Chris Pengilly: Let’s declare a family-practice emergency

 

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SEPTEMBER 28, 2017 12:27 AM

I read with interest the op-ed from Joanne Hamilton concerning her parents who are now “orphan patients.” The responses from Vanessa Hammond and Dr. Robin Saunders suggest solutions that offer a realistic and optimistic future. (“Physician shortage is now a crisis situation,” comment, Aug. 31; “Physician shortage doesn’t have to be a crisis,” comment, Sept. 5; “Victoria’s doctors strive to improve patient care,” comment, Sept. 19.)

The declaration of an “opioid emergency” enabled expedited remedial measures to be put into place. I suggest that a “family practice emergency” should be declared to enable similar accelerated interventions. The ideas of the Victoria Health Co-Op are very welcome, but will take time to institute. One of my late mother’s favourite expressions was: “While the grass is growing, the horse is starving.”

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.

She and I spent a long time trying to find physicians in the community to undertake the care of her sickest patients.

Unfortunately, family practice and/or Victoria were insufficient to retain one young female physician who had adopted several of my orphans, so they are re-orphaned.

One patient is a young woman who is wheelchair-bound with cerebral palsy. She does not let this hold her back in any way. She has a full-time job and is mother to two little girls whom she and her husband care for completely. She lives a full and active life, contributing to her community in many aspects.

She is diligent in maintaining her strength and health through regular exercise and physical therapy. Still, she is in desperate need of a family physician to assess and co-ordinate her multiple needs, which is essential to her ongoing quality of life.

The other patient who worries me is a youngster of about five years old who has a cancer of the kidney. This was detected early and he is doing well. He requires the sort of care that cannot be delivered in a fragmented form, as in an urgent-care clinic. Currently, he is being followed by a pediatrician, but this is not the appropriate role for that specialist, who then is delayed from seeing more urgent new referrals.

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.

I have already called in so many favours around town that my credence is exhausted.

We are not going to be able to get more physicians any time soon. It will take many years to graduate a significant number of practice-ready doctors.

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.

https://www.timescolonist.com/opinion/columnists/chris-pengilly-let-s-declare-a-family-practice-emergency-1.23047980