Posts Tagged "turn"


Eric Cadesky: Should clinics turn away those who are not ‘their’ patients?

by admin

Doctors of B.C. president Dr. Eric Cadesky.

Doctors of B.C. / PNG

When reading the recent editorial by Dr. Rita McCracken et al. and its call to limit people’s access to care from virtual “walk-in” clinics, one cannot help but think of Justice Potter Steward’s admission that, while he could not define pornography, “I know it when I see it.” Similarly, it is easy to label some brick-and-mortar or virtual clinics as “walk-ins” and deride them for offering only episodic care, posting signs that say “one complaint per visit” or sending most difficult cases to the emergency room.

But these extremes are outliers that are over-represented in simplistic narratives. Reality is much more complicated.

I certainly agree with Dr. MacCracken and her colleagues that there is a dire need to strengthen primary care. Sixteen per cent of Canadians do not have a family doctor and those that do often cannot access a family doctor when most needed. This matters because having a doctor or care team that knows you leads to better health outcomes and more efficient care. Simply put, having a family doctor is good for your health and good for the healthcare system.

But the lines between traditional family practices and episodic care are increasingly blurred due to factors such as increasing healthcare needs of an aging population, rising business costs, and doctors’ demographic changes. For example, what should we call family practices (like mine) that offer advanced access — appointment times during the day reserved for patients of the clinic with urgent issues? These patients, while being attached to the clinic, are walking in.

And should clinics refuse to see people who are not patients of the clinic but have urgent issues? I would not turn away a febrile infant or an adolescent seeking vaccination or someone needing care after a motor vehicle accident just because they are not “my” patients. In fact, my experience is that many of these patients actually have their own doctors but cannot access them for various reasons: perhaps their doctors are fully booked or away without a replacement or located too far away. The latter is an important issue as housing pressures in British Columbia mean that many people commute significant distances to work or school, taking them away not only from their families and communities, but also from their usual places of care.

For those patients without a family doctor, every visit is an opportunity to find ways to come into the system, whether through community initiatives or within the clinic itself. In fact, several of the doctors that see patients through virtual “walk-in” platforms also work in clinics but are limited in the hours they can physically spend in the office due to competing family responsibilities. By allowing virtual care, doctors can spend time with their families and later be available to patients — especially their own — outside of the traditional daytime hours of many medical clinics. Similarly, when doctors are able to leverage technology to work flexible hours, this means that patients can in turn access care without being away from their own work and families.

So while major restructuring of our healthcare system is necessary to ensure people receive the care they need, it is simply unfair and unacceptable to deny access to the 400,000 people in British Columbia who don’t have a family doctor.

Instead of defensively limiting innovation and technology, let’s test different models of care and spread the successes so that people can overcome the current barriers to in-person care, such as physical disability, mental health, and transportation. Rather than bickering over how different clinics are trying to improve care in an outdated system, we need to move past traditional ideas if we hope to achieve a healthcare system that provides timely access to high-quality, efficient doctors and teams working with patients in the context of ongoing relationships.

And that is a goal I hope we can all agree on.

Dr. Eric Cadesky is a full-service family doctor in Vancouver.


Province proposal to turn part of Trans Canada Trail to industrial use ‘mind-boggling’

by admin

Cyclists ride across a trestle bridge, part of the Columbia and Western Rail Trail.

Handout/Trails Society / PNG

A historic rail trail that was donated to the province by the Trans Canada Trail society could be opened to logging trucks if a government proposal to cancel its trail designation gets the green light, say trail advocates.

The Ministry of Forests is seeking to transfer management of a 67-kilometre portion of the Columbia and Western Rail Trail to unspecified agencies to reflect local interests and support “access for industrial activity,” according to a letter sent to stakeholders soliciting feedback on the plan.

A major logging company holds tenure for several cut blocks near the trail, which runs from Castlegar to Fife, east of Christina Lake.

“It’s mind-boggling that they’re even considering this,” said Ciel Sander, president of Trails Society of B.C. “The trail is a government asset. It should be protected as a linear park, not an access road for logging trucks.”

The Columbia and Western Rail Trail was donated to the Trans Canada Trail decades ago by the Canadian Pacific Railway for inclusion in the The Great Trail, previously known as the Trans Canada Trail, a national trail network stretching 24,000 kilometres across the country.

In 2004, the committee transferred the trail to the B.C. government with the “expressed intention that it would be used and managed as a recreational trail,” said Trans Canada Trail vice-president Jérémie Gabourg.

A cyclist on the Columbia and Western Rail Trail.

Handout/Trails Society

While the government’s proposal is clear that recreational access will remain, it marks the first time a group has sought to convert a portion of The Great Trail from a trail to a road in any province or territory.

“Sections of The Great Trail of Canada are on roadways, and we strive to move these sections of the trail to greenways, where possible,” said Gabourg. “To see a trail go from greenway to roadway is disheartening … It could set a dangerous precedent.”

The Columbia and Western Rail Trail connects with the popular Kettle Valley Rail Trail, a route that attracts cyclists from around the world. In accepting the trail from the Trans Canada Trail in 2004, the government made a commitment to preserve and protect it from motorized use, said Léon Lebrun, who was involved in the process as past president of Trails Society of B.C.

“We have a government who has not taken real responsibility,” he said. Officials have “turned a blind eye” to motorized users who have graded parts of the trail and removed several bollards designed to prevent access. “They had no permit and no permission, and the government did nothing.”

In its letter to stakeholders, the Ministry of Forests recognized vehicles are already accessing the trail, explaining the proposed administration change would ensure it was being maintained for that use.

“This portion of rail corridor contains engineered structures including steel trestles, hard rock tunnels, major culverts and retaining walls atypical of recreation trails and requiring management beyond typical trail standards,” said the letter by John Hawkins, director of Recreation Sites and Trails B.C.

Tracks on the trail, part of the Columbia and Western Rail Trail.

Handout/Trails Society

But Rossland Mayor Kathy Moore said that allowing motorized vehicles would be rewarding people who broke the law.

“While we acknowledge that this change reflects current use, this is clearly the result of years of mismanagement of what was intended as, and should have remained, a high-profile recreation and tourism amenity,” she replied to Hawkins in a letter that was shared with Postmedia.

“Those who have consistently flaunted trail use regulations are now being rewarded … We expect (Recreation Sites and Trails B.C.) to acknowledge this as a tragic failure, and ensure that resources and strategies are in place to prevent further losses of our valued trails.”

Stakeholders were given one month to register their feedback with the Ministry of Forests, ending Aug. 26.

In a statement, the Ministry of Forests said the process is ongoing to receive more information from regional districts. A decision is expected before the end of the year.


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