By Barry Rueger
Published: Globe and Mail
June 24, 2023
In need of medical attention
One of the first things that my wife and I did after moving to rural Nova Scotia was to look for family doctor, but we couldn’t find one accepting patients. Getting care has been a challenge.
My wife Susan and I arrived at our new home in Liverpool, N.S., at the end of 2022. Since then, we’ve discovered one valuable lesson: If you’re trying to learn anything about how things are done here, it will be via word of mouth. This is especially true if you need health care. The Nova Scotia Health Authority and the provincial government have websites, phone lines and pamphlets, but for real answers you need to talk to the people who live here: your neighbours, workmates, people you meet in stores and supermarkets, your librarian, the man who cuts your hair.
Susan and I had both been hammered by a vicious COVID-19 infection the previous September. Over the course of 10 days, we suffered all manner of extreme symptoms, ranging from sweating and coughing to diarrhea and a complete inability to do anything beyond survive. I have never been so sick in my life. Since that time, and continuing after we moved to our new home in Nova Scotia, we’ve suffered endless aches and pains, and continuing fatigue – symptoms that seem to reflect long COVID. We knew that we needed medical attention, and sooner rather than later.
One of the first things we did after unpacking our furniture was to set out to find a family doctor. At store counters and in lineups it didn’t take long to understand that there are only a handful of doctors in Liverpool, and not one of them was accepting new patients. And as far as we could tell driving around or looking online, there is no walk-in clinic here – those “fallback” services seem inexplicably rare in rural Nova Scotia.
Canada’s health care services are in crisis across the nation, but the situation in rural Nova Scotia feels especially severe. Official statistics say that one in 10 people in Nova Scotia have no regular family doctor. The reality is that the government’s “Need a Family Practice Registry” for people without a doctor recently reported that there are more than 142,000 on the waiting list – more like 14 per cent of the population. If you’re in the one big city, Halifax, you may have some choice, but the rest of Nova Scotia is rural, and doctors are scarce.
People in my area on the registry’s list can eventually sign-up with a “real doctor” at the Collaborative Family Practice at Liverpool’s Queens General Hospital. Until then, though, you’ll be encouraged to visit the emergency department during the few hours a day when they’re open. For instance, in a recent week in May there were four days when the emergency department shut down at 1:30 p.m. until the following morning at 8 a.m.
In the meantime, those 142,000-plus people without a family doctor are being directed to Maple, an online medical practice that operates across Canada. The publicly funded side of Maple in Nova Scotia – there is also a for-profit, pay-for-service side available – is also short of physicians, and many patients are directed to nurse practitioners.
Even if you reach a qualified doctor, there is no route available to you to return to the same doctor for a follow-up or to discuss the results of tests – you are given the first doctor or nurse practitioner available. If needed, it’s possible that you’ll be referred for an in-person consultation, but that usually doesn’t happen, and I can’t help wonder what’s being missed when knee problems or internal aches and pains are being diagnosed by a different practitioner every time, and over an online video instead of in person.
And that is the real problem. As willing and knowledgeable as the doctors and nurse practitioners are on Maple, it’s still a video call on your laptop. You can hold your phone or iPad up to the area where you’re hurting, but sometimes you really do need a medical professional to examine you in-person, touching, prodding and assessing where your problem lies.
The shift from in-person to online medical evaluations makes a profound difference. We’re feeling the lack of having a regular doctor who knows us and our medical histories. Instead of the familiar routine of visiting a doctor who already knows you, briefly checks your file as a memory refresher, and then begins a consultation and diagnosis based on that knowledge, we find ourselves sitting in our kitchen with printouts and pill bottles at the ready. Every consultation involves using most of the brief time allotted to update a new physician. The onus is now on the patient, not the doctor, to maintain, organize and communicate a full medical history.
