Quarterbacking healthcare: The central role of family doctors
👩‍⚕️ Medical professionals need to be experts in communication to provide the best care to their patients. Effective communication can help establish trust, avoid misunderstandings, and improve patient outcomes.
🗣️ Active listening, empathy, and body language are all essential components of effective communication.
đź’¬ Medical professionals should avoid jargon and use clear, simple language when discussing medical information with patients.
đź‘Ť Building a relationship with the patient can also improve communication and patient satisfaction.
👨‍👩‍👧‍👦 Effective communication is not only important with patients, but also with other healthcare providers to ensure coordinated care.
đź’» Using technology can also improve communication, such as telemedicine and secure messaging platforms.
🌟 Takeaway:
To be an effective healthcare provider, practice and improve communication skills with patients and other healthcare professionals to ensure the best care possible. Remember to actively listen and show empathy, avoid using complex medical jargon, build relationships, and leverage technology to improve communication.
The Value of Primary Care
Introduction
How valuable is a quarterback to a sports team? Whether it be a Pat Mahomes or a Tom Brady completing big passes to star receivers, a capable quarterback is essential to a high achieving team. To a fan, the value of these players is unquestioned. Yet in health care, the central role family doctors play on a patient’s team often gets overlooked, even to the point of governments imposing cuts affecting family physicians’ ability to care for patients in the middle of a pandemic and investing instead in private surgical services.
The Value of Primary Care
In a world that often falls into the trap of focusing on short-term measurable deliverables, it is easy to miss out on primary care’s value. In the big picture of healthcare, however, the value of primary care is clear: longitudinal care focused on prevention increases patient-centred care and prevents fragmented specialist care.
Primary care has directly measurable benefits in financial savings through preventable hospital visits. In palliative care, we know that good community-based care can save up to $8,000 per hospitalisation. Addressing a knee replacement is usually a one-time cost but poorly managed chronic diseases can result in repeated admissions to hospital and cumulatively larger bills to the system.
In-Home Patient Care
Dr. Mayura Loganathan, a staff family physician at the Mount Sinai Hospital Academic Family Health Team who also leads its home-visit program, says his work reassures patients and prevents expensive emergency room visits. Many of his patients are homebound and unable to access care on time. If, for example, these patients catch pneumonia, he estimates a two- or three-day hospital stay can cost the system up to a couple thousand dollars. Instead, he says, when he sees his patients in their homes, he knows their baseline health, can catch pneumonias earlier and treat them with oral antibiotics that cost the system just over a hundred dollars in total. Like Loganathan, about 40 per cent of family doctors make house calls for homebound patients.
Preventative Medicine
“The biggest value is preventative medicine and the problem with preventative medicine is the public doesn’t see the value,” says Loganathan. He reasons, for example, that patients and their families may appreciate the interventions of cardiologists after heart attacks but do not give thought to the contributions of guideline-based primary care that successfully prevent heart attacks.
Continuity of Care for Chronic Diseases
According to Dr. Liisa Jaakimainen, a family physician at Sunnybrook Academic Family Health Team who measures primary care performance using data electronic medical records (EMR), “primary care is comprehensive, it has continuity of care. And it’s patient centred. It’s got all these sorts of qualities that make it different from when you see a specialist. We know that having good continuity of care for people with certain chronic diseases improves their care.”
Challenges in Accessing Primary Care
There is a large body of research supporting the effect of good primary care and continuity of care for patients, including receiving better evidence-based care such as cancer screening and diabetes care and reducing the number of hospitalizations. Yet there are challenges to accessing primary care.
According to Dr. Walter Wodchis, an associate professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto, “It should be no surprise that we actually spend a lot of our money on a few people that are very sick.” According to his 2016 paper, 5 per cent of patients account for 65 per cent of total health care expenses. For patients representing the top 5 per cent of those costs, a third will remain at these high spending levels for multiple years since they are more likely to have more than one chronic condition.
Complex Care
Wodchis says that current guidelines do not address the complexity of caring for patients with multiple conditions. “For example, find a cardiovascular guideline that refers to how to manage someone’s arthritis or a depression guideline that helps you manage someone’s cancer.” While it might be ambitious to have guidelines for every possible comorbid disease combination, primary care providers already treat these patients regularly. Family physicians are trained to treat this wave of increasing patient complexity, thus it makes sense to invest more rather than less to support this possible future.
Lack of Access to Team-Based Care
According to Dr. Tara Kiran, an associate professor at the Department of Family and Community Medicine at the University of Toronto with a strong interest in primary care reform with a health equity lens, “One in six Ontarians still aren’t in a patient enrolment model and most of those patients are probably unattached: they may be seeing primary care physicians in the context of walk-in clinics and they are probably not benefiting from continuous comprehensive primary care.” She worries that for these patients, often immigrant-refugees in lower income neighbourhoods, as the quality of care is poorer.
Kiran adds that family doctors in Ontario continue to be restricted from entering team-based models of care such as Family Health Teams, where there is OHIP-covered access to mental health counselling, social work and dieticians. The inability of certain sectors of the population to access this care detracts from its value. Says Kiran, “I think that all Ontarians should have access to team-based care. It shouldn’t just be that you are lucky enough to have a family doctor who happens to be in a family health team.”
Investment in Primary Care
Currently, Ontario’s compensation models for family doctors are complex and range from full fee-for-service (FFS) and enhanced fee-for-service (Family Health Groups-FHGs) to blended capitation models (Family Health Teams-FHTs; Family Health Networks-FHNs; and Family Health Organizations- FHOs) where payment is a complicated derivation of a physician’s roster size and incentives for age, sex and other health outcomes. The latter three encourage doctors to enrol patients and provide extended afterhours care. Of those, only FHTs have access to funding for a team of multidisciplinary health providers (team-based care) for patients.
Reorganizing Health Care
Dr. Pauline Pariser has worked to address the challenge of community physicians accessing hospital and community services for their patients. Pariser helped develop the SCOPE program, or Seamless Care Optimizing the Patient Experience, in partnership with Toronto’s University Health Network (UHN), Women’s College Hospital (WCH) and the Toronto Central LHIN after noticing the disparity between available resources for local community physicians and those in team-based practices.
The Importance of Primary Care
From family physicians who help coordinate patient care to specialists who treat specific conditions, we should all be working together as a team to keep patients thriving and at home. We should ensure that no patient is left out and offer care providers incentives and supports to tackle the difficult and complex medical issues we face in modern medicine. Through enhancing primary care with better data and collaboration, we can build a championship calibre healthcare system.
Most importantly, in recognizing the value of primary care, we are not simply arguing for increased physician pay but rather the importance of adequate funding to invest in a future where Canadians can have stable access to physician teams and receive the best care possible; and they deserve no less.