Family medicine: Front line of the front line
Hamilton’s primary care doctors determined to protect patients in the ‘new normal’
The COVID-19 response is shifting from hospitals and emergency rooms to our community, where monitoring and testing is the priority to prevent new waves of illness.
As family doctors in Hamilton, we want you to know that primary care and public health are leading the effort in the community — just as they have since the shutdown began.
In mid-March, as Onta- rio shut down and hospi- tals built capacity to ab- sorb a surge, those in primary care and public health turned to a crisis plan three years in the making, drafted with our partners in local hospitals, long-term care, social services, the city and McMaster University.
Many of us, as well as Dr. Tamar Packer, chief of family medicine at the hospitals, co-ordinated the primary care response with the City of Hamilton. Dozens of family doctors began performing the COVID-19 assessments at the East End Assessment Centre. By late April, the Hamilton Family Health Team and the McMaster Family Health Team were running a new drive-thru testing centre at the Dave Andreychuk Mountain Arena in collaboration with the city and Public Health.
Eight family physicians provided backup crisis support to the doctors in nursing homes and other institutionalized settings. The research chair of the McMaster’s Department of Family Medicine, family doctor Dr. Dee Mangin, developed a website providing the latest research and practical support to doctors and patients. Primary care worked together with epidemiologists in Hamilton’s department of public health.
Hamilton has experienced fewer COVID-19 deaths and hospital ICU admissions relative to Ontario communities of similar or greater size.
Community health care, especially in nursing homes, can take much of the credit for this, and people like Dr. Doug Sider, a public health physician and epidemiologist in Hamilton, are calling for a new strategy that puts more resources into primary care as Ontario implements reopening.
If there is a second wave of COVID-19, primary care can and should play a large role in helping our community deal with the pandemic. A necessary resource for front line primary care workers, such as family physicians, nurses and community health service providers, will be a dependable supply of personal protective equipment. Ontario West has recently secured a large supply of this equipment and it is being distributed to the front lines.
We believe local co-operation kept people out of hospital, and plan to build on our unique partnership with public health going forward.
We had tremendous success in Hamilton because of the co-operative relationship between primary care, public health and the hospital and home care sectors. A major reason we haven’t been Italy, is we were able to deploy all these resources in the community to stop hospitals from being overwhelmed.
Family practices will be critical in detection and containment of COVID-19 as Ontario reopens, with a secret weapon of history with our patients in the community. We really know the most vulnerable people and their circumstances, and many family doctors have been keeping close tabs on their “worry list” of vulnerable patients through phone calls and house calls. We are also able to provide support and care for the loss and stress COVID has caused our patients — the demand for mental health care has increased substantially.
Family physicians are the new front line of the front line.
Premier Doug Ford announced nobody will be refused a test. At Hamilton’s assessment centres supported by family physicians, no referral is required and patients can book appointments to avoid lining up. Since the premier’s announcement, we’ve seen the numbers climb.
Most of us — whether family doctors, nurses, personal support workers or other health professionals — are pinning hopes on testing and containment as we await a vaccine or treatment. However, we are now seeing a flood of concerned but ultimately well people at assessment centres, which may result in longer waits for test results should laboratories become overwhelmed. Our challenge is to quickly diagnose patients, even while reassuring the anxious who may have been in contact with them. Ultimately, our community is safest with everyone playing their part to maintain hand hygiene, physically distance and wear a mask when physical distance is not possible. Testing works best when we are able to test the most vulnerable for the appropriate reasons.
In the days ahead, we are determined to protect patients in a new normal that is often bizarre and even frightening. As the province takes steps to reopen, we will take every possible step to guard the public’s health. Indeed, as health professionals, that must be our top priority. Dr. David Price is chair of the department of family medicine at McMaster, and an adviser to the province on primary care response to COVID-19. Family doctors Cathy Risdon and Scott Wooder have been leaders in the city’s primary care response.