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Three Ways to Shorten the Wait at your GP

In our first season of WCBA, we did a show about why you wait weeks to get an appointment with your family doctor. And if you manage to get an appointment, why you cool your heels in the waiting room while your GP runs further and further behind.

This week, WCBA travels across Canada to find meet three family physicians who have found three unique ways to improve efficiency and shorten the wait.

* Dr. Jeff Colp, a family doctor in Hatchet Lake, about 15 km south of Halifax, took the province up on a pilot program in which Colp hired Registered Nurse Patsy Smith to work in his office. The result: he sees 2-3 more patients per hour, takes home less paperwork, and takes better care of his patients.

* In Edmonton, Dr. Ernst Schuster, a leading family doctor in Alberta, got the bottlenecks out of his practice through an efficiency program run by the province. One big change? He's gotten rid of procrastination. When he sees a 50-year-old man with a sore toe, he maximizes the appointment by doing blood work as well as checking for common conditions like high blood pressure and diabetes.

* Meanwhile, in Fraser Lake, BC, Dr. John Pawlovich has found a way to clean out his waiting room. He sees up to 17 patients at one time and in one room. It's called shared or group medical visits. Think of it as group diabetes or group cholesterol.

Three different innovations with the same result. Each physician has seen wait lists drop to zero. Now, same day appointments are the rule, rather than the exception.

It's nice to know family doctors are finding ways to take better care of you.

Catch the show on Saturday at 10 am (1030 NT) and Monday at 1130 am (330 pm NT) on CBC Radio One.


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Previous Comments (11)

GROUP PASTORAL COUNSELING WORKED WELL
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Over the years--beginning in the 1960's--hundreds of people, from all over, came to a series of lectures and workshops, which I gave, regularly, on an integrated approach to total health. The lectures were under the general title PNEUMATOLOGY--study of the human spirit and its affect on the body and mind.

Also over the years, a number of doctors and nurses came to that series. I also lectured at the Donwoods Centre for Addictions.

In retirement I am still doing some counseling, but am now concentrating on writing on pneumatology--the mother of psychology.

At the time--in addition to mentioning it to my classes--at every opportunity I got, I especially urged all involved in the healing arts to consider practicing the kind of group approach to the practice of medicine as mentioned above.

I often asked individuals: Why don't you do group appointments with your patients--similar to what I am doing here with people who come to me for counseling?

Maybe the seeds that were sowed so many years ago are now beginning to germinate.

Rev. Lindsay G. King

RevLindsay King, November 7, 2009 1:18 AM

I'm wondering about privacy issues with the share/group medical visits idea. Feels like it could be a big issue. Do participants have to sign some kind of release?

Eric Snyder, November 7, 2009 10:46 AM

I have always appreciated Dr. Goldman's thoughtful radio shows, however, he really reveals that he has little experience with family practice.
I have been in a solo GP pracitice for 30 years and have explored the no wait idea etc.

This will work for group practices or a solo practice where the doctor is currently working what in Manitoba would be considered part time...ie 30 patients per day.

But the reality for a lot of us is far more patients per day due to the doctor shortage and the ridiculous waits in emergency departments.
As for the idea of group patient visits....Brian...you have gone over to the DARK /OPRAH SIDE.
Brian....if you had an STI or ED or substance abuse problem, would you really want to spill your problems in front of a bunch of your neighbours.
With crap like this you lose your cred with the rest of the profession.

JW MD, November 7, 2009 11:56 AM


I believe you attempted to reassure us by saying the chances of being killed by H1N1 were 1 in 250,000 if no vaccines were administered.

If my math is any good (and I am not sure it is) and if the numbers reported by The Current recently are right (and I do not know if they are right, or you are) this is too reassuring by more than a factor of 10. The Current reported: "without interventions such as a vaccine and antiviral medication, between 25 and 35 per cent of the Canadian population could become ill over a period of a few months." Assuming a minimal vaccination rate and a general refusal to use antiviral medication, for a population of about 30 million, a 25% rate of illness would generate about 7.5 million sick people. The Current continued: "Of the people who get the H1N1 virus, about 1 in 1,000 will become gravely ill and have to be hospitalized. Out of those, one in five will die." For 7.5 million sick people that would mean 7,500 gravely ill, and 1,500 dead in one season. Thus we arrive at about 1,500 dead in 30 million, which is a death rate of 1 in 20,000, which is more than 12 times worse than the one you reported -- a little less reassuring and not the least because of the uncertainty generated by the discrepancies.

