Today Greg should be turning 35. Instead we are left with fond memories of him and the pain of missing the many wonderful things he brought into our lives.
Greg died after many failures and gaps in the Alberta health system. Our description of Greg’s Journey is on our Health Arrows web site. The Health Quality Council of Alberta (HQCA) investigated some of the circumstances that Greg encountered and produced the Continuity of Patient Care Study (December 19, 2013). We believe 5 of those recommendations relate to the issue of after-hours care.
Since the HQCA report the College of Physicians and Surgeons of Alberta (CPSA) and the CPSA Council have taken steps to clarify their own standards on After-Hours Access to Care (now called Continuity of Care) and communicated to their members make sure everyone is aware of them. In Trevor’s Take, Dr. Theman’s contribution to The Messenger (March 2016 edition), he noted that after a second series of random calls to doctor’s offices in December 2015 the CPSA found that there was little improvement from the 2014 results. “This result is simply unacceptable” he wrote.
The CPSA standard is clear that it is not enough, during our doctor’s “after-hours” time, to have a message on their answering system telling patients to go to Emergency or to call Health Link (unless the doctor has made specific arrangements with this system prior).
From a patient’s perspective, most doctors’ offices are only open 40-50 hours per week, approximately one-quarter of the patient’s time. For the typical cold or flu, waiting to make a phone call, and then to organize an appointment for later is ok. But there are times when the issue is urgent, we cannot wait and there is the potential that the patient’s life is at risk. We need to be able to contact someone, if not our own doctor, who is fully informed about our case and who can successfully work with us in our care.
Without our most trusted health care provider, we are forced to join the line-ups in emergency rooms. There the staff must assess and make their own decision on treatment – often without all of the critical information. This worries us as patients and families, and it is definitely not the most efficient for the health system. Emergency rooms have the challenge of dealing with many patients caught in the same place regardless of the seriousness of their situation.
No one expects our doctors to work 24/7 although we certainly appreciate those who do provide patients with their direct contact information. The College requires their members to work together and organize to have someone available to respond when after-hours care is needed. This minimum standard of having an arrangement with someone or a facility accessible is barely enough and yet, there are too many doctors’ offices that do not even meet the requirement.
Greg’s surgeon’s office was closed on a normal business day less than 48 hours after surgery. His telephone recording was the non-compliant “call health link or go to emergency” message. Greg died from a blood clot less than 24 hours after we were forced to make a trip to Emergency to check for that exact concern. We agree with Dr. Theman’s statement that after-hours availability “It’s not just ‘nice to do’. It’s necessary.”
When we read the latest comments in The Messenger, we were very concerned at the lack of progress on compliance to the Continuity of Care Standards over the past 2 years (coming up to 4 since Greg’s premature death). We developed a plan to work hard to engage the public in supporting the CPSA’s efforts in order to succeed in getting all doctors to meet the bare minimum standards. Yesterday, when we suggested the plan to Dr. Theman before we implemented it, we learned that it wasn’t necessary. Over a thousand physicians have been contacted and those found not to be in compliance with their standards have been requested to report to the CPSA what they were going to do fix that. He said that the vast majority have responded positively. This is all great news of course. A remarkable change really, in less than a month from when the situation was described as “unacceptable”.
We look forward to the day that all patients will know how to quickly and efficiently contact our doctor (or the one that they have organized) when we need after-hours care for a serious condition that can’t wait.
Has that day arrived? We don’t believe so. Perhaps a timelier question is whether all doctors in Alberta either have put in place or at least have reported to the College with plans to meet the CPSA’s minimum standards for Continuity of Care. That question is one that we are going to find out more answers on over the next few weeks. We plan to seek some feedback from the public to help us learn how patients now feel about their after-hours care.