Local medical student heartened by job-shadow experience

This summer, I had the privilege of being part of a research study on collaborative care to better understand complex patient needs in primary care. I had the opportunity to job-shadow Dr. James MacKillop and his team in Sydney, through which I gained a better appreciation of the Cape Breton community and gaps in community resources.

The Sydney collaborative practice includes physicians, a nurse practitioner, a family practice nurse, a social worker, a dietitian and the administrative team. There is also a licensed practical nurse on site. The collaborative care model is a movement to enhance patient-centered care by optimizing the use of health-care workers to ensure patients have access to the right providers at the right time.

Common barriers for complex needs of patients include lack of time and fragmented care. The collaborative care model can address, and ideally overcome, these barriers. Health-care providers in the Sydney practice mentioned the lack of hierarchy, a collegial environment, and the ability to work together as highlights of the collaborative care model.

An advantage to the collaborative care model is having an interprofessional team including social workers and nurse practioners. The nurse practitioner’s role is to assess, diagnose and manage common acute or chronic conditions. While some patients are familiar with the role of a nurse practitioner, for others, being seen by a nurse practitioner was a new experience. One patient noted that he was very pleased to see a move to include more nurse practitioners in primary care as it is filling a large gap for Cape Bretoners.

As part of the research study, a question I asked the team was, “What is something that keeps you up at night?”

One physician replied that there are a lot of individuals in our community who are experiencing caregiver burden. It can be very difficult for caregivers if they are unable to manage their loved ones’ health condition. Caregivers need resources to help manage and cope, but often there are not enough community supports available. Caregiver burden and chronic disease management are key issues for the Cape Breton community, which is largely an ageing population. Some patient encounters I saw included discussion on long-term plans, including looking into long-term facilities. Furthermore, as highlighted by the social worker, Nova Scotia is behind in ensuring that all patients have personal directives and a living will in place and on file in their medical records.

Other barriers included lack of access to transportation, in large part due to limited public transportation available in Cape Breton. This prevents many patients from attending appointments. Another major barrier is the gap in mental health services, with wait lists up to a year. In light of this, many members of the collaborative practice, such as the nurse practitioner and social worker, will follow up and manage patients while they wait for mental health services. Limited resources in Cape Breton was a major theme in the discussion of challenges faced by patients.

There is a lot of work to be done to improve access to health care and community resources in Cape Breton. However, I am heartened by my experience this summer - it is inspiring to see so many incredible health care professionals and researchers working together to provide better care for our community. I am grateful to the teams, and to the patients I had the privilege of meeting, for deepening my understanding of the Cape Breton community and inspiring hope for its future direction.

Ashna Asim

Sydney

(third-year medical student at Queen’s University)