Changing health-care delivery

Hey there, time traveller!
This article was published 31/10/2023 (771 days ago), so information in it may no longer be current.

Health care has been at the forefront of the news for the last few months and many promises and solutions have been suggested in order to improve the system. However, all the solutions offered won’t really change anything. We may be able to hire more workers and reopen some ERs, but we will still be dealing with a dysfunctional system led by five levels of faceless bureaucracies.

Shared Health, one of the bureaucracies involved, promised a new provincial health organization with a focus on patient-centred planning. Unfortunately, its actions don’t match its words.

Nobody has a clear idea on how to reform health-care delivery in Manitoba. It has become too complex.

“Patient-centred planning” is certainly one key to success as long as it goes beyond words, but success can only be achieved by stopping trying to fix the system as a whole and focusing instead on small areas that have been identified as problems.

I have had the privilege of practising family medicine, as well as sports medicine for many years and this experience has been very valuable in opening my eyes to some very needed reforms in the area of musculoskeletal disease management.

One example of a problem area is the management of patients with back pain, a very common and mismanaged problem.

The presenting facts are as follows:

• Patient is suffering from low back pain and books an appointment to see his own physician.

• The family physician, for multiple reasons (overworked, lack of experience in musculoskeletal diseases) gives a very basic and insufficient assessment of the patient.

This statement does not intend to criticize family physicians, but is more an acknowledgment of the reality. To be comfortable and proficient to manage musculoskeletal problems, one needs to see such conditions on a frequent basis. Musculoskeletal examination is also time consuming — putting excess stress on overworked physicians.

• Following this visit, the patient will likely be sent for an X-ray, followed by CT and/or MRI.

• CT scan/MRI will likely show abnormalities resulting in a surgical consultation.

• After waiting years, the patient is finally seen by the surgeon.

For the first time, a proper clinical evaluation is done. This evaluation concludes that the radiological findings don’t correlate with the clinical findings and surgical treatment is not indicated. The patient is returned to the care of their family physician.

Such a scenario identifies the following problems: overworked physicians; lack of expertise by family physicians in musculoskeletal diseases management; inappropriate use of X-rays, MRI and CT scan; long waiting time to have tests and see a surgeon; and patients not treated appropriately and in a timely fashion.

A possible solution to resolve this situation is to establish a back clinic.

Such a clinic, staffed with sports medicine physicians, athletic therapists and physiotherapists, will have the goal of seeing patients suffering from back problems, do a complete clinical assessment and treat in an appropriate and timely fashion.

Patients needing physiotherapy and exercise therapy (majority of cases) can be seen the same day by athletic therapists and/or physiotherapists in the clinic and have followup accordingly. Patients with severe pain will be referred to the pain clinic. Patients suspected of needing a surgical treatment (the most infrequent situation) will be fast tracked for investigation and/or surgery.

The advantages of this system are that patients will get appropriate treatment in a timely fashion. Family physicians lacking expertise in musculoskeletal conditions or overwhelmed by work, will have the opportunity to make a quick referral to the back clinic. Ideally, self referral should be offered as well, eliminating the need to see a family physician. Cost savings for unnecessary tests will be achieved. Waiting list for CT/MRI and surgery will improve as well.

This is but one example of a complex medical problem that can be resolved by patient-centred planning. To be successful, front-line workers familiar with the situation must lead and manage the process.

Resolving this problem area will also improve health-care delivery in other areas and contribute to better functioning of our health-care system.

The new NDP government has promised to allow more decisions to be made at the front lines.

Hopefully they will act on their words before throwing money at a dysfunctional system.

Philippe Erhard is a retired family and sport medicine physician.