At their best, family physicians in Canada stand as critical frontline defenders for vulnerable patient populations. In a recent study titled, “You are the only other person in the world that knows that about me: Family physician stories of proximity to patients experiencing social inequity,” 20 Ontario-based family physicians shared their experiences and relationships with patients who were struggling with issues such as inadequate housing, lack of education, low income, and substance abuse. 

Monica Molinaro, a professor at the Institute of Health Sciences at McGill, investigated in this paper how family physicians navigate the challenges associated with providing care to patients facing social inequities. She also examined how sharing narratives from physicians may act as a form of support and resistance for other healthcare workers. Molinaro’s research specifically focuses on the implications of moral distress resulting from provincial policies, which have numerous effects on the healthcare system and the well-being of staff. 

In her work, proximity emerged as an important factor in family medicine when extending care beyond the conventional boundaries of medical practice. 

“The notion of proximity was originally conceptualized by nursing scholar Ruth Malone,” Molinaro explained in an interview with The Tribune. “Proximity comprises physical, narrative, and moral elements. Physical proximity involves being close to the patient and addressing their bodily needs. Narrative proximity entails understanding the patient as a human being. Over time, nurses transition to moral proximity, where they feel compelled to care for the patient based on shared values and beliefs about providing good care.” 

In Molinaro’s study, physicians encountered challenges related to physical proximity, which involved assisting patients in reconnecting with their bodies, especially those who had undergone medical trauma. Assistance included activities such as taking their blood pressure and temperature, helping patients to re-engage with their physical well-being through guidance and support. 

Proximity in all forms, including narrative and moral proximity, serves as a form of resistance within family medicine. Physicians often find themselves motivated by moral proximity to go “above and beyond” their traditional roles. 

Family physicians sometimes care for patients their entire lives, developing a high level of narrative proximity in particular. Through this care, they build trust over time and often feel compelled to take various actions, such as extending appointment times, to provide additional care to meet their needs. 

The research emphasizes the moral distress experienced by physicians when they recognize the broader social systems that prevent them from fulfilling their patients’ needs. 

“What is so morally distressing, is that they know what their patients need, but they can’t provide the care,” Molinaro said. “If a patient has issues with insomnia, due to chronic stress of racism, or colonialism, or sleeping rough in a shelter, there’s only so much a family physician can do within the scope of that in order to help.” 

Addressing the chronic underfunding of clinics in Ontario and across Canada is essential for improving healthcare access for patients and alleviating the moral distress that healthcare workers experience. Family medicine and primary care are among the few freely available resources to many Canadians. This means that for many patients experiencing different forms of social inequity their family doctor could be the only professional who might be able to get them access to potential healthcare services. 

“It is important to critique the structures because there are direct links between the way physicians are functioning and the way things are funded or the way policies are written or the way things are conceptualized,” Molinaro explained.

Molinaro’s research highlights the connection between moral distress and these broader systems and structures, along with the chronic underfunding of social welfare systems in Ontario. By examining these systems, Molinaro shows the need to develop new policies and practices, improving the future of healthcare in Ontario.