27: Healthy Communities are Health Care Innovators Walk In: A Case Study There is something wrong with our Health Care system, and it’s not just shortages of staff, resources etc. It is also about how we do things. I recently went though a health issue that involved three trips to Walk In Clinics, 2 trips to the ER, 5 days with a catheter, and 2 trips to the Outpatient Clinic. Not to mention a week of my life that I’ll never get back. I have a family doctor and I believe that if I had been able to get an appointment with him within a reasonable time after symptoms appeared, I could have avoided all that. The real issue is what did that cost, in a system that is strapped for resources? Why did that happen? Prologue I am one oI have those lucky ones who has a family doctor - the same one for about 20 years. Most people did back then. When my previous doctor retired I just selected another one from the same clinic. I took having a family doctor as a given. I’m very happy with his advice, the clarity of his explanations, and his attention to detail. He is cautious. **My Doctor works out of the Brandon Clinic conveniently located near the Brandon Hospital, A Comprehensive Lab, and other related services. As I proceed I will call it “My Clinic” to distinguish it from other clinics that also play a role in this story. I was a healthy guy. I’m 75. Never been in a hospital. I run, walk, paddle and cross- country ski regularly. A bout of prostatitis around that time was my first experience with a bit of medical inconvenience and stress, but with time that faded - except for a few mild relapses. Over the next few years I would get a slight relapse - or more correctly - a bladder infection that always brought some discomfort to the prostate and area. Already by 2012 a shift in the whole meaning of family doctor was underway - subtly at first. If I felt an infection coming on I couldn’t get an appointment for several days, perhaps a few weeks. That was no help at all, but My Clinic did have a reliable walk in service. So I would use that. A dose of antibiotics was all I needed. That was easy. Too easy. Soon some doctors were handing out a prescription with no urine test. I just described my symptoms. Sometime around 2018 my Doctor became concerned that my over-sized but otherwise healthy prostate gland might become a problem by impeding flow and making it difficult to empty my bladder. He carefully explained the serious consequences if that happened and the treatment options that might be necessary to avoid serious consequences. Just to be sure that I wasn’t in any immediate danger I was referred to a Urologist for a Flow test and later, after a small issue with some blood in my urine, for a complete scope of my urinary tract Very entertaining. It didn’t explain the blood in the urine - but everything seemed healthy, all was well for a time. By 2023 I was used to periodic bladder infection symptoms, a bit of burning, a bit of discomfort, frequent urination. I learned that with lots of fluids and a good helping of cranberries they sometimes faded without drugs. Getting up to pee a few times a night was just the new normal. In the first week of October I had a bout that I couldn’t shake. And so began my recent Adventure in Health Care. Just to show how things have changed, I couldn’t get in to see my Doctor for 5 weeks. I didn’t even bother. My Clinic used to also offer a Walk-In service, but that was recently cut back - now registered patients could still get Walk-In Service but space was limited - you couldn’t always get in. On October 5, I went to another clinic and received meds with just a short explanation, no test. Now, in my heart, I knew better. A year or two earlier after a similar interaction with a walk-in Doctor, I was able to get a phone appointment (Covid times) with my Doctor who sent me for a test and reported that my urine showed no infection. The implication was that something else was causing the symptoms with the culprit likely being my over sized prostrate. I explained this to the Walk-In Doctor but he believed that the burning symptom indicated infection. Might as well try the meds. I took the course of meds and things seemed to return to normal, but after a week the symptoms returned. On November 10, I visited yet another walk in doctor who agreed that my enlarged prostate might need attention but said that in the meantime we might as well check for infection. He prescribed meds and sent me for a urine test, indicating he would let me know. In response to my concern about the prostate, specially about the danger of cancer, the Doctor said the prostate would be sensitive right then and a PSA test would be a inaccurate. I didn’t hear from him and assumed the test was negative. I finished the meds, again, they worked temporarily. An aside...LabWork. I was used to waiting 2 or 3 three days to get lab results, so I was surprised to learn that at some clinics simple urine tests were done on site in a matter of minutes. Had that been standard practice a true diagnosis in my case would could have been made at least six weeks earlier. (Hint: that would have