Day in and day out, we connect with our patients and try to best address their needs. But what about the patient perspective? This month, I had the privilege of joining forces with Julie Drury, patient and family advisor and the inaugural chair of the Minister’s Patient and Family Advisory Council for Ontario to have a conversation about appropriate access.
Jennifer Young (JY): Work-life balance needs to be reasonable to allow for maintenance of our mental and physical health, and our relationships. Our patients respect this – knowing that one individual cannot always be available for all of their health care needs. What's known about how well we are doing? The OECD statistics are not encouraging – Canadian patients wait longer than other countries to see their doctors with less than 50 per cent reporting that they could see their doctor the same or next day. However, a recent study by Dr. Kamila Premji found that 87 per cent obtained an appointment as soon as desired.
Julie Drury (JD): How does access feel for a patient, family member or caregiver? I’ve been asked this question often as a patient and family advisor and my response is, ‘it depends’. It depends on how the doctor’s office is structured and how the patient understands what coverage there is for ‘last minute’ and ‘after hours’ appointments. It depends on how sick that patient is feeling and what support they receive in understanding their symptoms and how urgently they should be seen - can they speak with a nurse in the office that knows their history and who can advise them? A patient who calls for an appointment for a non-urgent issue and is told the wait list is several weeks to months, may also feel they lack access to their doctor.
JY: So appropriate access - for a UTI, that means TODAY (for any of us who have suffered with one, we know what that feels like!) For some other less acute issues, in a few days. And for other issues, a couple of weeks wait may be reasonable. Timely access is a key function within a Patient's Medical Home, which is grounded in continuity, coordination and comprehensiveness.
JD: We know the risk for patients (and their physicians) where access is an issue – fragmented care. We are all busy people, patients included. Walk-in clinics and emergency departments are not always the best choice for patients with what might be perceived as minor complaints or receiving care where follow up and coordination is not always possible, but the reality for many patients is that this is the only access they might be able to get. Sometimes, patients go to a walk-in or to the emergency because it’s more convenient. Part of our discussion around access must be about informing patients of their choices, the risks of poorly connected/coordinated care, and the accountability they have to a strong patient and physician partnership. Ensuring patients understand how and when they can access their family physician and how patients are triaged for care are important parts of effective patient partnership.
In a recent survey by Abacus polling, patients across the country have expressed an overwhelming interest in being able to access care virtually. Electronic booking, phone calls, emails, videoconferencing are pathways where patients feel they could more easily access care. In an increasingly busy world, we need to consider these advancements in technology to be able to support patients in getting to and keeping appointments. Often, we don’t consider the time patients spend booking appointments, time off work to attend, costs of getting to appointments and the fact that many patients are seeing more than one physician. How we make this more efficient for patients and physicians is important.
JY: Many of us do make phone calls, answer emails and have electronic booking. If we took payment models out of the equation, is this a win-win for family doctors and patients? Email methods remain a challenge on a few levels – privacy concerns and risk of significant extra time commitment are a few barriers often cited. Access to specialists is a topic I won’t tackle here, but please know that this is a part of our advocacy for an equitable and seamless system that serves our patients better. Access to information is essential for us to know what is happening with our patients in order to be the quarterback for their care. Patients are amazed that we don’t know what has happened to them in other parts of the system; we need to connect the pieces to minimize duplication and have less falling through the cracks. The case of Greg Price is just one example - people have died because of this, and our system must do better.
JD: Patients, families and caregivers are willing to work in partnership with their physician. There’s much talk about a ‘patient-centred’ health care system, but I prefer to talk about a ‘patient-partnered’ system. Ask us what is working and not working with respect to access; share the challenges and barriers with us from your point of view; invite us to have a collaborative conversation. Sharing physician notes and having patients contribute to their patient records are emerging areas of patient partnership. As we develop digital platforms to better access such as eConsults and eReferrals, we need to ask ourselves: what is the ‘patient role’ in this design? Patients can help you out!
JY: Our practice needs to a place for the small and the big, the simple and the complicated. This continuity of care is what increases trust and partnership, reduces mortality and improves well-being and health. Partnering with our patients will help design a better system – both within our practice and within the broader system.
| Dr. Jennifer Young President, OCFP |
Julie Drury Chair, Minister's Patient and Family Advisory Council |
As always, we welcome your feedback!