Fam­ily doc­tors a cru­cial part of a car­ing team

The Western Star - - EDITORIAL - BY MAU­REEN MENNIE Mau­reen Mennie writes from Cor­ner Brook.

I have read re­cent com­ments made in the me­dia by our health min­is­ter about us­ing nurse prac­ti­tion­ers to per­form many of the du­ties done by fam­ily doc­tors.

I’m not sure whether he’s giv­ing nurse prac­ti­tion­ers a small com­pli­ment for be­ing com­pe­tent or in­sult­ing fam­ily doc­tors for be­ing so in­ept that tasks have to be re­moved from their ju­ris­dic­tion.

If Dr. John Hag­gie meant nei­ther of these opin­ions, then let us call it poorly worded “po­lit­i­cal speak.” Ei­ther way, it is a re­mark­able state­ment from a for­mer dis­tin­guished med­i­cal doc­tor — the po­lit­i­cal part of the brain has taken over.

The min­is­ter tells us we have “sig­nif­i­cant re­sources.” I have been check­ing on two of those re­sources, which many peo­ple feel are sig­nif­i­cant: nurse prac­ti­tion­ers and mid­wives.

Be­ing a nurse prac­ti­tioner is a noble pro­fes­sion, long over­due in this prov­ince. How­ever, I can’t find out just how many are em­ployed here.

Con­sul­tants from McMaster Univer­sity pre­sented their re­port to the pro­vin­cial gov­ern­ment in 2013 on mid­wifery, which was first le­gal­ized here in 2010, but not reg­u­lated. In 2013 there were 100 mid­wives in­ter­ested in work­ing in New­found­land and Labrador.

In Septem­ber 2016, the gov­ern­ment an­nounced a “se­ries of reg­u­la­tions that out­line the nec­es­sary train­ing and qual­i­fi­ca­tions for mid­wives will come into ef­fect on Sept. 30. This means that mid­wifery will soon be of­fi­cially be rec­og­nized as a health-care pro­fes­sion by the pro­vin­cial gov­ern­ment.”

In May 2017, the gov­ern­ment was say­ing, “(a) pro­vin­cial mid­wifery con­sul­tant will be work­ing with the gov­ern­ment this fall to de­sign a ser­vices de­liv­ery model and to de­velop poli­cies.”

It is now 2018.

I think Dr. Hag­gie needs to ree­val­u­ate. These im­por­tant roles are still in some sort of gov­ern­ment limbo. In­stead, he turns on fam­ily physi­cians.

Fam­ily medicine oc­curs in the com­mu­nity. Those pro­fes­sion­als live in the com­mu­nity. They are part of us. The role of fam­ily doc­tor is be­ing wa­tered down from a noble call­ing by rules and end­less pa­per­work, turn­ing them into pa­per-push­ers and form-fillers.

The art of a fam­ily physi­cian has been blind­sided by gov­ern­ment, al­low­ing them less time to lis­ten to pa­tients, get to know fam­i­lies, deal with cuts, bruises and many ill­nesses which are now “go to Emer­gency.”

Since when was a doc­tor’s of­fice not the place to have a fin­ger stitched or a mi­nor ail­ment dealt with? Now it’s a six-hour wait in a hospi­tal. This is not medicine, it is a cat­tle mar­ket. This is a sick per­son ter­ri­fied and bereft, who des­per­ately re­quires the con­ti­nu­ity and com­fort of their fam­ily physi­cian.

We need the re­turn to the real po­si­tion of fam­ily doc­tor — some­one you know will be with you ev­ery step of the way, dur­ing some­times dif­fi­cult times and not dump you at the door of a hospi­tal. We need more fam­ily physi­cians.

Sick peo­ple need to feel safe. It may be just a flu shot, but a doc­tor who knows you can tell a lot from your de­meanour. I think the gov­ern­ment has al­ready taken a big part of health-care de­liv­ery away from physi­cians, and in the trenches it is not a pretty sight.

In an ideal reach­able model of a very old idea, a fam­ily prac­tice would have doc­tors, at least one nurse prac­ti­tioner and a mid­wife, each in­volved in his or her spe­cialty — a co­he­sive group. It will never be pos­si­ble in very small com­mu­ni­ties, but a nurse prac­ti­tioner and a mid­wife should be there, hope­fully liv­ing in the com­mu­nity. Most women would rather have the min­is­tra­tions of a mid­wife they know rather than be handed off to a spe­cial­ist in a large, noisy build­ing. If a hospi­tal is re­quired, the lo­cal mid­wife should re­main in at­ten­dance for the com­fort of the mother.

We do not re­quire more “Cen­tres of Ex­cel­lence.” We suf­fer from a cen­tre of in­com­pe­tence — Con­fed­er­a­tion Build­ing.

We de­mand more lo­cal physi­cians, nurse prac­ti­tion­ers and mid­wives work­ing in small groups in the com­mu­nity. Places of safety, gen­tle­ness and hu­man­ity, with med­i­cal pro­fes­sion­als who do what they were trained to do: be with their pa­tients all the way from cra­dle to grave. You know, “80 per cent of a gen­eral prac­ti­tioner’s day.”

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