Repeated surveys have shown that the No. 1 item Canadians take pride in is our health-care system. Overall, Canada scores well in international comparisons of usual health-care outcomes with other developed countries. By contrast, Canada’s provision of primary care falls very significantly below most of these countries.
This seems opposite to the optimistic tone expressed in recent Times Colonist articles that detailed proposed improvements in availability of CT scans, wait times for hip replacements, etc. (“B.C. has right approach to better medicare,” comment, April 5). The elephant in the room in those articles and other pronouncements from the Ministry of Health is the dire shortage of family practitioners in this province and in Victoria in particular.
Suppose I am 75 with severe hip arthritis. I need anti-inflammatory medication and painkillers. My GP just retired, and her practice folded for want of a replacement, a common situation in Victoria.
I go onto Island Health’s website and click on “How to find an FP in Victoria.” I am then informed that: “No FP are accepting new patients in the Victoria area.” No explanation. No assurance that the situation (which has been unchanged for years) is expected to improve.
I know that I can’t make a prearranged appointment at a walk-in clinic, so I take a taxi to the nearest one and arrive at 11:30 a.m. A notice is pinned on the door: “Closed today” (due to patient volumes). I am upset. The receptionist tells me that there is another walk-in clinic five minutes’ walk away.
For me this is a painful 15-minute walk. When I get there, an identical sign is on the door. Would anyone in the Ministry of Health or Island Health advise me what I should now do? This type of situation must be frequent because as many as 30 per cent of Victorians don’t have a family practitioner, and I saw two simultaneously closed walk-in clinics in the Hillside-Shelbourne area last week.
The advantages of having an FP are major and have been documented repeatedly in scientific studies. Having an FP reduces all-cause mortality, heart disease, hospitalization rates and emergency-room visits, and improves cancer-detection rates, and diabetic and blood-pressure control. Having provider continuity (same doctor) improves these numbers further.
Canada is far below the Organization for Economic Co-operation and Development averages in same/next day access to an FP, and in patient-satisfaction scores. Canadians use more emergency-room visits for non-urgent problems than most other OECD countries.
All of the above demonstrates widespread and severe patient suffering as a result of inadequate primary care in Victoria.
Elections come and go but this crisis is on no one’s political platform. The media are strangely quiet on this topic, and those health-care organizations whose mandate is to ensure adequate standards of care remain deafeningly silent. Far greater attention is given to the overpopulation of deer in Victoria and the new bridge than our very substandard primary care that undoubtedly shortens lives and causes unnecessary suffering.
Having worked closely with government for years to ensure adequate treatment for my dialysis patients, I can think of one possible excuse for this issue failing to receive the attention it deserves. Government health officials’ antennae start vibrating wildly when you can assure them that if they do such-and-such, they will save money in the long term.
It seems obvious that if one can reduce mortality, morbidity, unnecessary ER visits and hospitalizations by expanding the number of family practitioners, considerable savings would result, a no-brainer. But this has proven to be extraordinarily difficult to prove.
Some studies show a positive cost benefit, but others don’t. The reason for this discrepancy is the difficulty in collating the huge number of variables to compare one system with the other.
For example: Patient X has a bad heart. Because he has no FP, he is more likely to die. Suppose the government expands primary-care facilities (costing money). Patient X now has a reduced chance of dying. But if he died at home with no FP, he’d have saved the government money. There are no health costs for a corpse.
This example shows the near impossibility of being able to demonstrate scientifically a cost benefit to expanding primary care. And besides, how can a dollar value be given to pain, suffering, anxiety and death?
Other countries have proven expertise in delivering far better primary care than we do. Many of these models are available to study. One of the best of these is multi-discipline clinics (groups of physicians, nurse practitioners, pharmacists, electronic records, etc.). It is up to the custodians of the No. 1 item that our tax dollars support to step up to the plate, acknowledge the problem and start to solve it.
Only three of a group of 24 recently graduated doctors intend to go into family practice, a record low. The current model of primary care in B.C. does not work. It is unacceptable.
Dr. Adrian Fine lives in Victoria.
