Flawed health care system, strong family physicians

In February 2018, the Canadian Institute for Health Information published the results of the Commonwealth Fund’s international survey on the views and experiences of seniors from 11 developed countries regarding their own health care systems.¹ The survey revealed some very interesting data.

First, it’s amusing to note that Canadian seniors have more chronic diseases and take more medication but perceive themselves as healthier.

A pretty odd result. We could certainly generate several hypotheses to explain this contradiction. Some politicians might tell us that Canada is such a great country to live in that it increases our positive perceptions of our own health. As physicians, we might say that we treat many asymptomatic chronic diseases and that, consequently, people perceive themselves as healthier than the sum of their medications and diseases. Strange indeed.

The most worrying outcome is that our seniors are less satisfied with the general quality of their health care (67% compared with a 76% average).¹ On the other hand, the most reassuring revelation was that their level of satisfaction with their primary care providers was higher than the international average.

Compared with seniors from other countries, a higher percentage of Canadian seniors thought their regular doctors

• were more knowledgeable about important information related to their health,

• dedicated sufficient time to them,

• explained issues in a way that was easy to understand,

• encouraged them to ask questions,

• sufficiently involved them in decisions concerning their treatments and health,

• helped them coordinate their care with other specialists and hospitals,

• discussed healthy choices (nutrition, exercise, alcohol, etc) with them, and

• had reviewed their medications during the past 12 months.¹

More Canadian seniors had an end-of-life plan.¹ They were more likely to have discussed it with their loved ones and prepared documentation indicating power of attorney in case of incapacity.

However, the area in which we did less well was access. Fewer Canadian seniors were able to book an appointment in less than 48 hours (41% vs 56%) and at night or on weekends (38% vs 51%), and they were more likely to use emergency services for problems that could have been treated by their primary care providers (31% vs 28%).¹

This presents a real challenge for us. How can we improve access to primary care in Canada? A 21st-century family physician cannot be available 24 hours a day, 7 days a week. The key is teamwork, with help from other health care professionals. Canadian provinces must continue to invest in the Patient’s Medical Home model and family physicians must assume strong leadership roles within these organizations to improve access.

We must be creative to find ways to improve access. In my group, we have a physician available for walk-in appointments every day and we also introduced advanced access, but it was not enough to respond to demands over the short term. Therefore, we asked every physician to add 2 walk-in windows at the end of their work day, open to all patients within the group. These appointments could only be made the same morning. This greatly improved access for our patients over the short term.

At a time when daily pressure on family physicians to see more patients more quickly is immense, it is good to see that our work on the ground is appreciated. We have issues with access that must be solved, but we are performing well in how our patients experience primary care. We tend to be hard on ourselves, but this survey reminds us of the old saying in French: Quand on se regarde, on se désole, quand on se compare, on se console (When we look at ourselves, we feel bad; when we compare ourselves, we console ourselves).

I believe that these results demonstrate how invaluable our contribution to the Canadian health care system really is. Every day we hear the media talk about the failures of our health care system, but we never hear them talk enough about the extraordinary work done by our family physicians.

• Copyright© the College of Family Physicians of Canada