There’s also the very real worry about what would happen if we need emergency medical care. This week, the mayor of Middleton told Nova Scotians about a frightening incident. In a letter to Premier Tim Houston, Sylvester Atkinson described how on the evening of June 15, the local volunteer fire department was called to the Soldiers Memorial Hospital in Middleton. The local fire department was called because there were no doctors in the hospital, and no doctor on-call, and a patient was in cardiac arrest. The firefighters did what they could, but the patient died. A doctor did drive down from Kentville, a half-hour away, and declared the patient dead. For small-town residents like me, the story is absolutely terrifying.
Fortunately, we haven’t needed any emergency treatments since we moved here, although we have found ourselves at the local hospital for other medical services. Even when the hospital’s emergency room isn’t admitting patients, the hospital lab and X-ray departments are still open, and it’s possible to be in and out for X-rays or blood tests in a few minutes. And even if it’s near impossible to see a doctor some days, we appreciate that the rest of the medical workers there will take the time to explain what they’re doing, why they’re doing it and to gossip about local affairs.
That is honestly the one positive side to Nova Scotia’s woeful medical system: The local health care team of nurses and lab technicians are relaxed and friendly, and likely someone you’ll run into at the library or supermarket. After decades of brusque treatment in big cities such as Vancouver and Toronto, it’s nice to deal with real people who seem to genuinely care about your welfare.
Nova Scotia’s current budget claims to be ramping up health care spending, but the two headline areas in the government releases are retention bonuses for nurses (to the tune of $110-million), plus an additional $50-million to address continued surgical backlogs. Still, many people believe that not enough attention is being paid to the challenge faced by many Canadian health care systems: a significant lack of doctors, especially family doctors. As convenient as it is to access nurse practitioners and pharmacists for day-to-day health needs, the most important member of your health care team is still a consistent family doctor.
I was raised at a time when every family had a doctor – someone who cared for parents and children through all life stages, tracking their history from month to month and from year to year. These physicians lived in your community and were a constant in your life. It was understood that medical care was not just about emergencies, it was about keeping patients healthy on a continuing basis. It was about a long-term personal relationship with a physician who you knew and trusted.
Today, in rural Nova Scotia, that sort of relationship is harder to find. The older doctors are retiring, and news reports tell us that new, younger doctors don’t want to take on a small-town family practice.
I can’t help but think that decades of “restraint” budgets, and the losses to health care funding that resulted, have to be responsible for this change. Young doctors look at practices in small-town Nova Scotia and see nothing but overwork and underpay, long backlogs on routine surgeries and referrals, and medical treatments such as physiotherapy or prescriptions that aren’t covered in one of the poorest provinces in Canada. Is it any wonder they shy away from family medicine?
Ultimately this all speaks to priorities. Nova Scotia brags about an increase of 21 per cent in health care spending over two years, but every time I drive from Liverpool to Halifax to see a specialist or a relative in hospital, I can’t help but notice the tremendous amount of highway construction that is happening. To my eye, neither the population of Nova Scotia, nor the traffic volumes, merit the hundreds of millions of dollars being spent to upgrade all these roads to four-lane divided highways.
It feels as if Canada’s second-smallest province – only Prince Edward Island is smaller – chooses highways over health care. That, I think, is the core of the problem we face in Nova Scotia: Health care is seen as an expense, while highways are an “investment.” We’re faced with months of waiting for surgeries, and we sometimes get questionable treatment options over video chat – but at least the drive to Peggy’s Cove is wonderful.
After many months reflecting on the sad reality that we can’t have a family doctor, we had come to accept the unfortunate situation. Last week though, with no warning, we received a phone call from Queens General Hospital’s family practice. I don’t know how we reached the top of the list, but we now have a family doctor once again. Ours was trained in Khartoum, and several weeks ago he’d left a position in Birmingham, England, for his new job in Liverpool, N.S. He tells us he likes the small town that is now his home. We don’t yet know what chain of events led us to having our new doctor, but he seems good, and we’re very relieved. I hope the many other thousands of Nova Scotians on the family-practice waiting list also receive good news soon.