Consequences of our polite culture: 3 recommendations for primary care

An abnormal mole, unexplained changes in weight, a persistent ache. These are some examples of symptoms that many Canadians discuss with their primary care physician. If you happen to be one of the estimated 6 million people without a primary care doctor, unless a symptom becomes acute, it may be ignored.

Preventive medicine is challenging, even with a primary care physician. We are by nature a polite culture, reluctant to “complain” or “be a burden.”  None of us want to make things worse or divert care from someone who “really needs it.” Not only will this inaction likely result in personal consequences, it will most definitely impact the health of our society.

There are some encouraging signs from provincial governments that indicate tackling the crisis in primary care is a top priority and requires action. For example, changes to compensation structures, addressing changes to scope of practice, and facilitating licensing of foreign trained doctors have all been mentioned. I shared some thoughts earlier this year.
‍
‍In addition to the ideas noted above, here are 3 recommendations our Canadian health care leaders should consider in order to help address some of the challenges associated with primary care in this country:

1. CENTRALIZED FOCUS ON PRIMARY CARE OFFICE EFFICIENCIES

✓ Operating a clinical office can be complex and expensive, taking precious time away from direct patient care. We have an opportunity to coordinate and replicate the business of clinic operations.

✓ Selecting a location, buying insurance, implementing (and upgrading) technology, investing in (and replacing) furniture and equipment, billing, hiring/firing and developing staff. These are all necessary and important components for any primary care office.
‍
✓ Primary care offices also have many functions that are not directly related to patient care, but are critical to running an effective practice. For example, clinics must establish relationships with local hospitals, laboratories and specialists; recruit and manage partnerships (where there is more than one physician); implement models for interdisciplinary care; interpret and cascade new policies from provincial governments; adhere to provincial / territorial reporting requirements. Centralized - and specialized - support for these important elements of clinic operations will help create efficiency and more capacity for direct patient care.

2. IMPLEMENTATION AND ADOPTION OF HEALTH TECHNOLOGY

✓ It is proven that technology can improve reach, impact and quality of care. The pandemic demonstrated the power of tech in tackling traditional barriers to access in remote and non-urban areas of our country (and mental health services).

✓ It is imperative that we prioritize the implementation and adoption of health technology in primary care. While most primary care offices are digitized with EMR systems, we are still slow to adopt escheduling, ereferrals, virtual care and home health monitoring. And technology is the only mechanism to address the critical problem we face related to medication reconciliation and adherence.

3. ESTABLISH MORE PRIMARY CARE (NON-URGENT) CLINICS

✓  Branding here matters. If a clinic is called “urgent AND primary care” - urgent care wins (see above). We need primary care clinics for non-rostered Canadians to go, where the expectation is to discuss non-acute symptoms. Many of us have not had access to standard, preventive health testing that is essential to maintaining good health.  

✓ Access to specialist referrals is challenging at the best of times. Without a primary care physician and/or an acute episode that lands you in hospital, it seems insurmountable. Primary care clinics are essential to ensure patients receive referrals for the targeted care they need.

While most healthcare leaders across Canada have indicated that improving access to primary care is a top priority, more direct action needs to be taken in the short-term to address the challenges Canadians are facing. Failure to do so will result in problems that may take decades longer to fix.