Good access doesn’t happen by accident.
When Dr. Holly Zwicker and her business partner Dr. Shauna Herman were setting up their Tantallon-based medical practice in late 2009, they had a clear idea of how they wanted to provide care.
“Our vision was to provide community care, and to provide really good access and a really good standard of care for our patients,” says Dr. Zwicker.
Seven years later, through a careful combination of hard work, collaborative care and technology, that vision has been realized. Now, Drs. Zwicker and Herman work with four other physicians, a family practice nurse and several administrative staff to provide comprehensive medical care for 10,000 patients.
In the early days, providing really good access looked a lot like long hours in the clinic and on call.
“At first, we had physicians in the clinic six days a week, and we also provided after-hours care and 24-hour call for our patients,” says Dr. Zwicker. “We thought it was important for people to have someone to talk to in the middle of the night if they were worried.”
Since then, 811 has taken on the burden of the midnight phone call, and walk-in clinics are available for some of the after-hours and weekend care. But most of the patients at Crossroads Medical Clinic don’t need to resort to a walk-in clinic.
“We try to see our patients as much as possible,” says Dr. Zwicker. “Sometimes that means seeing patients on a squeeze-in basis; or they might be scheduled for the early morning slots that we reserve for same-day or next-day appointments. After hours we do house calls to see patients who can’t get in to the office, and we also do palliative care home visits and nursing home visits.”
Having a family practice nurse on staff has also made a huge difference, says Dr. Zwicker.
“Our nurse, Lori Bates, has appointments available every day. She’s the one that parents turn to when their kids are sick. She heads our immunization program and does a lot of our well-baby and well-woman care.
“Having her on hand to provide nursing care and take care of the task-oriented parts of patient care – things like immunizations and Pap tests – allows me to spend more time with my complex patients,” says Dr. Zwicker.
Using technology – particularly adopting an electronic medical record (EMR) and an online booking system – is another way that Dr. Zwicker and her partners have been able to improve access.
“We jumped from paper charts to an EMR seven years ago,” she says. “That really has been the revolutionary tool that’s necessary for the kind of improved care and improved access we offer.”
Using an EMR has helped Dr. Zwicker and her staff identify patient populations with specific health needs, and design clinics to serve those needs. These clinics include well-senior, well-baby and well-women clinics, as well as a Pap test recall program. “Every few years we do a record search for patients who were due for a Pap test but didn’t get one. We then invite those patients to a Pap test clinic,” says Dr. Zwicker.
It’s simple but effective; about 60 percent of patients who receive an invitation attend the clinic.
“There’s something powerful about being contacted by your physician,” says Dr. Zwicker. “When we say we care about your health, suddenly it makes people care about their own health more.”
“The tool that allowed us to do much of that work – being able to search out the patients who are over 65 for our well-senior clinic, for example – is our EMR,” says Dr. Zwicker. “That got us into thinking, how else can we use technology to interact with our patients?”
From there, it was a small step to online booking.
“When you book a massage, do you call? No, you book online. Everyone books online for everything these days,” says Dr. Zwicker, acknowledging that the convenience of online booking is a boon for patients.
“Our patients love being able to book online. And it has done wonders for improving accessibility.”
Patient Marianne Wyllie would certainly agree. As a teacher and a mom of two small children, she’s well aware that kids don’t get sick on a schedule. “Using online booking makes it easier for me – and sometimes the staff will read the notes I’ve left and find me an earlier appointment time.
“Knowing that I’ll be able to see our family doctor when an urgent issue pops up just makes life easier,” she says.
Next up, Dr. Zwicker and her colleagues plan to begin using MyHealthNS – the secure web portal that allows physicians and patients to view test results online and will soon allow them to communicate via email.
“The e-results function will be very useful to me and my patients,” says Dr. Zwicker. “And once the secure email function is ready we’ll be able to communicate with our patients by email, either by messaging the entire patient population – for example, to let them know it’s time to come in for a flu shot – or by sending notices to individual patients, for example with Pap test notifications, or to let them know about referrals.
“This is the way we communicate in all other spheres in our life, so it’s great that it’s finally becoming an option for us in medicine,” says Dr. Zwicker.
Even as primary care continues to evolve in Nova Scotia, Dr. Zwicker and her colleagues are guided by their vision – good care with good access – and they show no signs of slowing down.
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