“The medicine that we do right now in the health network is medicine fast food. It’s almost 6 p.m. and the Dr Michel Tran has just completed his consultations at the District Medical clinic in Montreal. Since 8 a.m., he’s seen 59 patients, or almost six every hour. And his working day is not over: he has to deal with paperwork in the evening.
“I have 325 documents that I haven’t looked at yet,” said the 31-year-old family doctor as he sat in front of his computer screen, looking visibly tired.
Laboratory and imaging results, insurer forms, documents from the Société d’assurance automobile du Québec (SAAQ), expert reports from the Standards, Equity, Health and Safety Commission work (CNESST), communications with other health professionals: his “electronic stack” is constantly growing. He seems to be in a hurry.
The duty spent four hours in the office of Dr.r Tran on November 16th. A dizzying afternoon during which many patients on sick leave – whom he sees regularly – paraded: a beneficiary attendant victim of a physical attack at work; an asylum seeker injured in the wrist; a production operator awaiting cortisone injections…
Originally, 45 consultations were scheduled. More than a dozen were finally added. “I don’t want to turn away patients,” says Dr.r Tran.
During our visit, the doctor remained courteous and calm; two patients sang his praises in the waiting room. But he was typing his medical notes at a frantic pace. And the printer was constantly spitting out prescriptions and forms, including reports for the CNESST.
“I always have the feeling that I am in the rush, says the young doctor. I’m sure patients feel it indirectly. »
The Dr Tran has about 1,000 registered patients, but he follows about 500 others who are off work, sent from hospital emergency rooms and walk-in clinics where they have come to get medical paperwork.
“Most of the patients I saw today [le 16 novembre], they could have been seen by another professional, he believes. The physiotherapist and occupational therapist together should be able to manage the majority of musculoskeletal causes. »
But now, the CNESST requires the signature of a doctor for diagnoses, for the follow-up of workers with occupational injuries, as well as for the determination of a date of recovery or stabilization of the disease or injury. The organization does not allow specialist nurse practitioners (SNPs), physiotherapists or occupational therapists to take on this role.
For nearly two years, IPSs have been able to fill out and sign SAAQ forms in the case of compensation and driver health monitoring.
At the Ministry of Health and Social Services, it is indicated that the CNESST is working on modifying a regulation that will allow IPSs to “compile and sign” the forms within “a few months”. “This first version does not provide for the integration of other professionals”, specifies however the CNESST in an email.
I always have the feeling that I’m in the rush. I’m sure patients feel it indirectly.
The president of the Professional Order of Physiotherapy of Quebec, Manon Dufresne, believes that its members should be called upon more to unclog the health care system. According to her, there is “duplication” of tasks.
Physiotherapists already fill out CNESST forms when treating patients on sick leave. “This information is transmitted both to the CNESST and to the doctor, who will take the information and ‘reproduce’ it, if you can put it that way, explains Manon Dufresne. Of course, the doctor will trust what the physiotherapy professional tells him, because he is the one who sees and who knows all the biomechanical aspect and work environment. »
Manon Dufresne would like Quebec to take inspiration from the United Kingdom in this regard. Since July, physiotherapists, nurses, occupational therapists and pharmacists can make official work stoppage reports there when an employee must be absent from work for more than seven days.
Too many administrative tasks
Family physicians have long complained about the burden of their administrative tasks. These occupy 20 to 25% of their time, according to the Federation of General Practitioners of Quebec (FMOQ).
“We will never go to 0, says its president, the Dr Marc-Andre Amyot. But at 9,000 doctors, if I recover two hours per week of administrative work, imagine the number of clinical hours per week that gives and the added value that it brings in terms of accessibility and service provision. »
The Dr Félix Le Phat-Ho, who practices in particular at the GMF-R Le Trait d’union, in Delson, in Montérégie, reserves a Monday every two weeks to carry out his administrative tasks, which also occupy him in the evening. During his interview with The duty, a stack of documents at least 15 centimeters high sat on his desk. “It’s mostly insurance forms,” says the family doctor, leafing through the documents.
The Dr The Phat-Ho considers it unnecessary for insurance companies to require a doctor’s note for the reimbursement of primary care, such as psychotherapy, physiotherapy or massage therapy. “It slows down the services for the patient a lot,” he laments.
According to him, insurers should use a “unique and standardized” electronic form that can be sent “easily” via the Internet. Physicians would waste less time filling out and faxing them. “Some have documents of dozens of pages; others it’s a page or two,” he says.
The Canadian Life and Health Insurance Association (CLHIA) has created “standard” forms for its members. She has already discussed the subject with the FMOQ. “But I can’t tell you that everyone will always use the same form, because it goes well beyond the insurer,” says ACCAP-Québec president Lyne Duhaime. It also depends, she says, “on the plan owner, the employer,” who may wish to customize their form.
According to Lyne Duhaime, fewer and fewer insurance plans require a prescription from a doctor to obtain health services offered by other professionals. “There is really a tendency to make the process as smooth as possible, among public insurers and private insurers,” she says.
However, it specifies that an employer may decide to request, for example, a medical prescription after three physiotherapy sessions. “This paperwork, when it exists, is to ensure the validity of the claim and to contain the costs, explains Lyne Duhaime. If we come to the conclusion that the cost/benefit is not worth it, we will eliminate these practices. »
It’s not just the private sector that needs to be made aware of these issues, according to the Dr Amyot. The Quebec government too. “It may seem paradoxical, but where we have a little difficulty is with the [établissements de santé des] CISSS, he explains. They don’t use the form [normalisé] ; they use an in-house form. We will have to make interventions with the ministry [de la Santé]. »
The Dr Tran, on the other hand, hopes that the administrative burden will soon be reduced: he wants to practice “the medicine” for which he was trained.