Family physicians routinely prescribe drugs under the wrong circumstances and overuse diagnostic imaging tests, serious problems the Health Council of Canada says must be repaired by introducing electronic health records across the country.
The council, an independent body created by federal and provincial governments to monitor the health system, released a report Monday that warns family doctors are facing increasingly complex demands but often lack the proper guidance to make the best decisions for patients.
It’s one of the strongest calls to action by the council, a prominent health organization that regularly helps inform policy makers. It predicts that if Canada continues to delay implementation of electronic health records and doesn’t do more to support family doctors, the problems of inappropriate prescribing and excessive medical testing will dramatically worsen as the population ages.
Drug spending is one of the biggest costs for Canada’s health care system and diagnostic imaging tests are becoming an increasing financial burden. The council pointed out the trends can also harm patients: many of them are getting prescriptions for expensive drugs that may not help them and could put them at risk of serious side effects, while others are exposed to potentially harmful levels of radiation during CT scans or other diagnostic tests that aren’t actually needed.
“If there is no change in how family physicians are supported ... we can expect a surge in health service use as the population ages, chronic diseases become more prevalent, new drugs and technologies are introduced, and patient and provider expectations expand,” the report said.
Overworked family doctors are increasingly taking on the care of patients with multiple or chronic health problems, the report added, and becoming more responsible for ordering diagnostic tests, tasks once largely handled by hospitals or specialist physicians.
Those trends aren't necessarily negative. Doctors are taking on more responsibilities in part because a growing number of patients are able to get the care they need outside of hospitals or without seeing a specialist, saving time and money.
But as their roles become more complex, family doctors across Canada aren't being given the proper guidance or support needed to determine the best course of action for patients, the report says. Doctors were also said to have chaotic, overwhelming schedules, making it difficult to spend time with patients to discuss potential options or alternate therapies.
As a result, family physicians end up prescribing drugs, sometimes at the request of patients, even though it's unclear whether the medication will help or if other therapies would be more effective, according to the health council. In addition, doctors order expensive computer tomography (CT) scans or magnetic resonance imaging (MRI) tests to err on the side of caution or because patients demand them, even though they may be unnecessary.
Danielle Martin, a family physician at Toronto’s Women’s College Hospital, said the problems identified in the report affect her life daily and are “frequent” topics of discussion among her colleagues. She said doctors must juggle demands from patients, emerging information about new drugs or treatments and overwhelming schedules, creating an environment where it’s often easier to order tests or write a prescription.
“It becomes a negotiation when you’re trying to ascertain whether there’s really a requirement for that expensive test. Those pressures are real and I think we all feel them and we need to do better.”
It's difficult to know the exact scope of the problem because of the lack of data that's collected in this area, according to the health council, which culled information from medical surveys and studies for its report. It can also be difficult to ascertain which drugs or tests are unnecessary. For instance, a child who suffers a head injury may undergo a CT scan that doesn't find any evidence of serious trauma, but many parents and doctors would still prefer doing the test to rule out the possibility.
But the real problem is family doctors aren't being given the information they need to make the best decisions and Canada does little to track the health outcomes of patients who are put on various medications or given diagnostic tests, the report said.
