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Dr. Chris Pengilly: B.C. primary health care needs a new model

Under our health-care system, as it is at the moment, I do not think Canada could ever graduate enough family physicians to fill the need. When I first came to Victoria in 1978, I was young and energetic. I would leave home at about 7 a.m.

Under our health-care system, as it is at the moment, I do not think Canada could ever graduate enough family physicians to fill the need.

When I first came to Victoria in 1978, I was young and energetic. I would leave home at about 7 a.m. and go to one or even two hospitals to see patients before going to the office at about 9 a.m.

During the day I would take time to go to the operating room to assist at surgery for my patients. Not infrequently, I would have to leave the office to deal with maternity cases.

After hours I would be on a call system of about four physicians, and this was a busy time requiring either visits to the emergency department to see the patient or night house-calls. Walk-in clinics did not exist.

My half day out of the office was spent, not in my vegetable garden, but in the nursing homes or visiting shut-ins in their homes.

In 2016, things have changed, and some of it for the better. Because of the increasing seriousness and complexity of hospitalized patients, Island Health now employs 70 or so primary-care physicians (many who were formerly full-service family physicians) who work full-time in the hospital, doing a better job of the work formerly done by family physicians on their way to the office.

There are now trained primary-care physicians employed full time as assistants in the operating room.

Nursing homes have full-time resident primary-care physicians.

The last few family physicians standing are inundated with non-clinical work.

For many years, I have had the privilege of professionally meeting family physicians throughout the province. Most are trying hard to do a good job, but are feeling discouraged by their failure to fulfil the needs of their patients and their community.

Many feel the amount of pointless, repetitive, unproductive form-filling demanded of family physicians is unreasonable. These come from insurance companies, lawyers, Pharmacare, Canada Pension Plans, provincial assistance programs, WorkSafe B.C., Insurance Corp. of B.C. and more — many more.

The result is that many family physicians are fully occupied in the office five or more days of the week, but will be seeing and treating patients for only three or four of those days.

The well-intentioned program A GP for Me has failed to reach its goal, but was not a complete loss. It did take a tentative step toward recognizing the value of telephone consultations.

One suggestion to increase the efficiency of the community-based family physicians will be to offer free typing for medical transcription, as has been provided for many years to all hospital-based doctors.

With the introduction of the electronic medical record, this can easily be arranged.

Assuming regular family physicians see about 30 patients in a day, the cost will be less than $1,000 a month per doctor. If all 6,000 B.C. family physicians were to use the service. the total cost will come to no more than $72 million a year — about half the cost of the A GP for Me program.

Dictating satisfactory medical records for 30 patients will save each physician at least half an hour every working day. That would mean that a total of 3,000 hours each day will be saved in which family physicians could see more patients.

Until dedicated clinics are built where a wholehearted team approach to delivery of medical care is practised, nurses could be provided to existing groups of family doctors. I have seen this working and working very well. It is a case of one plus one equals three.

It is my observation that the physicians, their support staff and the patients are very satisfied with this team approach to medical care.

I personally am very frustrated. About 20 years ago, a large space became free within my medical building. I and three senior colleagues consulted a health-planning specialist for a multidisciplinary clinic in the vacated space. A meeting with the health authority to present our completed proposal was cancelled at the last minute because we were told “we are not ready yet.”

Are “we” ready now? The patients of B.C. are ready for a new model. Many physicians, especially the younger ones, are ready.

 

Chris Pengilly of Saanich is a semi-retired family physician.