Aiding & abetting or Cradling & enabling?

The new face of primary care is all about access to care. Governments across Canada are mandating Emergency Departments to cut down on wait times. In turn, Emergency Departments complain that their long lineups are due to the growing number of non-emergent issues clogging up the resources. A solution for this bottleneckĀ  was to improve people’s access to their family doctor, more walk-in clinics, and urgent care centres.

Family doctor offices revamped their access by changing the way patients can make appointments. The new term is “advanced access”, which is basically same-day appointments. But first, a reminder of the “old” way of doing bookings: you call up and ask for an appointment to see the doctor about this or that, and usually are offered an appointment in a few weeks, or if lucky, in a few days. For the majority of issues, this is fine, but if you’re truly sick and want to be seen, you’re not going to wait the days or weeks – you’re going to go to a walk-in clinic or the Emergency Department. Otherwise, if you wait, you’ll either be better or dead by the time your appointment comes. By switching to this new system, patients now have the theoretical ability to call their doctor’s office and be seen by their doctor that same day when they need it most!

This causes frustration for some, and relief for others. Frustration for those with jobs or school where advanced knowledge of a set appointment time helps anticipate scheduling, or those who want the guaranteed security of an appointment time. Relief comes in the form of being able to be seen by your own family doctor when you need it.

The problem that comes with the advanced access system, and the theoretical improvement of wait times in the Emergency Departments as a result, is if this greater access to care has enabled people to seek out medical attention for pretty much anything and everything. The ability to cope with one’s medical issues has seemingly taken a step backwards. Once upon a time, not so long ago, when wait times in the ER were long, and it took weeks to see your family doctor, people seemingly dealt with their ailments. Albeit, there may have been those that did suffer needlessly as a result, but there would also have been a subset of people whose issues resolved over that period, and did not end up having to seek medical attention for it after all – without the suffering.

Are we helping the majority of people with this improved access to care, or are we enabling a new culture of an inability to cope?

Sufferers of mental illness are the clear benefactors of the advanced access system, as faster routes to care can certainly help settle any issues or flares more quickly before they become even more troublesome. Even those with sore throats and ear aches are better served by seeing their family doctor rather than going to the Emergency Department for these non-emergencies. But at the same time, a simple sore throat in the absence of a fever does not always need immediate attention. Nor does every indigestion or diffuse abdominal cramp. However, with increased quicker access, more and more mild and minor physical discomforts are coming in for medical attention at higher frequencies. This once again offers the question of enabling an inability to cope in these circumstances.

The camps will always be split on the better solution, with one side arguing for, and the other arguing that encouraging restraint may prevent a true medical issue from seeking care. It would be nice to defer to common sense of the individual to help determine true need from not, however, as the old adage says: common sense isn’t common.

Perhaps if Canadians understood the true cost of their healtcare visits, they may have a better understanding and appreciation of when and why to seek advice. But we’ll save that for a different entry.

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