A medical bomb drops in Kings County

A medical bomb has been dropped on the people of Kings County.

In October, a doctor in New Minas closed his practice. In November patients of two Kentville doctors learned that that practice was closing at year’s end. One of the doctors has been out on medical leave for over a month and decided not to return to this practice. His practice partner opted to also leave for another practice.

Then, in the last week, another long-time Kentville doctor announced his retirement.

These four departures leave approximately 10,000 patients in Kings County without a family physician. This wave of orphaned patients, doubles the number of residents without a family physician, which equates to about a third of the residents of Kings County without a doctor. With no replacement doctors for these practices the ER at Valley Regional Hospital, clinics in Wolfville and Berwick, and the walk-in clinic in New Minas are about to get a hell of a lot busier. That’s assuming there are doctors available to work those clinics. At least one of the departing doctors also worked the Berwick clinic.

So what’s the Nova Scotia Health Authority’s plan? What has Janet Knox got up her sleeve for solving this problem? And solving it NOW! We want remedies now, not some mythical plan that kicks in after Knox retires (she reaches retirement age in the next three years – typically health care executives quickly take retirement, collect any payouts, draw their pensions, then return as high-priced consultants, thereby doubling or tripling their income overnight).

Knox has been a health executive for over a decade. I am unfamiliar of any accomplishments during her tenure at the Annapolis Valley Health Authority or the Nova Scotia Health Authority. Other than progressively moving up the corporate ladder, what has she done for patients and to improve patient outcomes?

Not having a family physician means people receive a type of superficial care because medical professionals who have no relationship with the patient, treat the illness du jour and potentially miss other long-term changes in the person’s health. I know a resident, who waited three years to find a family physician. Once she had a doctor, he found an undiagnosed lung cancer. Recently a woman suffered a stroke because eight of 12 markers for temporal arteritis went unnoticed. That patient has lost her sight. Relationships with physicians are an important part of successful diagnosis and preventive medicine.

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7 Responses to A medical bomb drops in Kings County

  1. ausca says:

    “Not having a family physician means people receive a type of superficial care because medical professionals who have no relationship with the patient…”

    I agree it would be preferable to have continuity in family doctor. Still, with so many people in Nova Scotia (even in HRM) unable to find a family doctor, a situation about to be compounded by a wave of retirements and physician recruitment hampered by the lowest family physician remuneration rate in Canada (except for PEI), the number of people able to obtain such longer term service seems likely to decline. So what to do?

    Consider what would happen if we uncoupled our medical health record from the custodianship of one particular family doctor.

    Imagine it were possible to see any available general practitioner when you needed them, wherever you happened to be.

    Suppose any NS health practitioner could immediately access your entire electronic health record (EHR), their observations and treatments immediately appended to all those previous, so any practitioner could subsequently access them – including your family doctor, if you have one.

    Since 2005 Nova Scotia has been building electronic medical databases as part of its Primary Health Care Information Management (PHIM) program, using a privately developed web-based electronic patient record application to maintain electronic medical records (EMR) for clinics with access to high-speed Internet services. For each citizen, their EMR from each of the doctors they consulted could be compiled into their electronic health record (EHR) – a complete description of their known health history.

    Nova Scotia was the first province to develop province wide electronic delivery of lab and diagnostic imaging results for its provincially approved electronic medical records. The province has been nominated as a finalist for a Government Technology Exhibition and Conference Distinction Award for this achievement. The groundwork has already been laid!

    Ideally we could construct controlled data gateways to all medical, pharmacological, dental, physiotherapy data etc. within a province wide, secure database that could be accessed by registered health professionals on a logged, need to know basis. However, it would be illegal for employers, insurers, police (without a properly issued court order) or anyone else to access it or to require information to be furnished to them from it. Security and privacy would be comparable to those of tax records, and all patient data would be hosted within NS.

    Uncoupling my patient record from my family doctor means that I could see any doctor I please. Imaging or blood tests ordered by one doctor would be appended to my EHR to be accessible to any other available doctor. In fact, I might not even need to have a specific family doctor (although I would be free to do so one if I wished).

    Although this is not the same as having access to the same family doctor for most of your medical history, it brings in physicians in drop in clinics or others with availability to overcome inability of patients to find family doctors and would take pressure of non-emergency cases presenting at ERs.

    For a province of limited financial means facing a primary care physician shortage about to get even worse, the days of plodding along the way always have must surely be over. If we are to move in this direction we need to consider radical new approaches that might stand a chance of doing more with less. IMHO the Department of Health and Wellness needs to evaluate the pros and cons of something like this and if it does make sense they should start the consultation process with doctors’ professional organizations to get moving.

    As you rightly say, this needs to be solved NOW!

    • It’s a good theory, but the challenge is finding any doctor to see you when you want. Doctors are busy now. They struggle to fit their current patients into appointment slots, so a random drop in could have the same kind of wait you’d find in an ER.

      My doctor is one of the doctors giving up his practice. You build trust with your own GP. You feel someone has your back and will do follow ups. Plus, they know you as a patient and, in my case, take in lifestyle and work considerations in treatments, as well as family medical history in diagnosis.

      An electronic file should be available both for discretionary use as well as medical emergency. The impediment is the NSHA executive. They’re near retirement. Why should we believe they embrace technology or even innovation? I question whether they’re comfortable with either.

  2. buddyboy546 says:

    Until the NSHA conduct their management meetings in public and publish minutes of their meetings routinely, our citizens will have no true idea of what is going on behind the scenes. Until NSHA open up their operation, they can continue to reassure us that all is in hand and continue to operate business as usual. If and when we get see what they are really up to, then they will feel true pressure for results, true heat for change. I can understand why they prefer to operate in secret; for the life of me, I cannot understand why we allow them to get away with it.

    • This ‘trust us’ culture developed because of laziness of the public. To those who are prepared to trust “our betters”, I have three words: IWK expense scandal.

      The board chairman told us everything was fine, nothing to see here, then a week later, oops, there is something we’d rather you not see and hear about. The paid people the volunteer board relied on to police expenses and operations turned out to be part of the problem.

      Better management, better governance, better patient outcomes result from transparency. The question remains: what are they hiding?

  3. There is worse to come. There is a new deal for hospitalists which essentially pays them more than double than your GP for looking after hospital inpatients, treble if you figure in practice expenses.

    And don’t think EMR’s will save you. In this province they are balky, unreliable and time consuming to read, as well as containing vast amounts of irrelevant information. And they are no better than the person who put the stuff in there in the first place.

    • Ah, living up to the original observation about computers: ‘garbage in, garbage out’.

      In this province we seem paralyzed by so-called “due diligence”. Small armies of executives and consultants sit around discussing all the pitfalls to any action. By the time they have not only covered all the angles, they have created impossible case scenarios which result in policies and procedures no one understands and don’t make sense in real-world applications. But it creates employment – for non-medical personnel.

  4. Jane says:

    Even having a family doctor is not a guarantee for getting timely health care.
    For example: a medical problem was taken to the family GP last March (and the person had had it about a month, thinking it would go away). The patient was referred to the specialist – the one who was going to be the “quickest”, according to the GP.
    The appointment is in April.

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