As announced on the Phoenix Medical Practice blog and acknowledged in a Health PEI news release, Charlottetown doctor Robbie Coull is shutting his medical practice, letting go his 14 staff, and leaving his 4,500 patients without a family doctor.
Dr. Coull showed up on my radar last fall: I was intrigued by some of the novel aspects of his practice, like publishing patient wait times on his website, operating a paperless office, and, perhaps most novel of all, expressing social policy ideas in public. It was clear the Dr. Coull was not your regular everyday Island doctor, and when I received an email from him in reaction to my blog post about his practice, I took the opportunity to suggest that we get together for a chat about his approach to medicine, health and technology.
Which is how, about a month ago, I ended up spending a very interesting afternoon with Dr. Coull and some of his senior staff, learning about how they view the world.
Suffice to say that they view the world in a decidedly “not like everyone else” kind of way.
There’s no denying that Dr. Coull is a bull in a china shop: he has strongly-held set of views about the right way to practice family medicine, and it’s a model that doesn’t seem to have much in common with the kind of medical care we’re all used to receiving.
The first thing you see when you enter his office, for example, is a fridge full of fresh vegetables, free for the taking by visitors. The waiting room itself is unusual: most medical waiting rooms on PEI are designed, it seems, by the same design firm that designs underground prisons. Dr. Coull’s waiting room is actually rather pleasant. There are couches. Lots of natural light. It’s the kind of place you wouldn’t mind hanging out for a while.
Beyond the technology, the vegetables, and the sunlit waiting rooms, however, lies this simple, radical notion, laid out in the practice’s Guide to Patients:
Health Starts With You
We want to work with you to keep you healthy. We can help you stay healthy with education, health promotion, screening, and monitoring.
The general attitude that pervades the health system on PEI, especially the consumer-facing end of it, is “you should count yourself lucky that we’re taking time out of our busy, overworked schedules to spend any time with you at all.”
The notion that a family medical practice should actually want to work with you to keep you healthy shouldn’t be a radical notion – you’d think it was the whole point – but the siege mentality that’s gripped the medical system for as long has anyone can remember has meant that, somehow, this basic idea seems unusual.
There are many passionate, caring practitioners working to keep us all healthy on PEI, and I’ve benefited from their efforts time after time.
On a systems-design level, however, it’s clear that they’re working a framework that hasn’t been significantly re-examined in several generations: a fee-for-service system that incentivizes illness, a customer service model that strips us all of our dignity more often than not, and a human resources model that places too much emphasis on physicians and not enough on the team backing them up.
I’ve no real idea whether Dr. Coull’s ideas about family medicine are the right ones for Prince Edward Island, and even if they are the right ideas I’ve no idea whether it’s even possible to install a brand new operating system on such an intractable and complicated organism. I suspect that that approach Dr. Coull takes to his practice won’t work for every patient.
But I do know that the three hours I spent with Dr. Coull and his staff are the only three hours I’ve ever spent on Prince Edward Island with a group of people who had thought so long and hard about a new way of doing things, who were so passionate about not only talking about it but about listening to others, and who had built constant re-examination and improvement into the very core of how they worked.
Dr. Coull likely doesn’t have all the answers for Prince Edward Island, but I suspect we’d be better off listening to him than casting him out as an irritant.