I think Nurse Practitioners are a part of the solution to the #FamilyDoctorShortage in #BCPrimaryCare and the rest of 🇨🇦

👀
I expect to hear the following "buts"

1- see too few patients
2- spend too much time per pt, cost too much
3- have less training than FP's

And, I agree they are not 1:1 replaceable with FP's

But a "doctors only" fix to Primary Care is so 2019
Team-based primary care with other care providers:
nurse practitioners
nurses
OT/PT
counseling
SW
pharmacist
elders
patient navigators

This is what is going to address the shortages, in a meaningful and sustainable way.

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More from @DrRitaMc

Jan 26
Why is my family doctor running so far behind?

Another 🧵
to explore
the inner workings of
🇨🇦 care,
and
why the
#FamilyDoctorShortage
will not be fixed
by just hiring more family doctors.

@BCFamilyDoctors
There are two main reasons your doctor is running late:

1) undifferentiated illness
2) primary care service funding being stuck in 1985

#FamilyDoctorShortage
Let's start with undifferentiated illness.

You can show up at your family doctor's office looking for help for ANYTHING:

contraception
anxiety
drinking too much
sore knee
cough & fever
question about a drug ad you saw on TV
etc

#FamilyDoctorShortage
Read 17 tweets
Jan 24
What happens
when your
family doctor
orders
LAB TESTS
for you?

Another 🧵 about the inner workings of 🇨🇦 primary care (or how the sausage gets made), and how fixing the #familydoctorshortage is not just about hiring more doctors.

@BCFamilyDoctors
Let's say you go to your doctor,
after considering your story (= reason for your visit), your past medical history,
the possible diagnoses/treatments
for the issue,
she decides to order blood work (=evidence-based medicine),
& you agree with that (=shared decision making).
She creates a LAB REQUISITION (="req")
She selects the tests that she thinks will help understand/treat/monitor the issue.

This is based on what she learned in med school, what she learned staying up to date(=Continuing Medical Education) & sometimes, a specialist's advice
Read 11 tweets
Jan 15
I am a generalist,
full-service family doctor,
working in a clinic
that provides
longitudinal primary care,
and I referred
a few patients
to specialists
this week...

here's how and why that happens 🧵 1/9

(#BCPrimaryCare)
When I see a patient, we talk about:

-the reason they needed the appointment today
-how life is going in general
-as needed, their other medical history

after I get hear the story
do a physical exam
review old information
We may decide that we need extra advice
2/9
Sometimes it is:
to confirm the diagnosis or
change treatment or
decide on tests or imaging
consider surgery
etc

I need to formulate a specific question & summarize the patient's condition, history and preferences. I do this both on the fly & after the appointment. 3/9
Read 11 tweets
Jan 9
I am on call for my primary care clinic this week...

What does that mean?

A 🧵 about how
our fee for service (soon to be "group contract") clinic
of 16 clinicians, ~15,000 patients
delivers afterhours #BCPrimaryCare

@BCFamilyDoctors
Our MDs and NPs are on call for one week at a time.

Between 5pm-8am weekdays and all weekend,
we need to be ready to
support patients for
URGENT, not emergency issues
that cannot wait until the next business day

that means phone close by at all times
People call appropriately for:

e.g. sick baby with fever, to figure out does she need to go to emergency or can stay home

or

e.g. strained back shoveling snow and want to know what can do to alleviate pain

I can bill a "telehealth visit: 14x37"
~32$ for call + documentation
Read 15 tweets
Sep 28, 2019
@DocVan_Nostrand @MariaMichelleH Putting all the responsibility/money for all the things on family doctors, is not really working out:

❗️clinical care
❗️teaching learners
❗️running office
❗ transforming primary care
❗️Leading quality initiatives
❗️evaluating system change
❗️increasing access & capacity

🤔
@DocVan_Nostrand @MariaMichelleH What is the work that Family Doctors *must* have a leadership role in... ?

And what work could we rely on skilled professionals for?

(Analogy: if I was renovating my house, which bits would I want to be in charge of v. Get advice v. contract out completely)
@DocVan_Nostrand @MariaMichelleH I forgot

❗️cleaning data in your emr
❗️attending evening meetings about new fee codes &how to increase billing’s
❗️order the right amount of flu vaccine
❗️know all the non profit support services to refer your patients too in the lower mainland
❗️store &archive charts forever
Read 8 tweets
Sep 23, 2019
THREAD: Everyone gets a Family Doctor!

This new announcement by the @liberal_party recognizes the value of primary care. liberal.ca/liberals-move-…

And research shows us that access to primary care saves lives!
ncbi.nlm.nih.gov/pmc/articles/P…
Details in the Libs announcement are sparse, but to my BC ears, it sounds familiar ... GP for ME
straight.com/life/630116/gp…

Great idea, pay GP's a special incentive fee to take on more patients and ... everyone gets a GP, problem solved... right?
Except... it didn't work:
timescolonist.com/a-gp-for-me-do… (@cindyeharnett)

because...
Read 14 tweets

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