Without a family doctor

When Tamara Curnuck and her husband and twin daughters moved from Toronto to the small town of Kawartha Lakes, Ont., it was for a slower daily pace and gorgeous surroundings. And, as it turned out, no available family doctors.

The twins, now five, and their parents have become seasoned pros at putting in long hours at emergency room and walk-in clinic waiting rooms. “When you don’t have a family doctor, you almost feel disjointed,” says Curnuck. “When your child is sick, you feel helpless.”

Despite her frustration, Curnuck has figured out ways to get good medical care. And if you’re one of the 4.1 million Canadians without a general practitioner to call your own, there is a surprising amount of support out there that can help you keep yourself and your family well. Here are some coping strategies for making the best of life without a doctor.

Keep a record

“If you have a doctor, she has your medical records. If you go to a walk-in for the first time, they have nothing,” says Jodie Pappas, a health management expert and author of Your Family Health Organizer. “You need to be a lot more practical and organized.” She suggests starting a notebook and writing down everything: doctor visits, prescriptions, symptom details and immunizations for everyone in the family. When you see an ER or walk-in clinic doctor, ask for his or her name and contact information and record that too. Even if you’re confident, write it down anyway. “When you’re having an emergency, the last thing you want to rely on is your memory.”

Call for help

Most provinces have a toll-free health line that will connect you to a specially trained registered nurse who can assess your condition and either suggest treatment or direct you to a doctor. Prepare for a load of questions. “There’s a process to each call, and all the questions are there for a reason,” says Adam Jones, a registered nurse and director of client relations for Telehealth Ontario. Calls last on average about 10 minutes and wait times vary, but you’re most likely to get put on hold between 5 p.m. and 10 p.m.

Have details about the symptoms and prescriptions on hand, as well as the person who’s sick. The nurse might ask about your sick child’s breathing or pallor, so make the call by her bed or be prepared to peek in on her.

Nurses’ hotlines have their limits: A nurse can’t diagnose you, even though she might suggest treatment. As well, many people charge that they often just get told to “go to emergency.” Jones says he’s heard this complaint, but Telehealth keeps track and says that only about 14 percent of its callers get referred to hospital.

Ask at the drug store

Pharmacists know more than any other health care professionals about medications, and they can consult your medication history (which they keep on file). “There’s so much stress on the health care system, people come to us because we’re accessible,” says Jody Shkrobot, an Edmonton pharmacist. He says the pharmacist’s role has been expanding over the last decade, and today these experts can help you with an array of over-the-counter treatments such as allergy pills and throat lozenges as well as relief for pain, colds and flu.

And since your pharmacist knows what medications you or your kids are taking, he can quickly tell you if you’re dealing with a side effect or drug interaction, or simply not taking medications properly. Pharmacists will send you to an emergency room if they hear of worrisome symptoms that need immediate care. If you live in Alberta, your pharmacist can renew and even prescribe some medications — a new role that’s being considered in other provinces too.

Talk to the nurse

“We’re able to do 80 to 90 percent of what a family doctor can do,” says Donna Alden-Bugden, a nurse practitioner in Winnipeg. The 700 nurse practitioners in Canada either work alone, often in remote communities, or as part of a clinic’s health care team. These nurses have the medical training to allow them to diagnose, run tests, write prescriptions, do minor surgery and deliver prenatal and postnatal care. They consult or refer to doctors when it comes to surgery with general anesthetic, prescribing narcotics or diagnosing complex conditions. These caregivers can help healthy families, as well as those with diabetes, asthma or heart problems. “We usually have more time to spend with patients — our appointments last about half an hour,” says Alden-Bugden, who adds that these longer visits are ideal to help people with chronic conditions. You can find nurse practitioners by calling the college of registered nurses in your province.

Walk into a clinic

When you’re doctor-free, walk-in clinics are your lifeline to getting prescriptions filled, babies weighed and sore throats looked at. Come prepared: Bring a personal record of your family’s medical history and bring your actual prescriptions as well. Have some written-down questions at the ready, but keep them focused on the cough or booster shot at hand. “When patients come in with five items on a list, the doctor is going to say: ‘What’s the actual problem here? That’s the issue I can deal with today,’” says Dr. James Higginson-Rollins, managing director of the Albany Medical Clinic in Toronto, a family practice and walk-in clinic. Try to find one walk-in you like — with good hours — and keep going back regularly. The clinic will keep a chart on you and your family, and you’ll get to know the doctors. “You might be able to establish a regular relationship [with],” says Dr. Ruth Wilson, president of the College of Family Physicians of Canada.

In an emergency

Emergency room care is all about the wait times. Tamara Curnuck has her own strategy: She wakes her sick girls at 2 a.m. to take advantage of the hospital’s quiet hours (they tend to be busiest in the morning and at the dinner hour). She also keeps a backpack permanently loaded with books and toys that she can quickly grab on the way out the door.

How long you wait depends on how sick you are; all ERs and urgent care centres follow the Canadian Triage & Acuity Scale to assess the urgency of your condition. No point in trying to charm the nurse to reduce your wait. But do ask for an estimate, and if your child suddenly starts throwing up or turns extra pale, ask the triage nurse for another assessment, says Sara Marlow, coordinator of the Urgent Care Centre at St. Joseph’s Health Care in London, Ont.

A doc of your own

No family doctors taking patients in your area? Keep trying. Lynn Sauvé found one for her daughter in Barrie, Ont., by catching the attention of a doctor at a walk-in clinic.

Call or visit the website of your province’s college of physicians — it should keep a database of doctors accepting patients.

Another tip: Look for “opening soon” signs for doctors’ offices. Some existing offices that aren’t officially accepting new patients might be able to squeeze one or two in. (Those that say they’re open often get an avalanche of calls.) To find these GPs, talk to your friends and family.