Monday, November 25, 2019

Farewell to Close-ups

- Caroline Wellbery, MD

Next week we will be publishing AFP’s last Close-ups, a feature that launched in 2007 to give our patients a space to share their illness experiences. We have heard from countless patients about experiences with needle phobia, paradoxical insomnia, pregnancy loss and healthy aging. Patients have written about personal triumphs such as losing weight or surviving cancer, as well as about health-related setbacks such as disability and depression.

At the same time, the family physician has played a key role in these vignettes. Patients have used Close-ups as a forum for thanking their doctors for their diagnostic acumen and their support, and for celebrating long-standing relationships that that contributed to their health and well-being. In one Close-ups, a patient welcomed her doctor to her house to teach him how to can vegetables; in another, a one-time rock-and-roller patient described recording a CD with his doctor. Close-ups has been a little like a family medicine practice, with patients sharing stories in the waiting room, the examining room and in their communities.

It has been wonderful to publish a feature profiling patients. Patient engagement is a potentially powerful tool in research and education. Patient stakeholder participation ensures that those who are both most vulnerable and most directly affected by illness are given a voice in clinical decision-making. We believe that Close-ups has meaningfully contributed to these efforts.

However, research still has a long way to go in assessing the impact of patient involvement in the medical team; even understanding patient priorities in the context of primary care physician practices has not been fully elucidated. Perhaps hardest of all is finding ways of coordinating patient participation given family physicians’ busy schedules and patients’ separate lives outside the clinic.

Some of these obstacles have applied to running Close-ups as well. As much as we’ve wanted to hear directly from patients, it has been challenging at times for our family physician contributors to organize interviews, obtain publication permissions and make sure that the story follows a consistent format. Maybe that is why few medical journals have been able to make space for patients to speak directly to peers and physician readers.

We want to give special thanks to our three long-term Close-ups facilitators – Dr. Jo Marie-Reilly, Dr. Amy Crawford-Faucher, and Dr. Sanaz Majd – for helping to keep up a steady flow of material during the dozen years since the feature began.

Finally, our deepest gratitude goes to our patients for taking the time to tell their stories and their family physicians for transcribing and submitting them. The many patients and their physicians who have contributed to Close-ups are a testament to the strong bonds family physicians have with their patients. Recently, one of our readers sent in her patient’s story: a man with end-stage renal disease who agonized in silence about how his wife would manage after he died. Until his doctor brought the couple in for counseling, he hadn’t talked to his wife about his fears, and in order to avoid the issue even skipped his dialysis. With his doctor’s support, he was able to take the practical steps he needed to face his illness, and, having received a kidney transplant, is celebrating 25 years of marriage.

With the closure of Close-ups, we make room for new features in AFP. But the relationships and connections between family physicians and their patients will continue to be the greatest reward and the driving force of our discipline.


Dr. Wellbery is Associate Deputy Editor of AFP. "A Devoted Couple," a Close-Ups about her late parents' remarkably similar final illnesses, appeared in the December 1 issue.