Sup­port team could help with physi­cian short­age

Times Colonist - - Comment - CHRIS PENGILLY Dr. Chris Pengilly was a physi­cian at Tus­cany Med­i­cal Clinic.

Re: “Doc­tor-short­age so­lu­tions elu­sive,” let­ter, Sept. 9.

Ia­gree 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 fiveminute 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, pre­and 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.

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