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Insider’s View: Collaborative care in action

For Dr. Michel Chiasson, a family physician in Cheticamp, N.S., collaborative care is more than just a practice model – it’s a way of life.

“Collaborative practice means the best possible care for my patients,” said Dr. Chiasson.

Dr. Chiasson, who grew up in Halifax and attended Dalhousie Medical School, chose to move to Cheticamp after seeing the possibilities of collaborative care.

“I did a family practice rotation in Cheticamp when I was in medical school and it made such a positive impression,” he said.

“When I did my rotation here, I remember thinking, ‘This system works. The doctors here are happy. I want to be happy.”

Living in Cheticamp and working in a collaborative practice allows Dr. Chiasson to balance patient care with family life, professional development and community involvement.

“It means I’ve got the opportunity to juggle my practice with other things,” he said, “such as my work with the Nova Scotia College of Physicians and Surgeons and the GP Council.”

Dr. Chiasson is also actively involved in his community, coaching hockey and soccer. “I think that it’s important that physicians are involved in promoting healthy living in the community. We need to walk the walk and talk the talk.”

The term “community involvement” also applies to how – and where – Dr. Chiasson practises medicine. Collaborative care means that he works in multiple places, with multiple health-care providers.

“I don’t just practice in my clinic,” he said. “I also conduct the youth health centre at the local school, visit the nursing home and do home visits. I even visit the local Buddhist monastery.”

His work puts him in daily contact with the three other family physicians at his clinic, as well as specialists, nurses and nurse practitioners, pharmacists and occupational therapists – among others.

“You really need to have a good team, and we have a wonderful team here in Cheticamp,” said Dr. Chiasson.

The clinic’s family practice nurse sees patients for vaccinations, pre-natal and well-baby visits, and Pap tests. “Nurses do so much!” said Dr. Chiasson. “Physicians can be so much more effective with nurse support.”

The support of the family practice nurse frees Dr. Chiasson and his colleagues up to spend more time with patients who are managing complex or chronic conditions – some of whom are just a short walk away.

Dr. Chiasson’s clinic is located in a building that also houses the community’s nursing home and its 10-bed hospital. He works closely with staff at both institutions, meeting weekly to go over treatment plans and making himself available for ad hoc consultations, too.

“If one of the nursing home staff is concerned about a patient, they can just walk across the hall to speak to a doctor,” said Dr. Chiasson.

Cultivating good relationships with staff has a direct impact on patient care.

“Knowing and trusting your staff is huge,” said Dr. Chiasson. “The nurses know the patients and they have input into treatment plans. The patients see that we get along and trust us more as a result, and because we’re open to hearing from everyone, the patients get better continuity of care.”

In fact, in Cheticamp, that continuity of care extends all the way to the local pharmacy.

“Our practice also maintains a close connection with the three pharmacists at the local pharmacy. They are actively involved in patient care,” said Dr. Chiasson. The practice’s EMR is fully integrated, so prescriptions are sent directly to the pharmacy. “But if they ever have a concern, they just call. We speak probably 10 times a day.”

But living in a rural community does have its challenges, including access to specialists.

“Because we’re not in a city, it’s a real battle to get people to get patients in to see a specialist like a cardiologist, ENT or orthopedic surgeon,” said Dr. Chiasson. Cheticamp is more than a two-hour drive away from Sydney, so a specialist appointment can be costly and inconvenient. “It means a long drive, spending money on gas and food, potentially missing a day of work.”

So instead of sending patients to Sydney, Dr. Chiasson and his colleagues invite specialists to Cheticamp.

“We’ve cultivated relationships with specialists – including a pediatrician, an ophthalmologist and an internist – to ensure that our patients can get the care they need,” said Dr. Chiasson.

It’s a working relationship that benefits both parties.

“I think, a degree of collaboration is essential to being a good physician,” said Dr. Chiasson. “Working in isolation is to the physician’s detriment…which becomes the patient’s detriment. When doctors work together, they help each other immensely – you can consult on challenging cases, pass on things you’ve learned.”

“Working [with other health-care professionals] helps me make sure that we’re making the right diagnosis and deciding on the right treatments,” said Dr. Chiasson. “It helps me figure out who else can help me help my patients, so that we can make sure their care is optimized.”

Working in a collaborative practice also helps keep Dr. Chiasson interested, engaged and learning.

“It bolsters the variety of the care I provide,” he said. “Collaborative care means I get to be involved with lots of different kinds of care. It allows my practice to be bigger and more interesting.”

“Working with other physicians is crucial to providing continuity of care and avoiding physician burnout. Health care is complex – we can’t afford to work in silos.”

Act now

If you believe that every Nova Scotian should have access to primary health care, talk to your local MLA.

Remember, you have the power to make health care a priority during this election.