Opinion – Dr. Mackey on the use of Medeo in Fort St. John

Convenience imperilling continuity

It is an unfortunate reality that there are more people in Fort St John without a family doctor than with. Thus it is no surprise that many patients are turning to Medeo for their medical care. Medeo provides a convenient telemedicine service for many types of consultations. However the convenience and accessibility of services such as Medeo is a double-edged sword and it’s growth will likely hasten the demise of local health services in rural communities in much the same way that shopping over the border decimates local businesses.

When I have seen patients after they have had a Medeo consult, they often say “I didn’t want to bother you”. My usual reply is that I am more “bothered” that they didn’t come see me as their family doctor to ensure the continuity of comprehensive primary care that I strive to provide.

A larger concern is that we are seeing patients who are being sent up to emergency by the Medeo doctors. This is not unexpected as it is very difficult to make a detailed assessment of a patient via telemedicine as the doctor is unable to examine the patient. In the office your Family Doctor can listen to your chest and measure your peak flow and decide whether you can be treated then and there for your asthma or are sick enough to require a trip to the hospital. Thus, attending your family doctor can actually prevent the emergency room visit. Instead a Medeo visit in this situation simply adds an unnecessary (and expensive) step in care that further drains scarce health resources.

This is not the most serious way that Medeo will affect health care resources. While the Medeo doctor has to be quite skilled to be able to assess a patient via telemedicine, he or she can do this from the comfort of his or her own living room. These physicians don’t have to maintain an office, employ staff, order supplies, pay property taxes or drive through a blizzard at 3 am for the emergency c section. Given the choice, how (and where) would you prefer to work? The increased utilization of services like Medeo will make it even less likely that a doctor will want to move to a community such as Fort St John and provide comprehensive, full-service Family Practice. The doctors providing a consultation remotely are not going to volunteer at the Child Development Centre or at Party in the Park or be the part-time soccer coach or the hockey team doctor in your community. And, most importantly, they will not be training the next generation of students and residents who we hope will return to the community to be Family Physicians. Thus the individual convenience of a Medeo visit threatens the continuity of care for the community.

Many will ask, “But if I don’t have a Family Doctor what option other than Medeo do I have?” The 8-1-1 nurse line can provide guidance on many medical issues and can help you decide if you even need to see a doctor. And this is at no extra expense to the system. Your pharmacist can provide advice and treatments on many issues that can help avoid the extra inconvenience and expense of seeing the doctor. Optometrists can now prescribe eye medications and are an excellent choice for eye disorders. Granted this does not cover all eventualities and there are situations that necessitate a visit to to doctor. Services such as Medeo will have a limited role to play for those who only require infrequent, episodic care and who don’t identify a Family Doctor but definitely not as a first choice of care for the majority. I would suggest that those still fortunate to have a Family Doctor _do_ bother him or her for medical care and not use Medeo simply because it is “convenient” or “new”. Those who don’t have a Family Doctor but yet need ongoing care (which includes the “simple prescription renewal”) should be bothering the Unattached Patient Clinic so that the extent of the problem in our community does not remain hidden. They should also be bothering their MLA, Health Minister and Premier to ask them why they are content to draw the resources and tax revenues out of the community yet not support it with the necessary infrastructure and resources. Actually I would suggest those still lucky enough to still have a Family Doctor bother these elected representatives as well as it is no guarantee that they soon won’t be joining the ranks of the unattached whose only option will be services such as Medeo.

Dr Paul Mackey