Family doctor and medical secretary

Friday, 8 p.m. I have just finished my visits to the office, my 20 calls, my labs and my many faxes (drug renewals, corrections of my typing errors from my electronic file), not to mention the online forms (requests for exceptions to the provincial payor RAMQ, consultation requests) and the forms to be printed, then faxed. I have become a good medical secretary: in addition to my electronic file, which I finally mastered, I have everything at home to scan, fax and send documents by secure email. Soon to be 65, I am less energetic, but fortunately more patient. I note once again this evening that more than 80% of my 12-hour day has been devoted to countless clerical efforts so that my patients can access the health “system” and be seen by specialists. These people, visibly more overworked than me, delegate their administrative tasks to me more and more. I'm sure they don't forget to ask the patient: Do you have a family doctor? Because that means they can delegate the boring work to me. Here are a few examples from my day as a “family doctor:” A 48-year-old patient, whose mother died young of gastric cancer, whom I had referred to a gastroenterologist: She informs me that he found her, 12 months ago, that she has Barrett's esophagus, but I did not receive this report. The gastroenterologist requires a new referral from me to redo his gastroscopy annually. An illiterate patient, whose mammography and ultrasound are "borderline": The radiologist recommends a follow-up ultrasound in six months, 12 months, 18 months and 24 months, examinations that her secretary does not allow me to register on the same requisition. I must therefore put these four requisitions in my schedule for the next two years, while reassuring the worried patient. A roofer treated by an orthopedist for an ankle fracture: It will be up to me to complete the work stoppage form, even if I do not know much about the duration of the disability in this case. An elderly patient for whom I received three pages of medications from the pharmacist to renew: I discovered a cardiac anti-arrhythmic prescribed by a specialist whom I did not know and of which I did not have the report. I call the patient: he does not remember having met him. A request for urgent renewal of diuretics for a negligent heart failure, 18 months late for his blood tests: I am "at fault" if he has an electrolyte abnormality, and just as much if I do not renew his diuretics. A complex and demanding patient, in depression versus personality disorder to be specified, for whom I worked very hard to obtain a diagnostic consultation in psychiatry (forms, repeated calls). But the patient was put on the waiting list with a delay of at least six months. He says he is unable to work and his insurance company requires a diagnosis from me in order to prolong his work stoppage. A 73-year-old man with metastatic cancer who has lived 200 kilometers from my clinic since his retirement. I spend long hours looking for a family doctor in his area for home visits, to no avail. A gastroenterologist who refuses to see a patient again without a new CRDS (Montreal Service Request Distribution Centre) request from me. A complex case of weight loss and fatigue referred to internal medicine after several laborious procedures. Finally, the consultation arrives: it is illegible. A case of chronic distressing abdominal pain referred to gastroenterology: the patient returned to me with a report of "normal gastroscopy and colonoscopy," without diagnosis or treatment. And there you have it, another long day as a family doctor in the office comes to an end. But I am worried: could it be that some young doctors, trained in our hospitals in an active and exciting practice, choose a specialty other than family medicine to avoid this job of "medical secretary" which now occupies 80% of my days? The general urban office practice has drifted in recent years towards an anonymous technocratic practice where many forms are a springboard towards a fragmented specialized practice, in a vacuum, detached from the real care of patients. Family physicians in hospital practice (emergency, hospitalization) certainly also have boring tasks, but less than their colleagues in the office who are now responsible for coordinating the medical services of their patients, even those in specialties. Did you know that 75 family medicine positions were not filled this year in Quebec? Could it be this is because of the ever-growing clerical portion of our work, so far removed from our training as a clinician? Should the organization of specialized medicine be rethought so as not to discourage young family physicians in this way? When will we see real generalist /specialist teamwork in an urban environment, identical to what is practiced in remote regions? I am worried about family medicine in Quebec, especially this year. There you go, another office day is finally over. Dr. Geneviève Dechêne is a family physician in Verdun, Quebec. Originally ran on our sister brand in Quebec, Profession Santé. Translated from French.

Family doctor and medical secretary

Register for free access or login.

Related Topics