saved me a lot of trouble.) I thought I was almost back to normal, then on November 19, the symptoms came back - worse than ever. Late in the evening I went to Emergency, and after a mercifully short wait a Doctor did a quick Ultrasound - and showed me the problem - no surprise - my bladder wasn’t emptying. They installed a temporary (five days) catheter to quickly relieve the pressure, prescribed medication and sent me home. What a relief! I wish I could say my story ended there, but there had to be one more twist. Just over 30 hours after the catheter was in place, I found quite a bit of blood in my urine. I checked with the instruction paper that I was given upon discharge and it advised that I should consult medical advice, perhaps via a phone call. A helpful nurse suggested drinking lots of water and if it recurred the next day see a doctor. The water did clear it up, but it did recur again the next day. So I called my Clinic on the off chance I could see someone, but by that time all the walk in appointments for that day were taken. I considered Emergency but decided to go to another clinic. It was about noon. I was able to see a walk in doctor after about and hour and a half. He tested my urine and seemed alarmed by a very slight fever and told me I was in danger of infection and to go straight to Emergency and have the catheter removed. By 3 PM I was at the ER. It was obvious after a brief time with the triage nurse that she wasn’t sure why I had been sent. She took my vitals and said they were fine. It was clear that in the busy ER I wouldn’t be a priority. I settled in for a wait. Four hours later I was admitted to a bed. Four or five hours after that a Doctor saw me. Her first question was something like “Tell me why you are here?” I explained the process - had simply followed instructions. She had seen my test results from the walk in and said I showed no infection. She said she would scope me and do bloodwork, and if all was clear I could go home. I said that would be great, THANKS. A hour or so later this was done. She reported back that all was clear. I went home an waited anxiously for my appointment to get the catheter removed and get on with my life. I asked about the blood and she said not to worry about it unless there was clotting. (And looking back some months later I have to report all went well.) Just a word here about the staff at our ER. They are amazing. When I note problems and wait times, my concerns are about the system and the staff shortages - not the individuals. So what have I learned from this experience? No matter how competent the walk in doctors are (and I believe they are often great) they can’t have the perspective of my family doctor. In the case I’ve outlined, my doctor and I have monitored my prostate problem for years with the understanding that a time would come when we might have to make a decision and take some actions. I believe that if I had been able to get an appointment with my family doctor in early October he would have instantly diagnosed my real problem, prescribed the appropriate meds and solved my problem. As it was, solving my problem seemed to involve an incredible waste of resources. . There has to be a better way. For example: Right now the Doctors each take turns on Walk-In Duty. Once I went to Walk In and got to see my Doctor. Bonus! On a recent trip to My Clinic for a follow-up I was seeing a Walk-In Doctor while my Family Doctor was seeing someone else just down the hallway. Instead of that, what if each Doctor budgeted some free time each day for their own patients instead of spending time each week with other doctors’ patients? Wouldn’t costs and earnings even out? Another thought. It seems that the availability of walk in services has allowed us to think we have accessible health care, when in fact Walk-In Service is more like a Fast Food approach to Medicine. Just walk in and we’ll fix you up. ( I mentioned my experience getting meds). Let me acknowledge that there are times a Walk In is OK and should be encouraged. Times when patient history is irrelevant. Twice I have received excellent care after being bitten by a dog, and after finding a tick bite that could have led to Lyme disease. LIke fast food, sometimes you just nee a quick fix. In fact I remember when Walk-In Service was something new - available as it was on weekend and after hours it helped take the stress of of the ER. Another aspect we should consider is that reliance on Walk-In Service tends to make health care episodic as opposed to ongoing. I wonder what is it like for a Doctor to see a patient, prescribe a med, and never know how things turned out? To not be part of any sort of ongoing case management? What I received in the my ordeal was not “Care”, merely action. Not one of the health professionals that helped me was involved in any follow-through. My health crisis was a series of episodes. There are alternatives. Cooperative and Collaborative models have are available. But even within the current systems access to a family doctor would have lead to a much better outcome and would have save the system a great deal of money.