Friday, April 4, 2008


I've had this clipping on the fridge for over a month...
Followup MD visits need more thought
Marilyn Pachal, Special to the StarPhoenix
Published Friday, February 15, 2008
Following is the viewpoint of the writer, a senior from Yorkton

My husband had a recent appointment with a medical specialist in Regina. Although we were grateful to see the specialist for advice on my husband's condition, the trip involved winter driving that we dread because a storm can come up anytime on the prairies.

We were also concerned that a prolonged wait in the doctor's office – a common occurrence – would mean returning home in the dark. Both of us are older than 75 and aren't safe on the road when our vision is compromised.

However, the 3 p.m. appointment not only was on time, but lasted all of one minute. My husband was told to go to the lab for urinalysis and blood work – both of which I believe could have been done in Yorkton – with the results returned to the doctor. We were also told to return in a month.

I've come to learn this is a common experience for many rural residents, who must travel long distances to see a specialist. I had a similar experience following a medical treatment. On the return visit I was told that I am fine and require no further treatment. It's good news that I would have preferred to learn by phone or mail.

Taxpayers pay for all these visits out of a stretched health-care budget. Patients personally pay for transportation, food, wear and tear on our vehicles and our emotions. There is also the wear and tear on the environment and the highways from all this travel.

I understand specialists are now charging a fee to patients who don't cancel or keep appointments. I agree such patients are inconsiderate, especially when there is a waiting list to see these doctors. But the list would not be as long if unnecessary appointments aren't made. There's little consideration for those who must travel long distances for short, no-hands-on visit.

There's endless talk about making the health system more efficient and cost-effective. The initiative should come from the medical establishment itself, but the current practice is financially beneficial, so I guess it's hard to give up.

The shortage of qualified physicians in Saskatchewan and fear of losing them makes us hesitant to criticize their actions. But surely there is ample work for them all and they don't need to add this unnecessary strain and expense on the health-care system.

I’ve been holding onto this letter because it’s hard to know where to start dissecting it. In fewer than 400 words, she politely skewers so many problems with contemporary medical office practice.

The strongest message I take from this letter is this:  As physicians, we need to change the perspective we have about delivery of care.

When I share our Advanced Access project with other groups, I show this picture:

These Russian nesting dolls remind me of how the pieces of a transformed health care system would fit together. In our case, the smallest doll represents individual changes we’ve made in our practice, for example, requesting pooled referrals. That doll fits inside the larger Advanced Access initiative, which in turns nests in the broader Clinical Practice Redesign concept.

But the whole works only makes sense once it’s inside the biggest doll: Patient and Family-centred care. Once we look at the system from the patient’s point of view (as Ms. Pachal has shown us), it is unconscionable to carry on with practices that give no value to patients (e.g., the “short, no-hands-on visit”).

We’re fooling ourselves if we think patients are blind to our foibles. Ms. Pachal’s complaint goes well beyond the one from The Emperor’s New Clothes. She’s (rightly) angry, and undoubtedly not alone in that.

(Warning: Overblown analogy ahead!)

I wonder if this situation has some parallels to the 16th century Reformation. The elite use their privilege for their own convenience rather than that of the people they are supposed to serve. A few outspoken critics foment quiet grumbling into open protest. Change happens because consumers (penitent/patient) demand it. Of course, nowadays, this would lead not to civil war, but to elected representatives imposing the desired change.

Medical Reformation? Marilyn Pachal nails it like Martin Luther.

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