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PURPOSE There is little research exploring the experiences of family physicians caring for women who use illicit drugs. This study explores the experiences of these physicians in order to better understand the process of engaging these women in the patient-physician relationship. METHODSWe conducted a phenomenologic, qualitative study using individual, in-depth interviews with 10 family physicians working in inner-city Toronto and Ottawa, Ontario. An iterative and interpretive analysis was used.RESULTS Three broad themes emerged from the analysis. The predominant theme was that of the patient-physician relationship, which consisted of 2 phases: the engagement phase and the maintenance phase. During the engagement phase, issues such as access and women's experiences of trauma and violence were evident and impeded participants' ability to engage with this population. As such, the patient-physician relationship during the engagement phase was tenuous. Trust and presence were paramount during this phase. Once a family physician engaged a woman, the transition to the maintenance phase was made. Within the maintenance phase, 2 subthemes were identifi ed: continuity of care and "meeting people where they're at" (fi nding common ground). CONCLUSIONSThis study identifi ed a 2-phase process of the patient-physician relationship from the perspective of family physicians caring for women using illicit drugs: the engagement and maintenance phases. Our fi ndings identifi ed strategies to support the patient-physician relationship during each of these phases that have implications for improving the health of these women. Ann Fam Med 2011;9:244-249. doi:10.1370/afm.1225. INTRODUCTIONH aving a strong patient-physician relationship is good for one's health. Such a relationship may be especially important for marginalized women, such as those who use illicit drugs. Despite high use of emergency departments and walk-in clinics, 1-3 some studies have found marginalized women have low rates of outpatient visits and poor follow-up. [4][5][6] This pattern is contrary to that of women in the general population, who access the health care system more than men.7-9 Barriers these women face include spending time fi nding drugs, participation in sex work, homelessness, lack of health care coverage (eg, through loss of identifi cation), mental illness, lack of transportation, discrimination from health care clinicians, and distrust of the health care system. 4,[10][11][12][13][14][15][16][17] This lack of continuity is of particular concern given the high morbidity and mortality in this population. 11,15,17,[18][19][20][21][22][23] Just as a woman's health care needs are highest, her likelihood of accessing care is lowest.There is very little research studying the active role that family physicians can play in reducing the morbidity of women who use illicit drugs, particularly within the context of the patient-physician relationship. We speculate that higher rates of engagement in the patient-physician relationship will result in inc...

Background: Vicarious trauma is an understudied phenomenon among Canadian family physicians.Objective: This phenomenological study set out to explore the experiences of a group of inner-city family physicians caring for women using illicit drugs.Methods: Ten family physicians working in Toronto and Ottawa, Canada, participated in in-depth interviews. The data were analyzed using an iterative and interpretive process.Results: The first major theme emerging from the data analysis was the emotional impact of the work. Participants shared the challenges, sorrows, and joys they experienced as they struggled to care for their patients. The sub-themes identified were as follows: tragedy and death, difficult behaviors, and isolation from mainstream medical community. The second major theme identified was coping strategies. Participants were open, thoughtful, and eloquent as they reflected on the three primary coping strategies reported: adaptation and evolution of practice style, teamwork, and modification of expectations.Conclusions: Participants, narratives of loss, grief, and compassion were consistent with vicarious trauma and therefore participants risked developing compassion fatigue-a specific form of burnout.