Furthermore, if Australia (with a population perhaps two-thirds that of Canada) were like Canada in the relevant respects, and if Australians did not have the vaccine available for their flu season which ended before ours began (because the vaccine was not yet available – or was it?), then apart from the mitigating effect of antiviral medication (which we can suppose was available and used), something like 1,000 Australians should have died this season according to The Current's numbers above – i.e., about two-thirds of 1,500. But in a previous show you said something like 170 Australians were killed by H1N1 during the flu season down under.

If it turns out the vaccine was available for the Australian flu season, then we need to know what was its rate of use and if that is what kept the numbers down to about 170 dead, rather than about 1,000. If the vaccination was not available, may be it was the use of antiviral medication that drove the numbers down to about 170. But if that is the case, then the vaccine would not seem to be significantly more effective than the antiviral medications.

Or maybe the 170 number is right and a good predictor for Canada as well, in which case the The Current's numbers are too dire by about a factor of 9, and your reassurance is much closer to the mark.

What are the BEST estimates of H1N1 severity for Canada this flu season?

John, November 7, 2009 2:02 PM

At the top of your show this morning, I believe I heard the statistic that for every 250,000 cases of H1N1, there is only 1 death. Is this a national or global statistic? It would suggest that with 115 reported deaths in Canada as of Nov 5, 25 million Canadians have had H1N1. If that were the case, why spend another penny on vaccination?

Graham Vink, November 7, 2009 2:16 PM

There would be loss of privacy of course, and the patient would have to be willing to have the others know something about their health.

But think of it!!! No longer could physicians claim side effects of the cholesterol lowering drugs statins -- muscle pain and atrophy, memory loss, confusion and disorientation, insommnia, vision difficulties such as blurring, difficulty focussing, cataracts and bleeding, gall bladder, pancreatitis and helicobactor pylori ulcers -- are RARE among statin users. No longer will a physician's patients hear it's not possible for statins to do that. The physician can of course still claim it's "not in the literature", because it won't be, in the detailers brochures of pharma authored CMEs.

riv, November 8, 2009 2:08 PM

* Meanwhile, in Fraser Lake, BC, Dr. John Pawlovich has found a way to clean out his waiting room. He sees up to 17 patients at one time and in one room. It's called shared or group medical visits. Think of it as group diabetes or group cholesterol.*

There would be loss of privacy of course, and the patient would have to be willing to have the others know something about their health.

But think of it!!! No longer could physicians claim side effects of the cholesterol lowering drugs statins -- muscle pain and atrophy, memory loss, confusion and disorientation, insomnia, vision difficulties such as blurring, difficulty focusing, cataracts and bleeding, gall bladder, pancreatitis and helicobactor pylori ulcers -- are RARE among statin users. No longer will a physician's patients hear it's not possible for statins to do that when the 17 can compare notes.

The physician can of course still claim it's "not in the literature", because it won't be, in the detailer's brochures or pharma authored CMEs.

riv, November 8, 2009 2:13 PM

I loved this episode. The more creative ways we can come up with to deal with the current situation the better. If patients can get better care and physicians can get home in time to have dinner with their kids, that's even better. I did have one question though. If Dr. Colp was finding the fee-for-service system difficult why didn't he go on salary?

Heather Maxwell, November 8, 2009 6:28 PM

In conversation recently with a nurse, I learned the way these group sessions work is more like an education session (guess who wrote the curricula) led by a nurse. There may be a few limited questions allowed, but sharing among patients would be limited, curtailed or not allowed.

So. The point? Again?

riv, November 9, 2009 12:03 PM

I can't beliewe what I was hearing in this episode. "Group consultation as a method to "Clean Up" my waiting list?!!!!" What next? Blanket prescriptions for all invloved?
I may not hold a post secondary education or a BSc. However, I certainly don't need one to state that after all the money I contribute either through taxes or user fees that this is the avenue being pursued by the Health Sciences for better quality care.
How about starting to eliminate some of the reduntant if not repugnant layer of executive bureauacracy?
The other thing that we all need to realize is that a large part of our society (the Baby Boomers) has reached the age where they are requiring more medical attention more often. They also want to have access to the latest advances in medical tech. which was never available to their predissesors.
This all comes at a cost, either financially or in increased waiting times.
I, for one, will certainly not be willing to participate in any group sessions for medical care anytime soon.

G Grando, November 9, 2009 3:38 PM

"then apart from the mitigating effect of antiviral medication (which we can suppose was available and used),"

It was not available anywhere in the world until Sept and Oct of 2009. Australia and New Zealand et al went through their winter, the H1N1 flu, with NO vaccines, and 17 deaths instead of the thousands predicted.

riv, November 10, 2009 2:33 PM
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