Rural health's shifting landscape

For now, anyway, MDs still at centre of health-care orbit

Cam Fortems / Kamloops Daily News
December 1, 2012 01:00 AM

Dr. Willa Henry: Ontario is leading the way.

Whether it's Vancouver, Kamloops or Ashcroft, the point of entry for nearly every British Columbian requiring primary health care is a physician.

But what if a patient who would otherwise go to their family doctor or medical clinic were to first see a nurse? A chronic asthmatic long ago diagnosed could return on a schedule to see a respiratory therapist, for example.

Someone with diabetes could meet with other diabetics, together with a nurse-educator or specialist.

"The primary-care system in the province needs to look at more collaborative practice environments so not everything revolves around the doctor," said Dr. Willa Henry, head of the postgraduate program in the University of B.C.'s department of family medicine.

Henry said Ontario is leading the way in this country in shifting the model away from the family doctor as the axis around all primary care, a private businessman or businesswoman who works on fee-for-service.

Such a "medical home" to replace the doctor working alone may include mental health workers, nurses, occupational therapists, dietitians, physicians and respiratory therapists.

"There's a reluctance at first," Henry said of changing from the only model of primary care most patients and doctors have ever experienced.

"Doctors lose the ability of fee-for-service. But they come back."

When Martin McMahon, vice-president of planning and strategic services at IHA, worked in the United Kingdom's national health service "you went to a community health team.

"It was up front that you were coming to a health team, not a doctor. The doctor was part of a team."

McMahon said in an interview that "a team-based model is what we're moving toward."

But while it's a goal, the Interior Health Authority cannot point to any community where the model is in place.

It is adding nurse-practitioners to communities. But, like doctors, they are in short supply.

When McMahon worked in the Okanagan in health care in 1999, three years before the formation of IHA, he saw the trend of physicians moving to larger centres, often to specialize and escape the demands of being on-call around the clock.

With a shortage of physicians now going on more than a decade, IHA and the province have responded with measures that include tele-medicine, shuttle buses for rural patients and most recently, air ambulance service based out of Kamloops.

But it's not a perfect system.

Joris Ekering has used the shuttle from Ashcroft to RIH when he was getting chemotherapy. But it left at 4 p.m., while his treatments sometimes lasted longer.

He has also been taken by ambulance to RIH on a day when the shuttle was not operating. He was discharged in the morning - in the night shorts and slippers in which he arrived.

So Ekering borrowed a hospital gown and shuffled down to Thrift City on Seymour Street, where he purchased clothing. He also called his son, who took the day off to transport his father back home.

"The biggest problem is you end up stranded," Ekering said.

McMahon also points to success with the tele-thoracic consulting service, whereby patients and their general physicians are able to talk via video-conferencing technology rather than driving 10 hours to Kelowna and visiting briefly with a surgeon.

"Access looks different than it used to," he said.


© Kamloops Daily News

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