| Challenges |
“It is not easy because they [FUEDs] sometimes come at hours that are not, let’s say, working hours.” (U-PCP4) “I felt like they [migrant patients] were “consuming” medical resources without really having a regular follow-up. I felt that they didn’t really understand our healthcare system, (…) the purpose of having a follow-up.” (U-PCP9) “They were so many social issues that I sometimes felt that I wasn’t practicing medicine anymore, I was a social worker.” (U-PCP10) “Sometimes, patients think that the PCP is omnipotent, so it can be difficult. To make them understand that we can’t solve everything. (…) We have to deal with patients’ expectations that exceed what we can actually propose.” (U-PCP8) |
“(PP-)PCPs are limited to 20 minutes [of consultation]. (…) It’s a major pitfall. Here, TARMED has it all wrong when it comes to vulnerable patients, for whom it is required sometimes to waste time to gain some.” (PP-PCP16) “People working in hospitals tend to have a “crabs in a bucket” mentality. People are absent or we are not allowed to get their direct phone numbers, etc. It is a despairing waste of time and energy I have to say.” (PP-PCP2) “I can’t stay 4 hours with somebody. I mean, I can’t go take care of other people and keep him [the patient] in the waiting room. In the ED, you can do that. (…) It might make you busy [keeping patients for medical examinations] but you can do it because there’s enough space. In a primary care practice, it’s just not possible. I mean, it can happen, half an hour if there’s something you really need to do. But it’s an exception.” (PP-PCP6) |
| ED visits: reasons, legitimacy & adequacy of care |
“They were people who often didn’t come to their appointments. (…) And when they had an acute problem, and it couldn’t wait (…), they went to the ED.” (U-PCP14) “The PCP changed every 6 months, every year. So why not see somebody else, but at the ED?” (U-PCP6) “We have patients, who are really multimorbid, who have a lot of acute diseases, who maybe go regularly to the ED for very justified reasons.” (U-PCP3) “[ED] care might be poorer because it only addresses an X or Y question, purely in a biomedical manner, not at all from a biopsychosocial point of view.” (U-PCP8) |
“For somebody, who’s severely dehydrated, with electrolyte disturbances, and underweighted, ambulatory means are extremely limited.” (PP-PCP14) “The frequent and avoidable [ED] consultation should be targeted. Avoidable as it reflects a lack of adaptability of the follow-up framework for the person’s actual problem.” (PP-PCP12) “I think that the ED has neither time nor capacities to be efficient [for alcoholic FUEDs]. (…) Because when these patients arrive to the ED, they don’t need medical care. All the work behind is understanding what started it all, why people drank, (…)” (PP-PCP8) |
| Ability to provide care |
“The fact that residents [at Unisanté] are changing every 6 to 12 months does not enable adequate follow-up of that kind of patients.” (U-PCP12) “Is it fair that these patients have this kind of follow-up? Shouldn’t they have a long-term follow-up?” (U-PCP11) “But I think it is difficult to care for them [FUEDs] anywhere else [than Unisanté]. Things are hard to organize in a private practice. Translators cannot be organized. If they must be paid… But at Unisanté, costs are being taken care of.” (U-PCP13) “Chief residents’ supervision helped a lot. And we also had the possibility to call chief residents specialized in vulnerable populations.” (U-PCP8) |
“(…) play the role of an ally to the patient, to understand what’s happening, synthesize and orientate the patient according to (his/her) symptoms, instead of the patient going here and there. If there’s really the need for a second opinion, it is better that I accompany the patient, instead of care being completely scattered.” (PP-PCP2) “A basic rule of our practice functioning [group practice] is that every emergency will be seen during the day or the next day. We aim at a 100% answering to emergencies.” (PP-PCP9 [working in a group practice]) |
