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A telephone call during a duty evening in a doctor's sitting room in Stockton-on-Tees in January 1970 was usually a request for a home visit. But this call was from a general practitioner in Ontario inquiring about a six month exchange of practices. Eleven weeks later, we had swapped jobs and, with the support of home based wives, had exchanged cars, children's school places, and pre-booked holidays. Trusted accountants equated the finances. This event gave us a vision of our futures, the ways we wished our practices to progress, and led to lifelong friendship.
Practising in “renovated” old buildings in Stockton and a converted house in Canada showed that expansion of premises was vital for teamwork, teaching, and research: both practices now have modern, purpose-built premises. The British doctor realised that the Canadian system of having an individual list of patients, albeit within a group of four doctors, was fundamental to continuing personal care: on his return, the British practice was divided into five. The Canadian GP appreciated that capitation payment encouraged and facilitated team care: his practice became one of the first to be “capitation funded” in Ontario. From the team, the British doctor sorely missed the midwife (particularly at deliveries); the Canadian doctor soon appreciated her role. She has now usurped GP maternity care—in urban Canada it has become increasingly specialist orientated.
Visits to the McMaster University nurse practitioner programme showed nurses' potential in the team: nurses' roles have expanded in UK practices, but, paradoxically, this is still uncommon in Ontario.
Repetitive doctor “checks” of babies indicated a need to share care with health visitors—not part of the practice team in Canada but common in the UK. The British doctor was appalled by the frequency and futility of “well physicals”: the Canadian doctor was delighted not to do any, although feeling that some would be of value. Nurse-run “well person clinics” are now essential in British general practice. Despite all the health checks, the obesity epidemic was well advanced in Canada in 1970 and is now widespread in both countries. The Canadian tolerated the futility of many house calls, and the British doctor realised that, with increasing ownership of telephones and cars, they would almost cease. The British doctor visited his hospitalised patients but was unconvinced of the value. There seemed little future for this in Britain—in Canada it has reduced. The Canadian doctor despaired of trivial British consultations merely to certify inability to work—now reduced.
The British doctor rapidly realised that he had been “on a pedestal” in the UK: he was summarily knocked off it by his Canadian patients. He realised that a shared, problem-centred approach would be the future and that patients would increasingly question, debate, and occasionally litigate.
Using each other's place of work, and homes, has been followed by sharing lives. We have watched each other's careers and now those of our children. The British doctor treasures memories of friendly Canadians, of Niagara Falls by day and night, of unspoilt nature around the Great Lakes, and of burgeoning cities. The Canadian remembers afternoon tea and cream cakes, “the boys” playing cricket, northern moors and dales, the south Devon coast, the Highlands, the Ring of Kerry.
Now retired, we have trekked together in Britain and portaged in northern Ontario; lunched in Pisa's Campo dei Miracoli, marvelled as the sun set on the mosaics of Orvieto's Duomo, heard aghast of the 11 September atrocity in the shadow of Giotto's campanile in Florence, drunk Chateauneuf du Pape in that very town, gazed at Gaudi's work in Barcelona ... we are enjoying old age. One day there will be memorial benches in Swaledale and beside Lake Neighick in northern Ontario.