The program to give ‘orphan’ patients access to care has proved its worth. Quebec must allow it to continue — and expand.
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I am a family doctor in Montreal. If you manage to make an appointment in our overloaded and heaving public system, it is one of my kind you would see first.
We are also the doctors at the centre of the latest dispute to hit our public health-care system. You’ve probably seen the headlines. The government plans to withdraw compensation for physicians who see patients without family doctors — via the online Guichet d’accès à la première ligne (GAP) service — effective June 1.
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A bit of background: The GAP initially seemed like a Band-Aid measure to most of us. Family doctors, who had just weathered the hurricane of the pandemic, were asked to take on an extra 500,000 “orphan” patients — those without family doctors — on the front lines. It seemed like an absurd ask, but we accomplished it and then surpassed the number by about double.
At the time of this writing, it is unclear whether a last-minute solution is struck to extend the agreement and under what terms. I leave that to others to sort out. My intention here is to share a few personal stories about GAP patients — some of our province’s most socially and medically vulnerable.
I saw Ms. M, a janitor and single mother, who was seeing a doctor for the first time in years. The relative ease of making appointments through the 811 and GAP meant she had finally managed to see a doctor on her day off. She had weight loss, joint pain, and ulcers in her mouth.
She had once consulted a nurse through an online service, spending her hard-earned cash, but online people cannot examine you, and she got pain meds without investigations. My questioning, exam and investigations revealed the diagnosis of an autoimmune disease, and she got appropriate care.
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Thanks to the budget that came with the GAP program, she got to see the newly hired social worker in our clinic to help sort out the issues with her employer and find resources for financial support while she was undergoing treatment.
Ms. D, a 55-year-old woman, had grappled with symptoms of menopause for at least six years. Mood swings, hot flashes, insomnia and brain fog are not a gift. Spoiler: She got better once she managed to see a doctor. One long appointment with an exam and discussion of pros and cons of hormones, and off she went with the medication that, I quote her words, “saved her sanity.”
She came to the follow-up appointment six weeks later, in tears, with her arms open for a grateful hug. I fought back my own tears. This should not have taken six years.
Then there is J, a three-year-old boy who had never seen a doctor in his young life, besides the moment he was born. I saw him for a fever and a cough, but noted he did not speak. His mother confirmed this, eyes downcast with guilt. It would have been next to impossible for her to seek care prior to GAP while holding multiple jobs and caring for her other children.
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I sent all the referrals it took and brought him back a month later for a follow-up. Sadly, few people in health care and reading this would be surprised that he had not seen anyone yet. I picked up the phone. Getting J through the doors of the audiology department at one of the children’s hospitals took me around 45 minutes arguing with admin and being directed to the wrong extension.
On the follow-up with results, it turned out that J was nearly deaf. The ear specialist agreed to see him quickly after another long phone call. This one has a happy ending. J began to speak at four years of age. You probably wouldn’t notice anything out of the ordinary if you met him next year.
Being the first point of contact for people who have not seen a health-care provider for years is not for the faint of heart. Yet comprehensive care of complex health issues is what we do, and what I humbly dare say we are very good at.
Quebec family doctors have grown this initially patch-up solution to be the lifeline for just under 1 million Quebecers. For many, it is the only way they would manage to consult a doctor. It is far from perfect. It is a two-year-old work in progress, and we are all working to grow it further and create more access.
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A few weeks ago, in news that came as a shock to all of us, the Ministry of Health decided unilaterally to withdraw from the contract that provides funding for the GAP. This means cutting access for people like Ms. D, Ms. M, and little J who badly need to see a doctor. I, as well as many of my colleagues, worry that cutting this lifeline would create much longer wait times and make access more difficult for those who are in the direst need for our expertise.
Even if the Fédération des médecins omnipraticiens du Québec (FMOQ) manages to reach an agreement with the government before June 1, what worries me is the significant setback to patient access that will already have been caused by the government’s actions.
Family doctors in Quebec have many roles. We work in ERs, on hospital floors, in intensive care units and birthing centres. We provide care at residences, rehab centres, walk-in clinics and a variety of specialized clinics. Our schedules, for the most part, are made months in advance, and with the news of the intention to cancel GAP, we filled our schedules with our other roles.
In other words, the GAP project has already taken a hit, and access to care by “orphan” patients will be limited in the months to follow even if a new funding agreement is reached. It will take time for the system to recover, and patients are the ones who will suffer — something I hope our government will keep in mind next time it decides to change a crucial component of our health-care network seemingly overnight.
Shadi Rajabi is a Montreal family doctor and hospitalist.
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