDS framework includes an increased focus on anti-oppression and antiracism.¹⁰

Clinical knowledge is the lifeblood of our daily practice. But what is the benefit of knowing the latest diabetes guidelines if we fail to recognize that our patient will not fill their prescription because of the cost? I am a White physician and I work in an Indigenous community. How do I, in a position of privilege, work to eliminate racism from my own practice and within the discipline of medicine? We know that the consequences of racism can be dire.

Joyce Echaquan was an Atikamekw woman with a history of cardiomyopathy who live-streamed a video documenting derogatory comments being made to her by health care workers while she suffered in respiratory distress, later passing away from pulmonary edema secondary to her cardiac condition.¹¹ In the coroner’s report, it was written that “[t]he racism and prejudice that Mrs. Echaquan faced was certainly a contributing factor to her death.”¹¹

As a medical journal, CFP aims to inform our readers about the latest thinking in our discipline and improve the quality of care for our patients. Acting as socially accountable physicians is an essential part of providing that high-quality care. We must examine our own conscious and unconscious biases to ensure no harm is done. By discussing social accountability, we hope not only to ensure our patients receive the best care possible, but also to prevent tragic and unjust outcomes, such as the death of 37-year-old Joyce Echaquan, mother of 7.