For years we did not have a primary health care provider. Then we were lucky enough to be taken on by a clinic of Nurse Practitioners. A few years ago we had the extremely good fortune to be taken on by a Family Doctor, it was like winning a lottery.
In my opinion Nurse Practitioners cannot replace Family Doctors. I have a few theories as to why that is, but since I have not apprised myself of the raw data for analysis, they are not worth discussing other than for research formulation. My opinions are based on experience, decades and decades of experience, managing not only my own health care, but having spent 27 years managing the health care of my children.
The results of having experienced the full range of care options in Ontario, Canada, is that there is no substitute for a Family Doctor. The other options where I have lived and live are: Practical Nurses, Walk in Clinics, Urgent Care Clinics, and Emergency Departments. I have extensive experience with all of these options. These alternative options do not offer an adequate standard of care, for various reasons. Practitioner education is something that needs to be considered when assessing the efficacy of different alternatives for primary health care. However, most of the reasons that the alternatives are inferior, in my opinion, are related to funding and infrastructure, which is in the control of politicians.
I have never met a politician I liked, although there are a few, very few, for whom I have a modicum of respect.
Some years ago I was part of an international team working on the development of patient centred outcome measurements for health care. It was a privilege to work with seasoned and dedicated health care professionals from around the world on one of the Standard Outcome Sets. I was pleased to be one of the authors listed on the adjudicated journal publication of the work, and even more pleased to have been able to participate in something so worthwhile. A good finale to my academic career.
An example set is for Heart Failure (not the set I worked on).
What has me thinking about all of this is my experience yesterday.
The next six months my life are going to be very focused on my own health care.
The years Attila and I went through without a Family Doctor meant we had no consistent, and sometime inadequate health care. When we finally were taken on by our Family Doctor there was a lot of catching up to do. Some conditions had been left undiagnosed and untreated too long, making them harder, and in some cases impossible, to treat. Other conditions needed to be reassessed and treatments updated to meet current knowledge, technology, and standards. Our Family Doctor is excellent.
My general health is excellent, “for my age”. There is a great depth of meaning behind that saying, “for my age”. And of course, there are my anaphylaxis and my aneurysms, both potentially life-threatening, requiring significant and permanent lifestyle adjustments, but causing no discernible day-to-day symptoms.
Although I am in general good health, it is hard work maintaining that condition. A great deal of time and self-discipline is required in designing and maintaining diet, exercise, and daily routines that support good health. These measures, so far, have kept extreme chronic pain at bay, allowed me decent mobility, and have optimized my chances with anaphylaxis and aneurysms.
However, maintaining good health also involves interactions with the world of medicine. I have many health care appointments coming up in the next six months, involving different health issues, and different health care professionals. I feel pretty good about my Family Doctor, and the specialists I’ve already consulted with. But there are three or four new health care specialists and teams that I will be meeting for the first time. This involves new tests, new treatments, new people, and some surgery. It is a lot to take in.
Yesterday I felt overwhelmed by the weight of the health care journey, after delivering referrals to the next new health care facility. They were not friendly, which I seldom notice, but yesterday, for some reason, I found it upsetting.
Yesterday, after the referral experience, I logged into Youtube, and the first random video to display was for the movie Wit, starring Emma Thompson and Eileen Atkins. I had never heard of it. Not an easy watch, but I am grateful for the experience. The film deals with the concept and reality of death, so viewer beware, truly not an easy watch. Breathtaking talent, an excellent film in every way. Strangely, it was just what I needed, when I needed it. It brought clarity to several internal issues I have been dealing with. I found it comforting. Honesty affects me that way, even if it is something I don’t care for, I find it comforting.
I am not a fan of comfortable falsehoods.
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Quote
You can take all the sincerity in Hollywood, place it in the navel of a firefly and still have room enough for three caraway seeds and a producer’s heart.
Fred Allen
1894 – 1956
Maggie, I’m glad you’re going to get the health care you need but don’t envy you the journey. We’ve spent several years now dealing with my husband’s various health issues (which are ongoing) and I know how taxing it is even through I just drive the car. Take care.
Thank you Wendy for your kind thoughts. How wonderful you are to be there for your husband, as Attila is here for me, it certainly means a lot to have that kind of support. And I am sure it is taxing in its own way, to be by the side of a loved one going through health challenges. Best wishes to you and your husband!
I hope your new health care facility experience improves, and that the doctors there are skilled. I am impressed with the diligence with which you manage your health. I am diligent in some things (diet), but don’t exercise much.
Oddly, Julia and I just got back from dealing with those ‘power of attorney’ and ‘living will’ papers. We morbidly joked around which might have unnerved the notary public people. (The bank did one set, but we had to go to UPS for the other set.) The hospital system now has our wishes on record.
Maybe we’ll look into the movie? I’ll at least read about it at Wiki and IMDB.
Thank you Joan! I’ve always loved to walk, I think it stems from my Granny taking us for walks when we were little, it was such a joyful time.
Such a great idea, having power of attorney and living will documents! You have inspired me to research the legality of these things here, some surprises as I do the reading! It is definitely something to attend to!
The movie is intense.
Here in Canada we have MAID (Medical Assistance in Dying), which is quite wonderful, and allows people to leave with dignity, and without undue suffering.
You are the only person I know of, besides me, who has watched Wit. It was many years ago but I’m not sure I want to watch it again. Thompson was great, as always.
Out here, the nurse practitioners are so popular it takes 6-8 weeks to get an appointment. A doctor can be seen within a week. It’s because the nurse is a permanent resident in the community, while the doctors rarely stay more than the year or two they’re contracted for. They want to live in an urban centre where there are more opportunities for their spouse and children to be occupied with, I think.
Also many of the doctors are immigrants whose English is hard for some to understand, which doesnt help. There is racism. And often we hear that the temporary doctors don’t seem very good at their jobs — some of the stories about the ineptitude, condescension, and arrogance of some of them are shocking.
Kate, I loved the film Wit, but found it intense. I think watching it once has been very enlightening, and that the things I am exploring as a result of watching it will have a permanent effect on me. This is a good thing for me. I do not anticipate that I will watch it again, but I think adults should watch it once, for educational purposes.
Having continuity of care is important, so the popularity of local Nurse Practitioners makes a lot of sense, when Doctors come and go with great frequency, and are not familiar with the culture and the language. The context you are describing is very different than the one where we live.
I will say that smaller towns are difficult to integrate into even if you are born in Canada, familiar with the culture and languages. We find that here we are considered outsiders by the people who grew up here, who know each other from elementary and high school. People are nice enough, but we will always be outside of their shared history.
This has changed a bit with the pandemic, when office workers began working from home, so that there was an influx of remote workers from places like Toronto, buying homes here that were more affordable. They could live here and work in Toronto at the same time. The demographic change was noticeable during the last Federal election, voting didn’t go the way it always had in this area, local people were generally cranky about that political shift.