Summary of Meeting with Dr. Robert Drury
and CARP Ajax-Pickering/Scarborough Aug. 29, 2013
By Renate Crizzle
Dr. Robert Drury – Primary Care Lead for the Durham and North East Clusters.
Dr. Drury, a Lindsay-based family physician with over 35 years of experience practising across Canada including Northern Ontario, British Columbia and Prince Edward Island is the former Chief of Staff at Ross Memorial Hospital in Lindsay and was a member of the executive committee that oversaw the development of the Central East LHIN’s Clinical Services Plan. He has also served as the hospital’s Vice President and President of Medical Staff, Chief of Obstetrics, Chief of Pediatrics and Utilization Physician. As a surveyor for Accreditation Canada, he has surveyed small community hospitals and larger tertiary centres from Vancouver to St. John’s Newfoundland. Recently Dr. Drury travelled to Ghana in West Africa as part of a medical team to provide care in isolated communities.
Electronic records: Dr. Drury stated that other provinces, for instance BC, are way ahead of Ontario in electronic record keeping. In BC a doctor can access all pertinent information on a patient, all test results, all medications that were filled up to 30 minutes ago.
In Ontario it is not mandatory for primary care physicians to keep electronic records, however, the Ministry of Health is encouraging it. They pay for the cost of setting up an electronic system and pay up to $30,000 towards the set-up costs. A patient is entitled to ask for a copy of his/her record (the doctor may or may not charge a small fee). If electronic records exist, hospitals and other health organizations can access them. Previously, and still now in many instances, a patient goes to the hospital and somebody comes along with a clip board and takes down information from the patient which means that the patient has to be able to talk and remember all the details like medication names, illnesses, allergies, previous treatments, etc. But with the planned and expanding electronic record keeping, all this information will be immediately available to the attending physician thus preventing potential mistakes like administering wrong medications (i.e. allergic reactions).
If there is some sensitive data in the records, the primary care physician can indicate that this particular piece of information should not be forwarded to other health organizations, but a doctor cannot delete information from the records.
Operating mode: The way physicians operate has changed and will continue to change. First they used to work alone, then with partners, and now in family health groups working with allied professions (nurses, nurse practitioners, physiotherapists, etc.) and pharmacists. Specialists are not yet included in family health groups, only primary care physicians. Sometimes such allied health teams include social workers, housing experts, psychiatrists, etc. Such teams can do a better job at helping some patients than a primary physician can do on his/her own (health is influenced by many things). In a health care team not all the work needs to be done by the primary physician. His/her team can help with various tasks, such as information input, making home visits, telephone calls, etc. Also a team has more collective knowledge than a single person. However, not all physicians are on board with joining health teams. It is voluntary. Scarborough has mainly solo practitioners, i.e. primary care providers working on their own.
Rivalry in the health sector: There is a certain amount of rivalry among the health practitioners but primary physicians are gaining more clout. The new realization is that primary care physicians are actually important. The evolving role of the primary care physician puts more responsibility on his/her shoulders.
Changing care continuum: The continuum of care is changing. Previously the Ministry of Health looked at hospitals in isolation, i.e. as completely separate entities or silos. But staff in a hospital do not know the patient and his/her health history before the arrival at the hospital, nor what happens to the patient after his/her release. A new relationship pattern is the Health Link (in existence in Australia, England and Alberta) where the Community Care Access Centre (CCAC) is a central focus point, shares information and coordinates services between the silos.
Change in common diseases: The most common diseases are changing. We now have more cases of diabetes and obesity and less cases of heart disease and chronic lung disease (maybe due to less smoking). Primary care is shifting from the provision of acute care (for instance infections) to the management of chronic diseases. We also have better chronic disease management due to the health team approach.
Needed culture shift: Generally speaking there has to be a culture shift in the medical profession. The emphasis has to be on the Patient, not the interests of the Practitioners.