Former Canso doctor says primary care is broken: Better communication and reorganization needed, says Dr. Felderhof

·4 min read

GUYSBOROUH -- Last month Dr. Catharina Felderhof announced her retirement from the position she has held in the community of Canso for 17 years. Over that time, Felderhof has seen many changes in the provision of healthcare in the community and wanted to share her experience and insights which is why this month, she prepared and sent an exit letter to healthcare stakeholders in the community and Nova Scotia Health.

Last Thursday, Felderhof spoke to The Journal about the letter, her concerns about healthcare in Canso and some suggestions for the path forward.

“The purpose of my letter is to use it as a tool,” Felderhof said, adding, “I see Nova Scotia Health as having five domains of care; one of them is the IWK; secondly is metro or the cities, whether its Halifax or Halifax and Sydney; and then you have all the regional hospitals, then you have First Nations health … and finally rural outpost medicine, which is rural medicine.”

With her years of experience in Canso, a place Felderhof said she was privileged to work, and all of her experience in medicine, she believes, "The focus needs to remain on the patient and the problem that we see today is that the emergency rooms are full and I’ve tried to analyze that by seeing primary care is broken. Primary care has to be developed much like hospital care, where the physician in primary care gets the same level of support as a physician in hospital care, and that seems to be what I see is broken.”

Primary care, explained Felderhof, “deals with such things as poverty, for example, and you have our policymakers such as Mike Kelloway advocating for a basic income. And certainly, financial stability and financial security does a lot towards personal wholeness and wellness.

“Another primary care focus would be diabetes. Here, we have an example of Prince Edward Island and Ontario covering the latest technology in diabetic management which is continuous glucose monitoring covering the sensors…we desperately need those for our diabetic population,” she said adding that not only would it save billions of dollars in healthcare but it would also save patients’ eyes, legs and feet.

“Primary care, when it’s broken like this, you have full emergency rooms. And, when it’s fixed, we’ll have empty emergency rooms,” Felderhof said. But she doesn’t want to point a finger of blame at anyone; she believes the failure is due to changes in communication and system priorities.

“I think if you look at how communication has evolved, years ago face to face…and now I see cyberspace. And as a result … communication has broken down and, when you have government officials, bureaucrats, doctors and patients all looking at healthcare from a different perspective, the means of communication, the process has broken down. We need to come to the table. We need to identify the successes and the failures and barriers,” said Felderhof, adding that the goal should be consensus-based decision-making.

“I think one observation I’ve made over the years, when I first started, there was a whole lot of compassion and common sense, but now we have a lot of corporate medicine and protocols and somehow we have to marry the two so we don’t lose either,” she said.

“In Canso, what’s so important there, what we’ve been relying on, is the nurses who are always there. Where we fly in and fly out, we really relied on them…without living there and actually experiencing it, how can we convince the politicians and the bureaucrats that this is what we need? How can we convince them unless they actually experience it…I am not convinced that it is more money that we need, I think it is more reorganization of the structures that we need,” Felderhof said.

At the end of her exit letter, Felderhof offered the following suggestions for next steps in Canso, noting these were put forward to start the discussion, not the only possible way forward: provision of a family practice nurse and others; electronic medical records and in house IT support; ER back-up support to interested physicians while upgrading emergency training; and examination of the overall funding model.

“The big thing is to remain positive,” she said.

Lois Ann Dort, Local Journalism Initiative Reporter, Guysborough Journal

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