Yesterday afternoon, I attended the public meeting that had been promised by the Board of the REACH Medical and Dental service — and what a humdinger it was!
The public information session, just a few weeks before the organisation’s AGM, was supposed to settle some of the serious questions and rumours circulating in the community about the future of REACH, Grandview’s historic and unique medical facility.
About 50 people from the community were gathered, many drawn by having received unexpected letters saying their REACH doctor had resigned, leaving the member and family without a doctor and without further information. They have been aware of tension within the clinic, and the strain it has taken on some of the doctors. REACH’s salaried teams practice the old take-whatever-time-is-needed-to-solve-the-problem philosophy, and members with several decades’ history with the organization are concerned about changes that may occur in the level of this superior service.
All of this is exacerbated by occurring during major renovations to the facility on the Drive and the consequent displacement of service.
The Board hired a facilitator for the meeting; and it was clear from their agenda (three presentations followed by table-group discussions) that they had a workshop type meeting in mind. That was never going to stand. The members believed they had been invited to an information session, and direct answers were what they wanted, not more chat around tables.
Several times the facilitator and REACH management tried to get the meeting back into the shape they wanted it, but the meeting would have none of it. With jargon-filled definitions clashing against calls for openness and understandable talk, the managers were forced to give in. The meeting then continued as a straightforward Q & A session with the audience eager both to ask questions and to hear honest replies — which were not always what they thought they got.
Matters became heated at times, and often enough the offer to ask a question instead elicited a long comment or concern or personal anecdote. But this is what the community needed to do.
In the end perhaps there was a lot more light than there had been before.
- There was light concerning the difference between the REACH model of salary (known as APP funding) and the more standard modern practice of fee-for-service.
- Coastal Health pays the full cost of REACH Medical through APP.
- At some point — much historical dispute here — APP was defined as being for only the most complex medical/social clients (5% of the overall population, I believe); however REACH continued to offer medical services to the entire member community and were not meeting the funder’s commitments to APP.
- There were tensions within the clinic about whether or not to add clients to the doctors’ panels.
- There were personal and professional tensions between the doctors and the executive management team.
- These issues led to 5 doctor resignations. However, two of the resigners have discussed returning.
- More doctors and support staff have been and are being hired.
- The building renovations are more or less on schedule and March is now discussed as the completion date.
The primary change to the current model that the executive want to impose is the opening of a fee-for-service Family Practice and Drop-In Clinic. This is what will be offered to new members wanting to join REACH. It will more or less be like going to any other clinic on the Drive. If new people join who have the requisite degree of medical/social complexity they will, I assume (though I wasn’t clear) be added to the old-time REACH full-service lists.
This plan was not a popular one among those attending the meeting. Even though it was denied several times, and forcefully, there was a residue of suspicion that current members who are not “complex” will eventually be shoved out to the new service.
More interesting to me was the strength of opinion on the nature of fee-for-service medicine when compared to the traditional family practitioner model of REACH. Not a single speaker from the audience could find anything positive to say about fee-for-service. They want the present system to stay. Not just that, the loudest applause of the night came on a suggestion that the REACH model be expanded to other communities.
The REACH AGM is on 21st September. It is obviously an important year to be involved. However, in order to vote at the AGM you have to join REACH by 19th August!!
It was a wonderfully raucous meeting — Grandview at its activist best!
Jak's View of Vancouver v.3 
Sounds like the real thing. How great when people become truly involved and cannot be “managed” by consultants and facilitators.
The previous comment has been deleted at the request of the writer. I hope she reposts the interesting information.
Thanks Jak – reposting sans personal details… ;)
Fascinating – makes me wish I had attended and gotten the full details (if names were named). After over a decade living in Vancouver without a GP, early last year I (one of the aforementioned “complex” patients) was accepted at Reach. I was thrilled… until it quickly became obvious that the doctor I was assigned to was not even remotely capable of managing a patient like me. After requesting (confidentially!) to change doctors about 6 months in and having that request rejected, I tried again via the VCH patient quality care office to be assigned to a new doctor. The VCH rep said they could help – but Reach management blocked the request again.
As I continued to spiral into more debilitating illness – having major issues with a couple critical specialists and no support from my GP at Reach in dealing with them, by Christmas I literally thought I might die before getting adequate care and figuring out why I was so sick. I was scrambling to arrange power of attorney, etc. while the doctor I was assigned to continued to flounder and gaslight me when I pleaded with her to help me get the specialist care I needed. Finally I decided anything was better than this, and abandoned ship with no new care arranged, and decided I’d go back to the Women’s Health Collective in the DTES – less than ideal with the distance and the level of care I needed, but at least the nurse practitioners had always provided very respectful care. By some miracle I didn’t make it to even a second appointment at the Health Collective before I got a tip a couple weeks later that there was a new GP in East Van taking patients, and I managed to get in with a wonderful GP (who unfortunately just moved back to Ontario – I’m waiting to meet her replacement, and crossing my fingers).
The care I received at this new regular clinic (not geared towards complex patients) was miles better than what I had at Reach – everyone who works there has been so kind and respectful… It was only after moving there that I realized what a traumatic experience my time at Reach was. It took months for me to stop having flashbacks and insomnia from it, and start to trust my new doctor who was unfortunately like a magical unicorn – too good to be true. The real kicker is the (very rude) dismissal letter I got from the doctor at Reach, which revealed that not only had they not kept my request to change doctors confidential, but the doctor turned around and (I can only assume because of taking my departure very personally) blamed me for breaking the doctor patient relationship and ruining my own quality of care. The manager and VCH rep both kept touting “continuity of care” but what the hell does that matter when the quality of care is absolutely atrocious?
I’ve been too nervous to publicly write a full account of what went on last year – there is MUCH more detail than what I could summarize here, but suffice it to say even though I lament losing access to a full service clinic so nearby – and apparently I may have benefitted from waiting out the inadequate doctor at Reach retiring, I thought I might “retire” before they did, and I’m glad I left. It was one of the worst medical experiences of my life. Patient-centred care, it is absolutely not.