Paging Dr. Coull

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.


mary jane's picture
mary jane on May 22, 2011 - 07:32 Permalink

This Doctor may have fresh veggies for his patients, but he is rude and ignorant with a very large ego.Very rude to patients and nurses alike…. good riddens to him…

David's picture
David on May 22, 2011 - 14:36 Permalink

I find it problematic that, in the budget of Prince Edward Island, there’s so little room for piloting new ideas. There is plenty of money to bail out dying industries for the sake of tradition, but when someone actually wants to provide a data point on whether another system works or not, there’s no money there for that type of thing.

Dr. Coull wasn’t liked by everyone, nor was it really proven that his model yielded results in PEI. It seems very silly to continue to fund a variety of activities we know aren’t sustainable and exclude those we’re unsure of, though. I can’t imagine there will be a time in the near future where a physician shows that kind of initiative, as it’s been shown here that you’re going to have to do it on your own dime and at your own risk.

Denise's picture
Denise on May 22, 2011 - 14:54 Permalink

I have NEVER experienced anything like that. Whenever I saw the doctor he was very approachable and kind. When I was concerned about my pregnancy in its’ very early stages he was compassionate and open and let me know I could come in at anytime with my concerns. I have had nothing but the best of service from all staff there. A little research shows that his methodology has worked very well in many places. Too bad we don’t get to see it succeed here.

Robert Paterson's picture
Robert Paterson on May 22, 2011 - 16:19 Permalink

A real loss I think — makes it even harder to look at health in a better way

Ken's picture
Ken on May 22, 2011 - 16:29 Permalink

The Phoenix Clinic has been rejected by the body politic of Health PEI like an antibody. It strikes me as true that our current system is impersonal and always seems so hard pressed and I am sure there is a better model or at least a mixed model with some other option beyond the straight fee for service system. Changing the forms, policies, and payments system from the status-quo will take political power in government and the college of physicians. Can’t mess with the money.

Patients seem to have very little voice or choice in the current system, with regional health boards gone. Health PEI should factor more public input into their governance model, with community inputs from across the island. It is our health care system, we own it like the co-op, why do we let the politicians and doctors run it? I think the best metaphor for our current system is that of a castle. We are the peasant patients. We have the power to tear down the walls. We need the doctors more than they need us, individually. Patients of the island unite!

Josh Biggley's picture
Josh Biggley on May 22, 2011 - 23:45 Permalink

What Health PEI and the provincial government at large fail to understand is that the inability to offer reasonable healthcare to residents of the Island means that many do not consider PEI a viable option. Dr. Coull was my doctor and our loss of a innovative, open, honest practitioner has made us step back and reconsider our choice of PEI as a home.

Invest all the money you want in IT, bioscience and aerospace, if you cannot provide a reasonable level of basic services, healthcare among them, then you simply cannot compete with our jurisdictions. Our own family experienced this first-hand when my in-laws chose not to move to the Island early this year on the advice of the critical care team from Ontario. They said, quite simply, the PEI was ill-equipped to deal with medical needs they had now and in the future.

It seems to me that of Dr. Coull’s clientèle, and those who were most happy with his level and framework of service, were ‘from away’. Most were professionals, educated, articulate, and passionate about the issues facing all Islanders. With the loss of Dr. Coull, PEI has lost more than just a doctor, it has lost the faith of the very population it so desperately wants to attract. If we weren’t 20 years behind in medicine before Dr. Coull left, we certainly aren’t moving in the right direction with his departure.

How does the Island regain trust? There needs to be some open, honest and accountable discussions around why Dr. Coull left, the exact circumstances that dictated the decision to abandon this practice model, etc. Although this Dr. represents only 4500 Islanders, the demographic of Islanders impacted is not one that I would want to cross if my political future were at stake in October. Don’t dismiss us with one-line political talking points, but indulge our intellect, give us the data, and let us form our own opinions about Dr. Coull, Health PEI, and the system that we are funding with out tax dollars.

Rachel's picture
Rachel on May 23, 2011 - 04:03 Permalink

I agree wholeheartedly… Dr. Coull was my doctor, and although I only saw him a few times, I was very impressed with him, his staff and the setup. I am now left without a family doctor. Being “from away”, and here only less than a year now, I’m still on the fence as to whether I will stay long-term. Losing my family doctor, and the reasons he is leaving, doesn’t leave a good impression with me. Maybe I’m wrong, but I’m not sure I want to stay in a province in which the government is more concerned about American talk-shows coming the island than the health of its own citizens. Thank goodness I’m relatively healthy. If I wasn’t, or if I had a serious health concern issue come up in the future, I might seriously think of leaving.

