Introduction
Introduction to the Medical Hall of Fame Video, McWhinney Lecture Series
September 20, 2023
Tanya Thornton MD CCFP MClSc(FM) FCFP
Dr. McWhinney sat with his palliative patient. It had been over half an hour, and she had said nothing. He remained patient. Finally, she opened her eyes and asked, “Am I dying?”
He said, “What do you think?”.
She closed her eyes, silent again. He waited.
He waited some more.
She finally moved her hand to his and said, “I think so.”
He responded, “I think so too.”
More silence.
Then she looked him squarely in the eyes and said, “Thank you” and closed her eyes again. He waited in case she wanted to add something. And after some time, left the room quietly.1
Four words: “I think so too”. Four words with profound impact for this particular patient. This pithy statement emanated from a deep understanding of his patient, from his attentive presence, and from his unconditional commitment to her. He wrote, “There is never nothing more we can do, because one of the greatest gifts we can bestow is our presence.” 2
A philosopher, a critical thinker, a visionary, a leader….yes, Dr. McWhinney was all of these, but he started in the trenches as a generalist physician offering his listening heart, ever observing, and ended his career in the trenches as a family physician providing palliative care. In the interim, he founded the First Department of Family Medicine in Canda.
Let me set the stage for this development. It was post-second world war, during an era of increased technological advances. General practitioners began to disappear from the fabric of medical care. Instead, fragmentation of the profession into specialties with niches of expertise evolved.3 In its wake, a disintegration of the long-term patient-doctor relationship began to materialize. At the same time, Dr. McWhinney was observing his patients, writing down his observations. He ascribed to organismic thinking, seeing disruptions in an organism’s stasis as resulting in illness.4 And in this vein, he saw the need for the integration of the technoscientific knowledge with the patient in their environment.
In this context, Dr. McWhinney embraced the key insight: “in times of increasing complexity, paradoxically, the role of the generalist becomes more important.”5 Let’s read that again. “In times of increased complexity, the role of the generalist becomes more important.”5 This insight, from decades ago, surely can’t apply today in 2023.
We have advanced so much more technologically. We have the EMR which tells us everything about the patient; we have tools like POCUS and now we have AI. We have to ask ourselves, what are these new technologies costing us when compared with the values and principles of family medicine?
In the context of specialization, Dr. McWhinney observed, documented, asked questions, and developed his ideas which culminated in his vision of family medicine as a distinct discipline with unique expertise and dedicated training in family practice by family physicians6. He saw the need to establish Family Medicine as an academic discipline and defined a discipline as having 4 specific elements7:
It must have:
- a unique field of action
- a defined body of knowledge
- an active area of research
- rigorous training
His concept, in retrospect, was radical, luminous and idealistic. In 1967, these discerning insights captivated the attention of the Dean of Medicine at Western, and the head of the Department of Epidemiology at Western, who recruited Dr. McWhinney as the First Chair of Family Medicine in Canada. “His visionary work transformed family medicine worldwide from an unacknowledged subject into an academic discipline with undergraduate courses”8, a defined residency with rigorous teaching, and graduate training of faculty through the Master of Clinical Science degree in Family Medicine.
To complete the framework, Dr. McWhinney, with his team at Western, created the Centre for Studies in Family Medicine – what would become the heart of research in Family Medicine, to this day.
When we think of giants, we think of superhuman size, strength, and power. Physically, Dr. Mcwhinney was not superhuman in size, but the size and impact of his vision has been far-reaching and colossal. The power of the elements that founded Family Medicine continue to support us in our daily visits with patients: the undistracted active presence, the commitment to the individual and their particulars, and the sacred space of the patient-family physician relationship that is unique to family medicine. In the history of medicine, Dr. McWhinney was the intellectual giant who forged the path that we now take as family physicians. He reminds us that in moments of chaos and complexity, returning to our discipline’s roots, can be healing for both us and for our patients.
Roots anchor, they help us survive winds of change and they provide nutrients for us to flourish. Dr. McWhinney’s teachings give us these roots. In his memoir, A Call to Heal, Dr. Mcwhinney wrote, “the greatest task for doctors is reconnecting medicine with its spiritual roots”9.
We celebrate this giant’s enormous influence and contributions here at Western, through this annual lecture series and the named hall. In the larger domain of medicine, for his innovation, leadership, and for his tireless efforts on behalf of Family Medicine, he has been honoured with an Order of Canada, and in 2006, was inducted into the Canadian Medical Hall of Fame, as shared in this brief video.
