Doctorless Canadians

Over the four times Dawn Beharry has been stricken with the same, persistent infection since January, she has had one wish: that she could see a family doctor who would remember her. She can't find one. "I've settled on coming here to see whomever, randomly," she said, referring to the Doctor's Office walk-in clinic at Bay and Dundas Sts. she has visited over the past three years.

Beharry, 26, is one of 4.1 million Canadians aged 12 or older who are without a family doctor, according to the 2007 Canadian Community Health Survey, which questioned more than 65,000 Canadians about their health. The report was released yesterday. Among its worrying statistics: Recent immigrants, the poor and the young were all more likely than the bulk of Canadians not to have a regular doctor. Only 65 per cent of immigrants who have been in Canada for five years or less have access to a family physician, compared to 85 per cent for the whole country, according to the study.

Income level, gender and age also play a role. Of the 20 per cent of Canadians with the lowest incomes in the country, 82 per cent see a family physician. Men were nearly twice as likely as women not to see a regular doctor. And the probability of having a primary doctor increased with age.

So what do Canadians without regular physicians do when they get sick? The survey found that among those who have no regular physician, 64 per cent chose to go to walk-in clinics, 12 per cent visited a hospital emergency room, and 10 per cent visited a community health centre.

In the past year, Beharry has visited both walk-ins and even the emergency room at Mount Sinai Hospital, where it was three hours before she saw a doctor. "It just really sucks," she said. She thinks that if she had been seeing the same doctor regularly, her chronic bladder infections might have been cured by now. Beharry used to have a family doctor as a child, she said, but no more. "He's at Bayview Ave. and Sheppard Ave.," she said. "I live in the east end." To find a doctor in Canada, she reflects, "you have to go through people you know."

Sylvain Tremblay, an analyst who worked on the Statistics Canada study, was careful to note that the majority of Canadians who don't have a doctor haven't looked for one. Most of those people, he said, are also young and in good health. But the number of us who, like Beharry, have made an effort to find a family doctor and failed – 6 per cent – is statistically significant, he added.

Torontonians can consider themselves lucky: 88 per cent of us have access to a family doctor – three percentage points higher than the national estimate. The percentage of Canadians who do not have a regular doctor is slightly higher – by three points – than it was in 1996.

Source






Australia: Hospital Emergency Dept. 'like war zone'

South Australia: Flinders Medical Centre's emergency department "is frequently overwhelmed and resembles a war zone", the hospital's general manager has admitted. The comments were made in a letter of apology to a patient who had made a complaint to the department. The letter is from Flinders' general manager, Associate Professor Susan O'Neill, and apologises on behalf of Dr Di King for any distress the patient, Kathryn Gibbons, of Encounter Bay, had suffered. Dr King was one of several doctors to see Mrs Gibbons that night.

"Your comments regarding the level of overcrowding and strain on the ED at the time Dr King totally agrees with," it says. "Regrettably, the ED is frequently overwhelmed and resembles a war zone. "Staff struggle to maintain basic patient comforts and service, however patient safety is our highest priority and this was maintained." Mrs Gibbons suffers a rare and severe form of asthma, known as "brittle asthma".

In January, she went to Flinders to seek treatment for her asthma but, after a long and frustrating wait during which she felt her needs were ignored, she drove back to Victor Harbor to get treated.

In May, she wrote a letter of complaint to Flinders. On June 13, she received the letter from Associate Professor O'Neill, which goes on to assure Mrs Gibbons that she was in no danger and that her treatment was appropriate.

Southern Area Health Service chief executive Cathy Miller, speaking on behalf of Associate Professor O'Neill, said the letter was paraphrasing Mrs Gibbons' own words. She added that the emergency department was getting busier and putting additional pressure on workers. "There's no doubt the EDs are busy places and we've experienced an increase of 5 per cent from last financial year to this financial year, which is an additional 3000 patients," she said. "It is an emotive place to work and people are passionate about what they do. It can become a busy place (and) it can look quite chaotic."

Ms Miller said they were having success with new measures to improve patient flows and that the redevelopment of the department would also help. "It is the time lag between demand going up and other processes kicking in," she said.

The letter's release comes in the middle of a bitter and prolonged dispute over pay and conditions. Up to 85 per cent of the emergency specialists from the state's public hospitals have handed in their resignations, effective on Friday. FMC emergency medicine senior consultant Dr David Teubner said the doctors were resigning because the overcrowding in emergency department was risking the safety of patients. "It is impossible to practice safely in an overcrowded environment (and) the majority of the time there are more patients than there is space for them," he said. "It's undignified, it's just an awful environment in which to work. It's just soul-destroying. "To deal with (the overcrowding) we need adequate numbers of senior staff and we're unable to attract such people from interstate because of the pay."

Dr Teubner also said this year was the worst it had ever been, and that it would get even worse with winter. "The hospital is doing an enormous amount . . . to make things better but we're busier than ever and there's pressure from the Department of Health to close beds to save money," he said.

Health Minister John Hill said there was a "huge increase" in presentations at Flinders, but the State Government was working to address the issues. "We know thousands more people are going to FMC every year seeking help in the ED. Our ageing population and the shortage of GPs in the south are resulting in this huge increase in presentations," he said. "And the State Government is addressing this through the $153 million redevelopment of FMC, including building a brand new ED with increased capacity. "The expanded and redeveloped emergency department will include 21 additional treatment cubicles, to cater for an extra 14,000 people seeking treatment every year."

Mr Hill added that a GP Plus Health Care Centre at Marion and extra staff being employed by the Government would also help. Doctors and the State Government met again at the Industrial Relations Commission last night to discuss the enterprise bargaining agreement. Industrial Relations Minister Michael Wright said a new offer to the state's public doctors had been put on the negotiating table. He said talks were "progressing well", and they would possibly continue over the weekend. SA Salaried Medical Officers Association senior industrial officer Andrew Murray said there were still "significant issues" to be resolved.

Source