Patient-centred care means better coordination of medical appointments
I have lived in Kamloops, B.C., for 40 great years. I worked as an X-ray technician, mostly in the operating rooms, served my fellow workers as their union steward, and spent the rest of the time being a farm girl, competing with my horses in jumping and dressage events, enjoying life with my partner, Jim, and travelling a lot.
Twenty-two years ago I was diagnosed with breast cancer. Because Royal Inland Hospital in Kamloops is a mid-sized regional hospital, it offers most of the services needed for any diagnosis and some specialty treatments. However, for radiation therapy, I had to travel to Kelowna, a two-hour drive away. Before starting radiation therapy, I was scheduled for two appointments, a consult and a “mapping” of the region to be treated.
I never understood why all three of my initial visits (the third being the first round of radiation therapy) couldn’t be done in one trip, even if I subsequently needed to visit Kelowna for several consecutive days to receive the radiation therapy. To investigate this, I spoke with everyone at the cancer clinic from the chief oncologist to the booking staff. I compiled a report with several low-cost recommendations to streamline the system and sent copies to the cancer clinic, my provincial member of parliament and the Ministry of Health. My report appeared to generate lots of interest and everyone agreed that there was a problem, leaving me to think that some changes would be made.
Silly me—I came up against the same problem 20 years later.
In 2017, when I was diagnosed with atrial fibrillation, a disruption in the rhythm of the heart which is caused by chaotic electrical signals and can potentially lead to a stroke. All the diagnostic work was done in Kamloops, and I was referred to the atrial fibrillation clinic at St. Paul’s Hospital in Vancouver for a catheter ablation (cauterization of the areas in the heart causing the arrhythmia). In January 2018, I travelled down for what turned out to be a 15-minute chat with the cardiologist. The distance from Vancouver to Kamloops is 350 km; I flew down and bussed back. The trip cost me about $400, when a videoconference would have sufficed.
In April, I had a successful ablation in Vancouver.
In October, I was supposed to return to Vancouver for a checkup, but for unrelated health reasons I couldn’t travel so I requested that we do the appointment remotely. I assumed this would be by video, but when I discovered it wasn’t, I asked why not. Over the phone, the cardiologist told me the video equipment was in a different building, and it would have been too much of a “hassle” to go there. I guess it wouldn’t have been a hassle for me to travel to Vancouver again for a brief face-to-face at a cost of another $400!
After the successful ablation, I was asymptomatic. Even so, protocol demands that one remain on blood thinners, which was no longer possible for me. It was recommended that I be monitored by implanting a loop recorder. This is a small device that looks like a USB and is implanted under the skin near the heart, recording any time the heart exceeds pre-set parameters.
I was referred for the insertion of the device at St. Paul’s last fall.
I phoned the cardiac unit in Kelowna, and sure enough, they are able to implant loop recorders. I requested that my referral be sent there.
When the referral arrived in Kelowna, they called to let me know that the procedure could be done in Kamloops! This is a five-minute outpatient procedure! And yet, even after the recorder was implanted, I had calls from the Vancouver booking office to arrange an appointment at St. Paul’s.
Over the space of one year, I made one expensive and unnecessary journey and avoided at least two others. Not everyone is as lucky. But why? The atrial fibrillation clinic is in another region, yes, but it’s in the same province. The way the health authorities communicate with each other—or don’t—it’s as if they were in different countries.
Our health care system creates obstacles for patients when appointments are booked for tests, exams, consultations and procedures. For many, especially in remote areas, this causes anxiety, unnecessary expense, a waste of time and personal chaos.
I think this is a result of the rapid growth of the health care industry, the wide variety of services, regional fragmentation and swift technological change. I don’t doubt the good intentions of health care workers, but the lack of interest in scheduling flies in the face of “patient-centered care.” It is quite the opposite.
My goal is to change this part of the system. I want the mantra of patient-centered care to actually have some teeth. I want video and telephone consultations used where appropriate. I want health authorities to give greater consideration to the upheaval, cost and stress that unnecessary travel causes people.
Earlier this year, I sent a report to the Interior Health Authority in B.C. which was discussed at their board meeting in February. In mid-April I met with the same board. They get it! I have to be optimistic that remote consults will soon become the norm where appropriate.
I am not stopping there. I have spoken to many organizations. I have collected tales of frustration from people to share with authorities (personal information redacted). I interview specialists about changes they can accept around using video instead of face-to-face. I am networking with others around the province who share my goals. Government departments are hearing from me. It is a steep learning curve, but I am becoming a very squeaky wheel.
Fanny Monk is a retired X-ray technician and union activist, former competitive horsewoman and farm girl who rides a Can-Am Spyder for fun. Now her priority is working to change health care booking systems.