Share this page!

Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Twitter logo
Aug 12 • 6 tweets • 5 min read
🤔
How much time should a primary care doctor
SEE a patient (direct)
v.
THINK/MANAGE a patient's care (indirect)

This recent paper looked at all the EXPECTED work of primary care providers w large #'s of patients

@BCFamilyDoctors @DoctorsOfBC @JournalGIM
link.springer.com/article/10.100…
🐘 US Study

US & 🇨🇦 primary care recommendations are similar (NOT same, but similar)

Doctor-only care = 26.7 hours/day to provide "recommended" care (IMPOSSIBLE)

In a team-based environment (few in 🇨🇦) doctors need to work = 9.3h/day (Still a v. long day)

#primarycare #bcpoli Image
INDIRECT care in

doctor only model = 3.2 hours/d
= 12% of the IMPOSSIBLE day

team model = 2.6h/d
=28% of the very long day

INDIRECT CARE=
notes written
labs reviewed
forms filled
care coordinated
emails read
etc

HOW MANY PRIMARY CARE MODELS CONSIDER THIS WORK?
#primarycare
This "time motion study" followed
doctors in a
TEACHING CLINIC &
measured time spent on
direct & indirect care
& found that

~35 minutes/patient =
18.5 min face to face ~50%
18.6 minutes on computer ~50%

journals.stfm.org/familymedicine…
Both of these findings resonate with this 🇨🇦 study in @FamPhysCan (@Tina_Korownyk) that points out how large & (impossible?) the job is, & how some tasks may have little patient benefit.

INDIRECT care
is PART of PRIMARY CARE
measuring it
improving it
and paying for it are needed Image
This is the link for the @FamPhysCan paper by @Tina_Korownyk et al.

Competing demands and opportunities in primary care
cfp.ca/content/cfp/63…

• • •

Missing some Tweet in this thread? You can try to force a refresh
　

Keep Current with Dr. Rita McCracken, MD, PhD (she/her)

Dr. Rita McCracken, MD, PhD (she/her) Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @DrRitaMc

Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Aug 5
The #FamilyDoctorShortage
Can we fix it with more walk-in clinics?

A 🧵 about access hours
for (episodic) primary care in BC
based on our recent pre-print paper

#Cdnhealth #primarycare #bcpoli #tweetorial
@ircoopy @LindsayKHedden @UBCISU @sarah_fletch

medrxiv.org/content/10.110…
1⃣ What's the difference
between seeing a family doctor at a walk-in clinic
versus
a "regular" family doctor's office?

There are two typical kinds of "relationships" people have with a family doctor - EPISODIC + LONGITUDINAL #Cdnhealth #primarycare
A LONGITUDINAL relationship
with a doctor, NP, clinic,
ie you get to know each other

Research has shown that LONGITUDINAL primary care
improves the health of a community +
reduces overall costs of the system.

🪄Magic, right? #Cdnhealth #primarycare
pubmed.ncbi.nlm.nih.gov/16202000/
Read 20 tweets
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
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
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
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
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Jan 20
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.
Read 4 tweets
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
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
Dr. Rita McCracken, MD, PhD (she/her) Profile picture
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

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(