(As published in the Hamilton Spectator, March 30, 2021)
Anne Pizzacalla
A friend phoned to update me on her latest doctor’s visit. She and her husband, like over 60 % of older Canadians, have chronic health issues, and she is his spokesperson. The challenges – describing her concerns to the family doctor, sorting out the plan, her sense of time pressures during the visit – affect her ability to share things in an organized way. She left the office without asking two important questions and once out the door, was unclear about test results.
Health care professionals spend years learning to get the most out of their encounters with patients, but as recipients we do not have training on navigating the health care system. Laura Funk, a Canadian health systems researcher, noted that “older people and their caregivers often need to learn as they go, relying on their resourcefulness to navigate and access health and social services.” Common examples of navigation tasks are:
- Searching for information about services and how to access them
- Working around barriers to the services
- Coordinating formal help and resources
- Ongoing follow up to ensure that the services are adequate
Navigation work entails “dealing with multiple providers, filling out forms, making appointments, contacting professionals, prompting providers for feedback, and mitigating the risk of errors”. She argued that “navigation problems are rooted in the structures and operations of existing care systems, as well as the downloading of administrative and coordination tasks to individual patients and their families” and that “the system needs to continue to transform navigation work from the private into a system responsibility.” (https://on-irpp.org/2CiPb5D).
In some areas of healthcare, professional navigators and case managers support patients so their voices are heard clearly, they communicate between parts of the system and ensure the plan is carried out. Most often, however, we need to be our own navigators. Helpful resources are beginning to appear. Dr Samantha Winemaker, a palliative care physician from Hamilton, and Dr Hsien Seow, a McMaster healthcare researcher, created a timely series of podcasts focused on seven strategies to help patients and family be hopeful and prepared when facing serious illness. They acknowledge that our current system can sometimes leave us in the dark rather than “in the know” and we can find ourselves navigating without a map. https://www.waitingroomrevolution.com/podcast.
Virtual visits by phone or computer mean new learning for both providers and patients. The Canadian Patient Safety Institute (CPSI) and the Canadian Medical Association (CMA) have developed guidelines for virtual visits. The CPSI template entitled During Your Visit is particularly helpful in exploring goals, plans of care, and methodsof communication. CPSI_Checklist_During_Your_Visit-FINAL.pdf (patientsafetyinstitute.ca). The CMA guide also lists conditions suitable and not suitable for virtual visits. https://www.cma.ca/how-navigate-virtual-care-visit-patient-guide.
Years ago, a family practice resident shared a mnemonic called FINE to ensure he had covered patients concerns. We could use this to organize our thinking before we see our healthcare provider.
Feelings – What are my feelings, fears and worries?
Ideas – What do I think is going on?
Needs – What needs do I have because of the health issue?
Expectations – What are my expectations from this visit?
Another strategy used by some providers is “Teach Back”. At the end of a visit, they might ask “I want to make sure I gave you the correct information so tell me your understanding of we what discussed today”. We too could say “I want to make sure I understand correctly, so here is what I heard …. is that correct?”
One friend makes two copies of her written questions and gives one copy to her docotor. The questions serve as a memory aid and help to focus everyone. As well as organizing our thinking and giving voice to ideas and feelings, putting concerns on paper can have a calming effect. For complicated issues, she brings a friend to act as a recorder.
Another always asks for a copy of test results to share with other specialists, follows up on bookings and specialist appointments to ensure they happen. She also consults office staff with unanswered questions. Several use the annual OHIP funded MedsCheck program, a one-on-one interview between the pharmacist and the patient to review prescription and non-prescription medications. Take your medication safely | Ontario.ca
The more skills we have, the more we as patients can fully access health and social services. The Hamilton Council on Aging will be offering workshops on Strategies for Navigating the Health Care System in spring and fall of 2021. Check our website for updates at coahamilton.ca
Anne Pizzacalla is a retired nurse practitioner and a Board Member of Hamilton Council on Aging. For more information on the Hamilton Council on Aging or to make a donation please visit www.coahamilton.
Click here for the Hamilton Spectator article.