Keith Burgoyne's picture
Keith Burgoyne on May 24, 2011 - 14:15 Permalink

Dr. Coull was my doctor. I was very impressed with the organization of his practice and was delighted by each experience I held while visiting it. I found his staff pleasant, and I felt welcome each time I went. This new-to-us method of medical practice is exciting and very interesting.

Now, contrast that with my previous doctor, Dr. Keizer, who dropped me as a patient after I didn’t go to see him for 6 years and whose rude staff didn’t inform me of having been dropped until I called with a medical concern. This led me to Dr. Coull.

Coull encouraged us to be healthy. Keizer penalized me for being healthy. The old system is broken, and the new — well, we’ll never know now, will we? Thanks, Health PEI.

Back to the enormous waiting list, I go.

Anne Leblanc's picture
Anne Leblanc on May 26, 2011 - 22:04 Permalink

Kudos for your comments Josh! I feel the same way, thank you for articulating our concerns about the health system in PEI so clearly.
Now, do the College of Physicians and the Health PEI read this? We need to send all these comments to them so they know what Dr Coull’s patients think and feel about their decision.

Oliver's picture
Oliver on May 26, 2011 - 22:57 Permalink

I’d suppose at the very least that patient education is calculated as an element of any consultation, for each and every one of which a doctor is indeed paid. I don’t see what’s so wrong with a system that requires you to visit your doctor to be educated, because being educated one-on-one and personally by an obvious authority has to be a fairly effective way to get the job done. I guess your concern is that not all doctors educate enough, and/or that doctor compensation isn’t high enough for them to do that, given how often patients visit. Then one fix would be simply to get people to visit their doctors more often, so that conscientious doctors need not teach so much in a single visit. An equally simple fix would be to increase doctor pay, so they can take their time, but then you might well want a system to verify they’re indeed spending that time, and spending it well.

Anon123's picture
Anon123 on May 28, 2011 - 17:03 Permalink

I think it’s time to start calling a spade a spade and recognize that as a small jurisdiction, PEI fails miserably at providing the basic services, let alone advanced, when it comes to health care. Our political leadership and bureaucracy have a rural mentality and we get a commensurate level of services as a result. I personally think it’s time for the 4 Atlantic provinces to create a single regional healthcare bureaucracy that the 4 provinces contribute to on a per-capita population and per-capita GDP formula. Then the operating agencies, such as Health PEI, Eastern Health (Avalon Peninsula), Atlantic Health Sciences Corp (SW New Brunswick), Capital District Health (Halifax Reg. Mun.), Pictou Health, Cape Breton Health, Colchester — East Hants Health, etc. all operate at the same level of service regardless of jurisdiction and must meet the same level of accredidation, etc. Merge the 4 colleges of physicians and surgeons into a single Atlantic-wide body, provide standard pay rates for MDs and RNs regardless of geography, and derive economies of scale through region-wide health-related procurement. AND…. one of the big things that we should be doing is implementing something similar to Quebec’s CLSC network of community health centres that would accommodate surgeons and other specialists, family physicians, nurse-practitioners, dentists, naturopathic medicine, midwives, etc. at a one-stop shop in communities across Atlantic Canada and all accessed under a common health card. I think Dr. Coull’s efforts to move PEI out of the 1960s or 1980s style of healthcare are commendable and it is truly a shame that we are pushing away innovation rather than embracing it. If anything good comes out of this in advance of the provincial election this fall, it’s that it should awaken citizens to the fundamental problems PEI and this entire region faces in the jurisdiction-based model we place health care under. It’s time to broaden that thinking considerably.

Square1's picture
Square1 on May 28, 2011 - 23:56 Permalink

It’s unfortunate that in an already desperate time of need for family doctors on PEI that we have lost one more. In this particular case, we have lost an innovator who was trying to bring better health care to our Island. And personally for me, a doctor who save the life of a family member. This family member who was long without a family doctor was bounced from one walk-in clinic to another with several different and inaccurate diagnosis. Dr. Coull’s arrival to PEI, the openings created for new patients who have been without family doctors, and of course Dr. Coull’s medical expertise brought my family member back from near death. With these thousands of patients now back to not having reliable health care, how can we have faith in our system? What will be done? I suspect not nearly enough!

Roderick MacDonald's picture
Roderick MacDonald on May 31, 2011 - 22:48 Permalink

I thought he was great. Its just too bad I have to find this out by seeing a random page online. No doctor again! I had waited 10 yrs for a doctor because mine had died back in the early 90s. Now how long do I wait this time??

Peter Rukavina's picture
Peter Rukavina on July 17, 2011 - 10:57 Permalink

I have removed recent anonymous ad hominem comments from this post, along with a defense by Dr. Coull and closed this post to further commenting.