Reaction to Re-inventing Family Medicine
Time pressure is the norm at many a GP’s office these days. If you’re like many patients, you’ve had the unfortunate experience of calling to see the doctor, only to find that the next available appointment is two, three, or even four or five weeks again. Check-ups are in a different category altogether. Some family doctors report that they’re booking annual physicals three months in advance. For those physicians, if you need to see the doctor today, try a walk-in clinic or ER instead.
And when you finally do get an appointment, the wait doesn’t stop there. Patients seem to be crammed into impossibly tight ten-minute windows. That’s a schedule most MDs find very hard to stick to. That means you spend extra time in the waiting room as your doctor gets further and further behind.
Lucie Desbiens writes:
“Listening to Dr. Goldman's broadcast on waiting to see the doctor on Sat. Nov. 7th, made me yearn for my old family doctor of 28 years, who retired 4 years ago. I was able to see him most times the same day, after office hours or the next day for me or my children. Now with a new young doctor, I am told to get used to the "new culture" of medicine. Our family had to be "approved" by this newly graduated M.D. before becoming a patient, and since we were healthy, she took us on. She turned away many friends who were ill at the time of her interview. My family's efforts to make appointments with her are very frustrating at times with no appointments being taken for 2 weeks and to call back to be told our appointment will be in 3 to 4 weeks. If we are 5 minutes late, our app. is cancelled. With cases such as ear infections and strep throat, we spent many hours in the local hospital ER. After trying to see her for over one year, I finally got in, to be met by a replacement doctor that day since she had taken the day off.”
This week, WCBA featured three family physicians who adopted three different strategies with the same goal in mind: increase the number of same day appointments and zero the wait time at reception.
We had a lot of reaction to our interview with Dr. John Pawlovich, a family physician from Fraser Lake, BC. His solution to long waits is to see up to 17 patients at a time in a Group or Shared Medical Visit. In case you missed it, listen to this week's podcast.
Diane Dawber of Toronto writes:
“Group appointments are an interesting idea. Back up a step and think of group meetings to do what you can for yourself (diet, nutrition, environment and exercise) before you take up the doctor's time. Our group (mostly disabled teachers, nurses, etc.) has been meeting for the past 14 years. We have done extensive research (reading and trying out what we read) into what we can do for ourselves and, in the process, improving many chronic conditions. In fact, the University of Toronto Medical School in conjunction with the Environmental Health Clinic at Women’s College Hospital studied us last year. It found that the Health Pursuits Reading/Study Group is the only model of a support group in the medical literature that actually helps people, with Fibromyalgia, Chronic Fatigue Syndrome and Multiple Chemical Sensitivities, improve health. Since these are time-consuming cases for doctors, we think we have something that will help reduce the doctors' loads and system costs. Because these are multifactorial problems, we have developed tools to help people discover how to individualize their diet, nutrition, and environment. We are working on exercise and movement tools now.”
Arleen Simmonds of Kamloops, BC sent us this:
“Just look on the Internet and see how many support/discussion groups there are from everything to cancer to anxiety. The members of these groups discuss and support one another in all the illnesses plus the social, relationship and other spin off issues. I think the medical profession might just be catching on to what patients have been doing for themselves in their isolation from that all round care we used to experience years ago. And they'll make money too you say? Just one woman's opinion.”
A number of you focused on the money aspect of group medical visits. Ken Weatherill of Delta, BC made this observation:
“I think the group sessions are just a cash grab with the physician looking for ways to increase per patient billings. If a family physician has a hard time remembering all of his/ her patients now, imagine being able to see dozens more. I believe physicians (like pilots, truck drivers, etc) should have a limit to the number of patient visits they can reasonably and healthily attend to in a year. I think they should be fairly compensated for that but should not be put in a position where they have to increase patients to make more money. Would your physician entertain group sessions if, as a full time physician, he were capped at, say, 2500 patients and $500,000 per year?”
But most of all, you loved the idea that GPs aren’t just complaining, but are finding ways to make the system work better for them and for you. Wendy Bradley of Vancouver writes:
“Doctor & Nurse Partnerships: Love it. Group appointments: Love it. These are brilliant ideas, doctors, & show. We need all hands on deck to figure out how to make our sick health care system well, and that means doctors, nurses, bureaucrats, and patients – working collaboratively. It's not brain surgery, and it's actually fun! Come on, Canada! Keep the innovative ideas coming, and help the good ones take root!”
Couldn’t have said it better myself.
Thanks, as always, for letting us know how you feel.
Categories: Past Episodes
Previous Comments (3)
I was surprised that you were surprised that working with a nurse in family practice would improve volume and quality of care. Family Practice Nursing is not new and many family physicians in Ontario and across the country do work with nurses in their clinics and offices. Good for Nova Scotia to pilot every family physician working with one. I look forward to their research results, In Ontario, Family Practice Nurses have an interest group of the Registered Nurses of Ontario if anyone wants to learn more about this very important primary health care provider. From a former Family Practice Nurse from London Ontario, currently a Nurse Practitioner.Joan Mitchell , November 13, 2009 10:12 PM
I recently listed to a whole round of WCBA Podcasts including the Oct 3rd edition about Orphan Patients, and the Nov 7th edition on reinventing family practice. I love the ways these doctors are finding to take charge and make a difference rather than expecting the Province to do something then complaining about the solution the politicos come up with.
I have a great doc, whom I can usually see within a week of calling for an appointment. But I would happily take my concerns to a nurse working in his office if that was an option. I always took my now 2 year old son to our doc rather than the public health nurse for well baby checks and vaccinations because I was concerned that issues I raised with the health nurse would never get back to my Doc. If I could see a nurse in our doc's office who could do our basic history taking, vaccinations etc, and save the doc some time in the process I would be happy to do so, knowing that issues would be documented in one chart and issues could be forwarded to the doctor promptly!
I wait with baited breath to hear about the research results on the family doc + nurse program in Nova Scotia. Maybe this brilliant idea will spread, and help good docs get more done for their patients and run a thriving practice to boot!Meagan, December 2, 2009 2:49 AM
My daughter became ill prior to the labour day weekend and since no available appointments with our family doctor I saw the nurse practitioner.
Turned out to be an ear infection, she has a history of them , we rec'd antibiotics and she rebounded quickly-OK for first day of school. I'm thankful for this option since I dislike walk in clinics. No need to wait for the research results from Nova Scotia-I agree it's a brillant idea and glad our family practice has adopted it
It's a win for everyone!!!!!
Medical history/records are current
Followup appts scheduled
Offers doctors flexibility & ability to expand practice