Re: Crisis facing family practice

This is further to the discussion regarding access to primary medical care in the BCMJ (2004;9:441) in which Dr J.R. Dale notes that walk-in clinics are often more challenging to work in because of the lack of knowledge of the patients’ history.

Two interlinked problems facing patients across Canada are, first, the inability to find an available family practitioner and, second, having to attend the rushed service that is often available at walk-in clinics and emergency rooms, without an adequate medical record.

These problems would be greatly ameliorated if the patients’ medical records were in their hands.

In France, where they have a generally well-received and efficient medical service (total hip replacement in 2 to 4 weeks and appointment with specialists within 10 days), they are moving in this direction. At the moment each patient has a carte vitale which functions like a credit card. It has the vital statistics of the patient and a health care number. A photograph is being added to avoid fraud. After seeing the doctor the patient hands in the card at the desk together with the doctor’s billing information. The card is swiped and the physician is paid within 48 hours.

It is the intention of the French health care services to develop this carte vitale into patient-held notes (dossier partage). The patient would present a small electronic disc or card to the physician who would enter a note and hand the electronically recorded medical history back to the patient. It is not clear at this stage whether this would be integrated with the billing system.

With our patients already having free access to medical information in the records, it is not much of a stretch for them to have the records. Certainly sick patients who are unable to find family doctors and who have to make the rounds of walk-in clinics and emergency rooms are far better off with their medical histories in a quick electronic form in their pockets than having them in the filing room of the previous GP.

The colleges may be reluctant to go along with this because of a defensive attitude to litigation, but since all notes are part of a patient-owned record each new doctor might be encouraged to make an intelligent note, making litigation less likely.

A spin-off benefit of this system would be the removal of files and the space they occupy from doctors’ offices. This is now becoming a crisis with retiring physicians who are unable to find available practitioners to pass the records on to. They have to be kept for 7 years, or in the case of a minor, for 7 years after the age of majority, which could be 20 years. Walk-in clinics won’t accept them. There can be no argument medically that the record would be far better placed in the hands of the patient who needs it.

I think the Canadian colleges should look at this idea. It may well be not only the way of the future, but it would immediately solve most problems of patients not being able to find informed primary medical care. Apparently several European countries are watching the French system to see how it develops.

—Anthony Kenyon, MB
Fort Nelson