By Sheryl Ubelacker, Health Reporter, THE CANADIAN PRESS
TORONTO – More than four million Canadians aged 12 or older are without a family doctor, either because they can’t find one or have chosen not to look, Statistics Canada said in a report released Wednesday.
The 2007 Canadian Community Health Survey found that among those without a primary-care physician, 1.7 million had tried but were unsuccessful at being taken on by a doctor as a regular patient, while 2.4 million weren’t even trying.
However, about 78 per cent of those without a regular doctor – or 3.3 million people – reported having an alternative they usually turn to when they are ill, require tests or need prescriptions.
The annual survey of 65,000 Canadians found 64 per cent of those without a regular physician reported going to a walk-in or appointment clinic, 12 per cent went to a hospital emergency room and about 10 per cent went to a community health centre.
The remaining 14 per cent chose to use other types of health-care facilities or services such as hospital out-patient clinics, telephone health lines or doctor’s offices.
Where people go for care varies by region, said Sylvain Tremblay, a project manager for CCHS.
“When we looked at the west part of the country (and Ontario), most people tended to use the clinics,” Tremblay said from Ottawa.
“But as you move toward Quebec and the east part of the country, especially in Quebec and Newfoundland and Labrador, it’s more the community health centres,” he said, explaining that these group practices often include doctors, social workers and physical therapists.
In New Brunswick and Nova Scotia, nearly one-quarter of residents without a regular doctor sought help in a hospital emergency room, the survey found.
That figure would come as no surprise to Phil and Deborah Sellars, who recently moved to Sussex, N.B., from Calgary and have not been able to find a family doctor.
“If we need health care, we have to go and sit in emergency for half a day,” said Phil Sellars, who must have his blood tested monthly for a medical condition and has waited for as long as four hours to be seen.
“I’m sure that everyone that’s in the same situation is frustrated about it,” said Sellars, who operates a bed and breakfast inn with his wife.
“I guess the only good feeling I have is I know there’s an emergency near in case something critical happens. But certainly for anything we would normally see a doctor for on a regular basis, that’s not going to work.”
“I guess the best word is we’re left out of the mix.”
Dr. Ruth Wilson, president of the College of Family Physicians of Canada, said the number of primary-care practitioners in Canada is starting to improve as more medical school graduates are now choosing family practice as a specialty, compared with the last decade.
But she agreed many Canadians are still forced to use walk-in clinics and hospital emergency departments as a “back door” to health care – and that can be especially problematic for people with chronic conditions like diabetes or high blood pressure, who need continuity of care.
“The wonderful thing is we do at least have that as an absolute safety valve, if you like, so if there’s no other way of getting care, that’s there,” Wilson, a family practitioner in Kingston, Ont., said of clinics and ERs. “But it’s certainly not a great way for the patient or for the health-care system to provide care.”
“I’m always disturbed when I hear about diabetics or people with heart disease having to get care in walk-in clinics or emerg because that kind of chronic disease really needs consistent, careful followup over time, tracking medications carefully … and managing the chronic disease well.”
She said patients need to be able to go to a doctor with a list of issues to discuss, such as: “How is my diabetes? How is my hypertension? How’s my heart disease? What were my last blood test results? Do I need a mammogram? How about my Pap?”
Dr. Alan Drummond, a spokesman for the Canadian Association of Emergency Physicians, said that while people without family doctors contribute to overcrowding in ER waiting rooms, generally these “orphan patients” are not a major problem for staff.
A bigger concern is the backlog of seriously or chronically ill patients who need to be admitted to hospital or transferred to another facility, but a lack of beds in those centres keeps them on stretchers in the ER – sometimes for days – and less seriously ill patients waiting.
“If we had appropriate capacity to see people in a timely manner, they would be seen in a timely manner,” Drummond said from Perth, Ont., where he practises. “It’s nothing for an emerg doc to see anybody with a cough, cold, diarrhea, rash or sprain. It’s really not a major burden for us.”
But there is no quick fix for patients with potentially life-threatening conditions like heart disease – and that can add to already long waits for other patients seeking help at emergency departments, he said.
“The ones that have chronic disease states really are there because they’ve got nowhere else to go. And when they do come to us, by definition, we’re going to take our time and make sure we’ve got things sorted out. Because a 92-year-old who’s weak and dizzy could be just weak and dizzy, or 92, or they could have an ongoing heart attack or stroke, so they require prolonged evaluation.”
“So that’s where the absence of a family doctor really does matter,” Drummond said, stressing that primary-care physicians provide the followup that ER doctors aren’t able to.
“The concern here is, yes, we can provide primary care to a select group of patients who don’t have a family doctor, but by no means can it be considered the same level of care.”
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