How Can Physicians Improve Access to Healthcare?

In medical school a substantial amount of time is spent discussing upstream social determinants of health and the impact it has on patients‘ well-being. In Canada, the reason why people get sick attributed to social determinants of health (50%), access to healthcare (25%), followed by genetics and environment (25%). I appreciate the emphasis on practicing holistic medicine and looking at patients beyond their illness. However, I find that we are ill equipped to improve access to care among other social determinants of health for all patients in the clinical setting.

During my emergency rotation, I saw an immigrant woman in her early thirties, about 8 months pregnant. She was turned away at the registration desk without even being seen by a physician. She was not registered under the provincial healthcare plan nor did she have the money to pay for her visit. The first question that came to mind: “is there a policy that states who can be seen without provincial healthcare?”

After doing some quick searches, I found that in Quebec, the provincial healthcare coverage extends to certain patients who are not registered and they include patients requiring “urgent care.” Urgent care is defined as: life-threatening or could lead to serious and lasting damage such as domestic abuse, services related to pregnancy, child birth or termination of pregnancy, and services needed by people suffering from infectious diseases that have an impact on public health.

In the case of the young woman, she was turned away inappropriately. Many women are in this vulnerable position and are unaware of the policy. One way to rectify this in the hospitals and clinics is for physicians to be aware of this policy and communicate it effectively with the registration desk and triage team. It is also essential for physicians to know, within their province, which patients can be seen even without provincial coverage.

We need to advocate for our patients’ well-being. But how can we advocate for our patients when patients cannot access healthcare? The answer goes beyond the clinic and involves change in the system and organizational culture of healthcare. As physicians we can do a lot in the clinic to improve access s. We could provide our patients with a wealth of knowledge regarding community resources.

Going back to the case of the pregnant patient, if she was appropriately seen by an emergency physician she would be referred for follow up by a family physician or obstetrician depending on the risk level of her pregnancy. Even if a physician followed her during her pregnancy, she still may need other resources.

A possible challenge is that she may already have 4 children at home and no one to take care of them if she came to her appointments. Or she may rather use the money she has for food and not for transportation or medications. Or maybe she does not speak English or French and does not understand what the physician tells her as part of her treatment plan. To mitigate this, a suggestion would be for a translator to be present at the first appointment. At McGill University (where I trained) there are a couple of translation services offered on a volunteer basis by medical students.

For a patient like this, I would contact one of these services and have a volunteer present for the first visit and subsequent visits. If the patient speaks little to no English/French it is important that I write or draw key points of the discussion so she can at least have someone read it to her later. As a primary care physician it is essential to be familiar with the local food banks to refer this patient to if need be.

These suggestions are just scratching the surface of what can be done to improve access to care for this patient. In 2013, the Canadian Medical association conducted wide-ranging consultations to gather input on Canadians’ views on the social determinants of health and how equal access for all to the health care system can be achieved.

Many barriers exist to access care but one that is top of the list is finding a primary care physician. As Virchow has said, “the physician is the natural attorney of the poor” and therefore, we need to continue to find ways to assist our patients who are most vulnerable.

Evangeline Seganathy is a fourth year medical student at McGill University and is a member of the CFPC Global Health Committee.