Letter addressed to Christian Dubé, Minister of Health of Quebec.
As you know (and as pointed out The duty recently in his series of articles on the first medical line in Quebec), access to basic services by a family doctor has become a laughing stock in Quebec. It takes years to get a family doctor. The search for this doctor is done in tension, anxiety and discouragement. Patients without a doctor face insurmountable obstacles in obtaining an appointment at medical clinics.
You recently became Minister of Health. I have been a family doctor for almost 25 years.
I do not want to dwell on the historical and multifactorial reasons which led to such a crisis. Because it is indeed a crisis, let’s not be afraid of words. Sadly, patients and healthcare professionals face this reality every day. In addition to observing an obvious discrimination between patients with a doctor and those without a doctor (those we meet daily in our walk-in clinic which is dedicated to them), we are humanly grappling with their distress.
My team and I are at the heart of the action. And we are convinced that adding more and more physicians to clinics or more patients for each physician will not solve the problem of access to primary care. It is high time to think differently. And to move away from the medico-centric thought, dating from the old school, which wants only the doctor to be king.
Part of the solution is to be found in multidisciplinarity. Each professional in our clinic has a role to play in improving patient health. Thus, therapeutic interventions do not necessarily have to go through the doctor. Improving the professional autonomy of nurse clinicians and the arrival of nurse practitioners specializing in physical and mental health are at the heart of the new center of care, not to mention the improved autonomy of clinical and community pharmacists. The great skills of our social workers and their in-depth knowledge of public services are a major asset in the quality and efficiency of care.
In summary, services to the population should focus on local services where anyone would be welcome (whether they have a family doctor or not), quickly sorted by a nurse and directed to the right worker depending on the reason for consultation, with a rapid assessment of the reasonable time to care for his particular problem. A pyramid of care is then set up where the doctor is no longer at the base of the service, but rather at the top, in order to provide care to those – and only those – who really need this type of clinical intervention. Everyone, patients first, wins.
All this is undoubtedly easy to write in black and white, but changing the ways of doing things in the medical sphere, with the strong corporatism of this profession (and its financial stakes), the lack of collaborative experience of physicians (even among the most young people) and university and hospital education that does not always go in this direction is quite a contract. No doubt, Mr. Dubé, you will need what we call political courage to move things forward and negotiate with all these fine people. Nevertheless, it is clear that in a certain way the logistical and organizational issues of the health system have become real obstacles to health, which is not lacking in ridicule in a rich society like ours and endowed with scientific means. that we have.
Is it time, Mr. Dubé, to shake up the cage of this system and move forward? With, perhaps, a commission (but not interminable) where the various professionals and members of the CIUSSS could testify to the failures and the ideas retained in order to make its letters of nobility to a first line of human care, simple – yes, yes, I insist on this word – and effective?
To ask the question is already to answer it.