We have been experiencing long waits in our clinics recently, which have been running over an hour behind frequently.
There are lots of reasons why doctors run behind - for example, they may receive an urgent phone call, an emergency may occur, or a patient may be much sicker than they realised and may require a lot of time.
However, the main cause of our clinics running late just now is patients bringing long lists of problems with them to their appointments. Quite a few patients have been attending with lists of between 5 and 10 problems that they want to discuss!
This is understandable - many of our patients have been without a family doctor for years. They have many issues they wish to discuss. We are very busy, and they may not want to wait again to discuss those issues.
We don't want to impose a 'one visit, one problem' limit on our patients. And we have several nurses/technicians helping with each clinic to make sure we deal with as much as possible in the time available.
But, we only have between 5 and 20 minutes per patient, and it really just is not possible to deal with more than one or two problems in that time.
To avoid long waits, and to provide safe care, we will now be prioritizing the problems when there is more than one. Patients bringing long lists will find that simply organizing the list will take up the first appointment, and they will then be advised how many appointments we think will be required to work through their list.
2 comments:
What is the actual time you are suppose to have per patient that the gov't is paying you for.. I heard it was 15 mins per patient and I certainly did not get close to 3 mins. I feel you should be able address more then one issue with that amount of time if it actually happened to be there for the 15 mins.
There are two types of payment system in PEI - salaried (or contract), and Fee For Service.
Salaried doctors are paid by the hour and are expected to have 1,200 patients on their books. They generally book 15 minutes per patient.
The problem with salaried payment is that there are not enough doctors to see all the patients in Prince Edward Island - if all doctors were salaried, there would be a huge number of patients without a doctor.
Fee-For-Service is the traditional 'old fashioned' family doctor that most people in Canada know. Fee For Service is paid per visit. The fees are very complex, but basically most visits are classed as 'less then 10 minutes'. All Walk In Clinics are fee-for-service.
The advantage is that Fee For Service doctors provide care to a much larger number of patients (usually 2,000 to 3,000 patients each).
The problem with fee-for-service is that you don't get much time with the doctor - usually only around 5 minutes. That is nowhere near enough time to properly manage patients with multiple, complex, chronic illnesses.
The biggest problems facing patient in PEI (and Canada in general) are:
1. Many have no family doctor.
2. Chronic diseases are not being managed well.
Using alaried doctors can solve the second problem, but make the first problem worse. Using fee for service doctors can solve the first problem but makes the second problem worse.
Our plan is to combine the best of both. We want to provide high quality care to a large number of patients
The only way to do this is to use nurses to provide all of the care that is better done by nurses. PEI is around 20 years behind the UK's NHS in the use of Practice Nurses for this kind of care.
The only way to pay for those nurses is via Fee For Service.
It is still not clear whether our experiment will work or not. We can provide the high quality care, but we are not sure we can sustain the fees to pay for it. I think the rewards to patients of having access to high quality care are worth the risk we are taking.
I also think high quality care is worth patients making an effort for - be that having to come to see the doctor more often or waiting longer to be seen.
Interestingly, the NHS in the UK has gone down a different route. In my Scottish practice we are paid partly for the number of patients we have (like a salaried doctor) and partly for the quality of our care (Quality and Outcomes).
The quality money pays for the Practice Nurses which provide the bulk of care for chronic diseases.
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