🩺❤️‍🩹
The #FamilyDoctorShortage in 🇨🇦 is ... bad.

What can you do to keep yourself as healthy as possible if you don't have a family doctor?

A🧵of (unofficial) ideas for "the unattached" 1/11
2/
❤️‍🩹🩺
First, let's get this important caveat out of the way...
If you are VERY SICK
e.g. issues breathing
or chest pain
or you're bleeding excessively
or another urgent/emergency condition

GO TO THE CLOSEST EMERGENCY ROOM or CALL 911
3/
🩺❤️‍🩹
2nd crucial caveat
If over the last 3-6 mon you

-had unintended weight loss >10lbs
-have drenching night sweats (& aren't experiencing menopause)
-blood in your stool/urine
-have a breast lump

Get seen by an MD < ~2 weeks, & tell them these things (in person>>virtual)
4/
❤️‍🩹🩺
Ok.
You don't have a family doctor & you want to stay healthy...

VACCINATIONS 💉
SAVE LIVES &
REDUCE ILLNESS SEVERITY &
ARE SAFE
get them, all of them.
Great resource to get yourself & your kids sorted for which ones you need, etc👇
immunize.ca
5/
❤️‍🩹🩺
Ok.
You don't have a family doctor & you want to stay healthy...

WASH YOUR HANDS
&
WEAR A MASK AROUND SICK PEOPLE
(this usually means most public places... the bus, the mall, at work, etc)
*effective masking reduces transmission of airborne viruses
6/
❤️‍🩹🩺
Don't have a family doctor &
you have a cervix &
are between 25 - 69 yo
GET A PAP TEST EVERY 3 YEARS

In BC, there is a clinic locator for pap tests for people with no family doctor: bccancer.bc.ca/screening/cerv…
(please add other provincial resources as a reply to this tweet)
7/
❤️‍🩹🩺
Don't have a family doctor &
you need a refill of your regular medications

1) check and see if the pharmacists in your region can renew them
2) try a walk in clinic (in person >> virtual)

the emergency department should be your last resort for this kind of thing.
8/
❤️‍🩹🩺
Don't have a family doctor &
you want to stay healthy

EXERCISE
movement is medicine
if you are able, walk, a lot
10-15,000 steps a day will do wonders for your mind & your body
go with a dog, a friend, an audiobook, or listen to the birds
9/
❤️‍🩹🩺
Don't have a family doctor &
you want to stay healthy

Do the things you know you should:
-stay hydrated
-wear your seat belt
-floss
-minimize alcohol/other substances
-quit smoking
-get enough sleep
-make more friends
-get a hobby!
10/
❤️‍🩹🩺
Don't have a family doctor &
you have a cold

colds are normal &
as long as you can breathe well
are eating & drinking relatively normally...
a sore throat + fever + cough + runny nose is usually viral & takes 5-21 days to clear in healthy people wellness.uoguelph.ca/services/healt…
11/
❤️‍🩹🩺
Don't have a family doctor &
you really want that to change?

WRITE A LETTER TO YOUR
PROVINCIAL
&
FEDERAL
Members of Parliament
ourcommons.ca/Members/en

Tell them your story
Tell them you want SECURE FUNDING &
EVIDENCE-BASED solutions for our Health Work Force crisis

• • •

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More from @DrRitaMc

Sep 20
How do we fix healthcare?

A @CBCnewsbc spoiler 🧵
1/

❤️‍🩹🩺⬆️⬆️ FED & PROV 💰💰 in PRIMARY CARE

=Directly fund buildings + operations + non-MD staff

= "global funding" to CHC's-no more grant hustling to pay for community health needs

=transparent evaluation & QI

#bcpoli
2/

❤️‍🩹🩺 SHIFT MD PAYMENT TO MODELS THAT INCENTIVIZE HIGH-QUALITY, LONGITUDINAL CARE

= e.g. capitation (lump sum pay based on # and complexity of patients in a practice)

≠ fee for service - it incentivizes VOLUME
3/

❤️‍🩹🩺 INTEGRATE PRIMARY CARE w MENTAL HEALTH & SOCIAL SERVICES

💥income disparity, racism, colonialism, etc have serious deleterious effects on health

💥addressing these "social" determinants of health in primary care is essential (ref: @BCACHC)
canada.ca/en/public-heal…
Read 6 tweets
Aug 31
🧵 1/5
Will "time modifiers"
added to family doctors fees
help more people in BC
access primary care?

🩺❤️‍🩹Probably not

2006-14, BC spent a BILLION $$ (!!)
with incentive fees family doctors for work that typically takes more time (e.g. mental health)

#bcpoli #primarycare
2/5
The new fees were "on top" of the usual "fee-for-service"

The stated aim:
💥to encourage family doctors to return to a traditional model of "full-service family practice"💥

And acknowledged that some work was taking doctors MORE TIME⌚️
@globeandmail
theglobeandmail.com/opinion/was-bc…
3/5
The result?😢

-family doctors got paid more
-family doctors saw fewer patients

⁉️But maybe patient outcomes like hospitalizations improved, she types hopefully (see next tweet...)

ref: longwoods.com/content/23782/…
Read 5 tweets
Aug 31
1/5
Today is International Overdose Day

Education is important

Whether it's
understanding how to use naloxone students.ubc.ca/health/health-…
or
proper language when speaking about substance use
fnha.ca/Documents/FNHA…

there is a lot of learning to do.

#IOAD2022 @BCCSU @CHEOSNews
2/5
Our REDONNA team has been working on educating prescribers in BC about sparing opioid analgesics for noncancer pain among opioid-naïve patients.
@ShawnaNarayan @ircoopy @JanKlimas @Drug_Evidence
ti.ubc.ca/2021/11/24/web…
3/5
200 participants (FPs, NPs, Nurses, and community members) attended an educational webinar focused on opioid sparing practices and the (lack of) evidence for opioid analgesics to treat noncancer pain.
You can read more here: doi.org/10.1093/fampra… (3/5)
Read 5 tweets
Aug 31
The REDONNA study doi.org/10.1016/j.cct.…
began from the motivation for improved & safer opioid prescribing in primary care

We aimed to educate MDs about their OWN prescribing practices using audit & feedback letters developed by the @Drug_Evidence @JanKlimas @ShawnaNarayan 1/4
They received information about the number of new opioid initiations & how they compared to the average physician. They were provided information on the (lack) of effectiveness on pain for opioid naïve patients through an educational webinar: doi.org/10.1093/fampra… (2/3)
From this study, we hope to support the uptake of quality prescribing practices that are equity-oriented and evidence-based to help patients experience less pain. (3/4)
Read 4 tweets
Aug 25
1/ Why I am worried about these emergency funds and why I think they probably won't help improve primary care access, a thread #bcpoli #PrimaryCare
2/ 💯Primary care is in a terrible state in BC (has been worsening for 20 years), and this money might "stem the bleeding" but it won't remedy the sharp objects causing the bleeding🩸🩸🩸
3/ Imagine public education in the same state, a million kids don't have a school to go to and teachers quitting everywhere because they are burnt out, and the cost of running their own school is unsustainable
Read 19 tweets
Aug 12
🤔
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
Read 6 tweets

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