Re: “Doctor-shortage solutions elusive,” letter, Sept. 9.
I agree with the comments from Dr. Brian Pound that the family-physician shortage is not looming, but has been with us for some time — as I know when I found it impossible to give my practice away, let alone sell it, three or so years ago.
The current situation is not acceptable.
That is to say, a physician sits in a walk-in clinic for four hours, in which time he/she is expected to see and treat 50 patients (and sometimes up to 65). This works out to four minutes and 50 seconds for each patient, not allowing for bathroom breaks.
In that time, a history of the problem needs to be taken, as well as any relevant background information, including a list of medications. Then a relevant examination needs to be undertaken.
The diagnosis should be decided and explained to the patient. Some form of treatment or investigation is then instituted. Finally, the physician will have to make a detailed record of the visit.
This is just not possible. It is not fair to the physician or the patient. Nor is it fair to the taxpayer, in that this kind of rapid medicine is fiscally grossly inefficient.
This could work with a five-minute appointment for the doctor if he/she were provided with the necessary support.
The first would be a receptionist to greet the patient and take the pertinent information — name, address, healthcare number, etc.
The next step should be a nurse, nurse practitioner or physician assistant. These are specially trained personnel who will undertake triage. They could take the history of the illness that brings the patient to the clinic and important background history. Vital signs (temperature, blood pressure, pulse, height and weight) could be taken.
Any initial investigations could be done by this team member. For example, urine testing and pregnancy testing. The patient could be helped at this juncture to prepare for an examination, if the history suggested one is likely to be needed.
When the patient reaches the physician, the problem could be dealt with promptly. The story might need to be expanded and the physical exam undertaken.
The physician could then give a prescription or a requisition for any proposed investigations. This latter form could be completed by a member of the support staff.
An in-house pharmacist, pre-and post visit, would be invaluable to explain the medications and to check the list of medications for possible harmful interactions.
The pharmacist could also ensure that the patient’s immunizations are up-to-date, with special reference to flu and pneumonia.
Finally, there should be a stenography service so the physician could rapidly dictate a record in appropriate and safe detail.
Under the current scheme, all these extra helpers would be paid for by the physician from his/her fees. In order to pay a living wage to the support team, the physician would literally be paying to come to work.
This utopia would be expensive in the short term, but in the long term good value for money. The current 50 patients in four hours simply offers a Band-Aid — potentially harmful to the patient, and likely prolonging disability, and professionally frustrating to the doctor.
I agree there is a shortage of family physicians — but we could ease the current situation by using these highly and expensively trained professionals, who are available, to much better advantage.
Dr. Chris Pengilly was a physician at Tuscany Medical Clinic.
