Canadian doctors among least accessible

Study of family physicians shows other countries better in many areas

Twenty years after email started to eclipse snail mail, most family doctors in Canada are still in the dark age, with 85 per cent not set up to reply to email from patients, the worst mark in an international report released this week.

That poor finding for Canada was one of many in a report that found family doctors here ill-prepared to manage patients with the most challenging conditions, from dementia to multiple chronic ailments.

Published by the U.S.-based Commonwealth Fund, the annual report is grounded in surveys done each year of primary-care physicians in 10 countries — Canada, Australia, Germany, Norway, Sweden, Switzerland, the Netherlands, New Zealand, the United Kingdom and the United States.

“We’re not doing very well,” said Dr. Richard Birtwhistle, a family doctor who directs the Centre for Studies in Primary Care at Queen’s University in Kingston.

It’s not that Canadian family doctors lack training to help their patients, he said, but rather that those doctors struggle to get patients timely access to specialists and services in the community in a health-care system that too often is fractured.

Asked if they felt “well prepared” to manage complex cases, family doctors in Canada trailed the pack or finished near the bottom for patients with dementia or severe mental health issues, palliative care, long-term care, social services, substance abuse and multiple chronic conditions.

Only 36 per cent of Canadian primary-care doctors think the health-care system works well and requires only minor changes, the survey found.

The fact that other countries are doing better on many measures is evidence that Canada can do better, too, said Dr. Gord Schacter, a family doctor for 19 years and a liaison between primary-care doctors in Southwestern Ontario and those who oversee health spending for the region. He said doctors in Canada should seek to learn from those other countries.

“I look at us having opportunities,” Schacter said.

One opportunity involves electronic records. Though more doctors use them, many don’t make full use of their capabilities. Instead of building a seamless way to share records, Canada has allowed vendors to create many systems, some of which are so incompatible that e-records can’t be shared among doctors, hospitals and homecare providers.

“There are five or six systems in Ontario alone,” said Dr. Stephen Wetmore, head of family medicine at London hospitals and the Schulich School of Medicine and Dentistry at Western University.

Wetmore and Schacter are concerned that Ontario may retreat from gains made before the province restricted the growth of multidisciplinary primary-care teams — family health teams. An aging population will grow the number of patients with complex needs, they said.

“We’re going to face increasing demands,” Wetmore said.

In other countries, as many as 80 per cent of family doctors used email to field and reply to questions and concerns from patients. Even the second-worst performer, Austria, had a rate double that of Canada. The lack of access here is pervasive: Canadian family doctors finished next to last on three measures — home visits, after-hours care and the ability of each patient to view, download and transmit medical records online.

Regulatory colleges and professional associations for Canada’s physicians have sometimes fought email access to doctors, but Birtwhistle said the concerns they have about privacy can be managed without shutting the door on the technology.

Canadian family doctors finished next to last on home visits, afterhours care and patients’ ability to view medical records online.