Access to care opinions

[Annette McKinnon]

Hi all

I've been working on the Commonwealth survey for the past few years with CIHI (Canadian Institute for Health Information) as a citizen and patient giving input to the questions prior to the launch of the surveys. They are going to do a highlight for one that is upcoming and are looking for some quotes about experiences getting after hours / weekend care or about difficulty booking appointments.

I started with my husband, who was sitting on the phone trying to get an appointment. Here's what he said to start the conversation.

There is no doctor to see you now (his title)

As it happens I believe I've injured the tendon in my leg at the ankle.
I've been trying for two days to establish contact with more than an answering service that provides only another number to call.
If I were to be tweeting on this topic I would use the hashtag #MyDoctorIsNeverInNow
When I did make contact I was given the number for an office that still has their overnight message on their office number at 10:15am.
This is radically worse than my experience 10 years ago

[Annette McKinnon]

It's great that you have good access. My husband had a great Dr but the one who took over the practice he is in is hard to reach or to get an appointment with. My Dr is good, but even though she denies retirement is in her future (haha) it will happen eventually.

I'm thinking of trying to get into a family health team as my future plan.

It will be interesting to see what others say.

Annette

[Vivian Bethell]

Hi Annette,

I have many problems with the health care system but access to my family doctor when I really need care is not one of them. If I phone at or around 8 am I will have an appointment the same day. I'm in Ontario and I think this is the standard.

Vivian Bethell

[Charmaine Jones]

Hello. I am a new member. I also live in Ontario. I agree that with my local family health team (FHT), if I call in the morning, I can get an appointment that day with either the family physician, the resident (it is a teaching practice), or the nurse practitioner. On weekends, the FHT advises either to go to the closest emerg or call the Ontario after hours nurse advisory service. I haven’t had to use this service. I have spoken recently with a friend who did on a long weekend. The nurse on this occasion was excellent, advised that the patient had acute Lyme disease and to go that day to the emergency room. She also called ahead to the emergency room and the physician was expecting the patient! This is excellent. I hope it is the rule not the exception.

One group of patients who are most vulnerable are the terminally ill who wish to remain at home. The nurses who look after them at home require access to physician support 24/7 otherwise these patients are sent to the emergency room, which is not the best care for a dying patient and their family. I speak from experience of being a palliative medicine physician. When I initiated 24/7 coverage, hospital admissions for end of life care dropped..

My daughter has recently moved to BC. She has a young family (4,8,9 yo). It is almost impossible to find a family physician. We used any contacts we had. She signed up for the province’s list of patient’s awaiting a physician. Just last month, 14 months later, she had her intake interview with a nurse practitioner and I believe they are now linked up. Thankfully, this is a healthy young family

Charmaine

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[Charmaine Jones]

It’s me again.

I would also mention that getting specialist care is another problem, in Ontario.

We have a friend with a rapidly developing movement disorder. She is on the waiting list at 2 movement disorder clinics. The wait is approximately 2 years!!! She can’t seem to get into a neurologist (in Ottawa). You are no doubt aware of the waiting list of hips/knees/shoulders replacements - 1-2 years - and patients are often in quite severe pain leaving them with limited QOL and exposing them to adverse effects of medications such as NSAID’s (alter your microbiome unfavourably and high risk of GI bleeding in the elderly) and/or opioid pain mediciation.

Even when linked with a specialist, such as a rheumatologist in my case, it can be difficult being seen on an urgent basis.

I have recently completed a photo essay of my experience with health care to date with my autoimmune inflammatory arthritis both in AZ and here at home in Ontario. I have not yet decided how best/where to post it.

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[Kathy Smith]

Hello Charmaine, access to care is a huge issue here in northwestern Ontario. 30,000 people do not have a primary care provider. We must travel for much specialist care - with wait lists measured in years. Imagine being an elderly solo palliative patient with no access to a hospital, no available homecare, and facing travel for treatment. Nothing can be transported to him - his community is no longer served by Greyhound. And how does this palliative care patient get to treatment? They may not.

[Kathy Smith]

This message is especially for Annette. My sister-in-law, and now my friend, both had a similar problem with their Achilles’ tendon at the ankle. In my sister-in-law’s case, a delay of many months to see an orthopedic specialist meant her tendon snapped and it could not be reattached. She walks with the support of an orthopedic shoe so her foot does not tun out too far sideways. With my friend, she waited months to get a bunion shaved off. When the orthopedic surgeon got ready to do the surgery, he found that her Achilles’ tendon was twisting and shrivelling. He did a reattaching of ligaments and tendons operation instead. After two and a half months healing, she just got her cast off and is getting physio to strengthen the walking muscles and ligaments. I mention this because both were told that this is a common problem found mostly in elderly women. Apparently the Achilles’ tendon stiffens and shortens as we age. May not be your problem, Annette but, I think it’s good to get this heads up.

[Troy Stooke]

Reminder- Not just a N Ontario issue- though I know this thread started with an ‘Ontario’ issue

but also N Alberta / rural & remote across Canada..

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[Kathy Smith]

Troy, silence is not golden. The leaders, political as well as healthcare, need to be put to task to recognize their talk does not match their walk. Nothing about me without me means including the omegas with the alphas (large urban area residents, big tertiary teaching hospitals etc.). Time for a cool change.

[Kathy Smith]

Thanks Charmaine. Did not know tendon rupture was common nor that it was connected to quinolone antibiotics. I only know of the two cases I mentioned. Neither of them mentioned that connection. It makes perfect sense in my friend’s case. She lost her spleen in her teens (injured in a train/car accident). She has been prescribed megadoses of antibiotics for decades. I wonder if this connection was explained to either of them. I’ve only taken Cipro once and don’t recall reading anything about this common adverse side effect in the Rx literature. Patients should be given that info though.

Re First Nations. Our region serves 87 remote FN communities. We lead the way with standardized OTN Telemedicine consultations as a method for managing patients with chronic diseases or transitioning home from hospital. Nursing Stations within these communities are life savers. Thunder Bay Regional Hospital has had up to 2/3 of its patients from rural and remote fly-in communities. Im working in a provincial group developing a new model of quality primary care delivery. Community Outreach Healthcare centres with teams of multi-disciplinary primary care practitioners, extended hours of service and more in-home and street care might offer the best delivery of care by the right provider, in the right place at the right time. Sweden has a very interesting primary care plan called “What’s Best For Esther”. Spain and the Netherlands too.

[Charmaine Jones]

FYI tendon rupture is a not rare consequence (adverse effect) to the quinolone antibiotics: such as Cipro, Levaquin.

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[Charmaine Jones]

HI Kathy

Yes... health care access in N Ontario is a huge problem ...same for the poor and for First Nations.

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[Annette McKinnon]

Thanks Kathy

It's good to know these things. My husband had an unsatisfying visit with the Dr he saw. I'll pass this on to him.

Troy

I'm in Ontario but responses from across the country are welcome. CIHI has good representation nationally except in the Territories where there are fewer doctors. They are a Pan Canadian Group

Thanks for the answers so far everyone. My own access is medium good, but I'm lucky to have good specialists to help fill in the gaps in my Primary Care. With only one problem per visit my chronic disease never gets a turn. I only see my GP for minor issues.