September 28, 2017
Excerpt: I am particularly sensitive to the subject of orphan patients at the moment because I retired from family practice early in 2015. After great difficulty, I found a physician to continue the care of my patients, but because of a serious medical condition she was unable to continue.
I have approached several colleagues asking them to adopt these patients, but they really are full. They think, quite appropriately, it would be unsafe to take on more than their current patient (over)load.
What we need to do now is to make the current physicians more productive, and less burdened by unnecessary paperwork and bureaucracy — until the community health centres are up and going.
These suggestions could begin to be effective by the end of this year:
• Provide each physician with a typist service, as has long been provided to hospital physicians.
• Compensate family physicians a quarter of an office-visit fee for the responsibility and time involved in repeating prescriptions of their own patients; these are more safely prescribed by the family physician who has access to the medical record, and not infrequently the patient might not need to come to the office.
• Encourage physicians to form groups of four or more doctors (which are proven to be more effective and more efficient) by offering a one-time grant to cover the cost of amalgamating and moving offices.
• Integrate and co-ordinate public-health nurses to work in close liaison within group practices.
• Eliminate, or at least simplify, the form-filling needed for a patient to access “special authority drugs.”
It will not be cheap — but it will be less expensive than graduating more and more physicians who might even then fail to embrace family practice. Most family physicians want to reduce the number of “orphans,” and they can do it if bureaucratic barriers are smoothed out, and out-of-date patterns of practice and remuneration are energetically reviewed.
Chris Pengilly, formerly of Tuscany Medical Clinic, is a part-time family physician.
Click on: Chris Pengilly: Let’s declare a family-practice emergency to access the article