Caring for patients (when your hair’s on fire)

Canadian healthcare is experiencing a crisis, and many physicians have long lists of what systemic changes are needed. But as doctors wait for healthcare reform to ease their burdens, what can they do to at least try to manage crushing patient loads and provide adequate care day-to-day? “It feels a bit like giving tips on how to meditate to someone who’s on fire,” said Toronto family physician Dr. Chris Sun. His first piece of advice for doctors and patients, he said, is to, “vote smarter, protest louder and hold your elected officials to account.” But in the meantime, he and other Canadian physicians offered these tips. Virtual care rethink Like many physicians post-pandemic-crisis, Dr. Sun is rethinking and adjusting his balance of in-person and virtual appointments. “I have cut down some of my work-from-home hours and replaced them with in-office hours,” he said. “I can’t stand phone calls mostly because the remuneration is terrible and it has the potential to require an in-person visit anyway, which duplicates work. I thought it would be harder to be at the office more but it’s really not. I like my colleagues and it’s been nice to see more of them and to re-establish those pre-pandemic bonds.” Setting boundaries With patients increasingly coming in with multiple issues, Dr. Stephanie Zhou, an FP and addictions physician in Toronto, said she needed to establish some boundaries, which has helped her keep on schedule and still see more patients. “Currently, patients can see me the same week, with a zero- to 10-minute wait. (I) hear the issues, document them, but pick only one to focus on that is the most urgent. Some of the other issues can be addressed via phone or a later visit. With this change, I can be more focused. I find patients are accepting of my boundaries and understand that this is necessary to ensure wait times are manageable.” Managing referrals Dr. Zhou said that having a patient care navigator on staff can make a big difference in managing the potential chaos of referrals and help patients get the care they need. “Our office manager is also our patient care navigator,” she said. “She does referrals for our clinic and often checks up on the referral to ensure they’ve been received. Her specialty is referrals and keeping track of which specialists speak which languages, what their wait times are, etc. She has been a helpful central resource for all the doctors in our clinic.” Make friends with technology To find ways to see more people and do less paperwork, Dr. Alykhan Abdulla, a comprehensive family physician in Manotick, Ont., and member of the Ontario Medical Foundation board, advises getting familiar with and using the available technologies. “You want things like Canvas (an EMR and payments platform), and the different healthcare dashboards offered. And you want to think about companies like Doctor Care, that evaluate your practice and . . . optimize that functionality of your office,” he said. “Also online booking because that will help reduce the amount of energy used by your administrative staff, so they don’t need to be answering phone calls and getting people coordinated.” Dr. Sun agrees. “Online booking of appointments has taken a huge load off my front desk. HR is one of my biggest pain points and reducing the burden here saves time in multiple arenas (hiring, training, negotiation, retention, office morale).” Dr. Abdulla also recommends using text messaging with patients (and charging for it), “because there are lots of things that can be done very simply, like a renewal of a prescription. You don’t even need a phone call, you just need a text message. You also have to unfortunately charge for those things that are not covered. And so SMS messaging and prescription renewals and so on and so forth are things that are chargeable. So you have to be thoughtful about doing those things.” Encourage self-advocacy Communication is a two-way street. In addition to doctors communicating available services to patients, patients should be encouraged to always ask about services (online booking, for example, or after-hours options) and be their own health advocates. For the patients in his Toronto clinic, says Dr. Sun, access to after-hours care is not an issue. But he believes that many patients who have trouble with access (through no fault of their own) could be doing more for themselves. He says doctors might want to pass along these considerations and strategies to their patients: Encourage them to plan ahead: “Oftentimes the urgent issue has really been brewing for weeks but all of a sudden needs to be examined at 6 p.m. on a Friday for no reason other than patient convenience,” he said. “Knowing that issues may become more pressing (e.g., running out of medications, illness interfering with weekend plans), (patients should) get ahead of the problem by dealing with it proactively rather than suffering when there is a health crisis with no one available to help.” Tell them to try, try and try again: Patients should be advised to try to get in touch with their doctor’s office, then try some more. “(Tell them that) due to demand, labour shortages and underfunding, doctor’s offices are swamped and giving up after a few calls probably won’t get the job done,” says Dr. Sun. Say no to no-shows: Some patients don’t understand the impact of no-shows, so it is helpful to explain. Dr. Sun suggests saying: “We (doctors and patients) are all needing the same system to work efficiently. Booking an MRI, dermatology appointment or sleep study and then not showing up or cancelling is incredibly wasteful and harmful to the next person on the wait list.” Communicate . . . Dr. Melanie Bechard, an emergency room physician at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, said patients should be told, when in doubt, after hours, to go to the ER. She notes that some physician clinics provide after-hours urgent care, but this is not always communicated to patients, even though doctors in some provinces receive financial incentives to offer such care, and disincentive if their patients opt instead for a walk-in. “One of my colleagues who is a primary care provider says a lot of the time her patients are surprised to hear (about the after-hours urgent care). She’ll notice that they went to the emergency or the walk-in, and she’ll say, ‘Oh, did you know that we offer this service?’” Something else patients may need to know, said Dr. Bechard, is that a lot of emergency department websites have a patient guide for when to present to emergency or not, as well as what the real-time waits are. Physicians can convey information about after-hours care casually in patient conversation, in waiting room posters, email blasts, or automatic email responses. . . . and communicate some more Dr. Lawrence Loh, CEO and executive director of the College of Family Physicians of Canada, said the most important tactic for improving patient access to healthcare is for physicians to share their stories. “I think just being human with your patients and just sharing that this is a difficult time, even an email out to all your patients, just saying, ‘Hey, you may wait longer for an appointment, this is just a reality of what we’re navigating. It’s obviously not ideal, but we need you as well to stand up for us; we’re here for you.’” He also believes sharing challenges can be appropriate during patient meetings. “I think sharing stories has a twofold purpose. First of all, it incentivizes and drives change in policy to build the system of the future that will actually function optimally in our day and age,” he says. “At the same time, it also educates patients. I think people understand the system is under pressure, but they don’t necessarily understand what impact that has on family physicians, or on all of the healthcare providers. I think sharing the stories and sharing the challenges if you feel comfortable in doing so helps to put a face to it . . . and helps drive the system change that we need to see.”

Caring for patients (when your hair’s on fire)

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