Thank you.
I represent 9,000 family physicians in the province of Ontario. We were at ground zero during SARS. In 2003, following the outbreak of SARS in Toronto, the Ontario College of Family Physicians was asked to present to the Campbell commission in Ontario and to the National Advisory Committee on SARS and Public Health. Our discussion document, entitled “The Mushroom Syndrome: SARS and Family Medicine”, and a second document, written with our community partners, called “SARS and Community Care: Impact and Opportunities”, outlined the struggles we faced in Toronto during the SARS outbreak and the heroism of family doctors, our specialist colleagues, nurses, and other health professionals as we worked tirelessly in a confusing fog related to a lack of surge capacity, a lack of supplies, and a lack of proper communication systems to provide the guidance and advice that we desperately needed during this tragic episode. The recommendations in those two papers focus on the needs of family doctors and our community-based professionals in relation to pandemic planning. But just as importantly, they focus attention on the need to repair our health care system and to better align public health units with family practices and other community-based services.
When news of H1N1 hit the front pages of the national newspapers, controlled panic overtook the health care community in Toronto, especially among those who were providing care in family practices. We relived our experiences with SARS. You see, during SARS, the public was in a panic and so were we. With every sniffle, the public feared that they had SARS. They were worried about going to emergency departments or to SARS clinics. Instead, they headed in droves to their family doctors' offices.
Family doctors not only work in their offices; they work in emergency departments, they deliver babies, they look after people in hospitals and in long-term care facilities, and they look after palliative care patients and home-bound patients in people's homes. When SARS hit, they continued to perform all these tasks. They also manned the SARS clinics and took over the emergency departments and the ICUs when other physicians were deadly ill with SARS. But no one thought about their needs and those of their families. They worried of exposing their loved ones to that deadly disease, and their families worried about them. Most frightening of all, many of our patients in those days were our own colleagues, the ones we worked with day in and day out. We thought health care professionals were invincible and we found out that they weren't.
For the most part, SARS was confined to hospitals in Toronto, but the only physician who died from SARS acquired it in his family practice. Not until that family practice was brought to its knees did the system start to appreciate the role that family doctors were playing during SARS. It took our college and the family doctors themselves to make people take notice of them. Believe me, it was a tiring and stressful process to get noticed.
Post-SARS, a great deal of health planning has occurred. We are very much more prepared than we were then. Family doctors have actually had a place at the planning table in Ontario. We were first invited to the table with dentists, pharmacists, funeral directors, and the like, people who may have a role to play in the outbreak, but not the central role that family doctors play. Unfortunately, health care planners may still believe that the outbreaks are hospital-centric and they forget about the central role that family doctors play in our health care system, particularly through influenza.
During the initial few weeks following the H1N1 outbreak in Mexico and across Canada, communications were swift and concise. But since we don't have one list of all the physicians in the province that can be used to send information, news briefs from the Public Health Agency of Canada, the Ministry of Health, and our agency on health promotion and prevention were sent through a variety of organizations, so the same message was received multiple times. Fortunately the messages were usually concise and usually consistent, but there has to be a better way of getting the right information at the right time to physicians. The information needs to come from someone in a trusted position. Where physicians are concerned, the information needs to come from a physician with the authority to say, “This is what you will do, and you will do it now.”
The system we did use provides some degree of two-way communication. The OCFP regularly communicates with our members, and they're used to e-mailing us back with questions, concerns, and solutions. We received a lot of e-mails during those early days of H1N1, and we passed them on to the ministry. The ministry also set up a hotline to provide information to the public and to health care professionals. Those who answered the phone were confident and very well meaning, but it soon became clear that they were not able to address the clinical questions that family physicians were asking. We assisted the Ministry of Health by recruiting retired family physicians and some of our members who were on maternity leave to be a valuable source of providing that telephone contact. This strategy gave the Ministry of Heath an opportunity to hear from the field, and news briefs were then used to address most of the questions that were coming up the pipe. Hospital departments of family medicine also play a really key role in supporting and informing their members.
We still have a lot of work to do, as we approach the fall, in improving that two-way communication system. We need to address public education and messaging, and soon. While we certainly don't want to alarm the public unduly, it seems as if the public and professionals alike have been lulled into thinking that H1N1 is a non-event. People need to better understand the potential for a severe reaction to the virus, and they need to—