Living Well Integrative Health Center

2176 Windsor Street, Halifax, Nova Scotia, Canada. (902) 406-1500

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Nurse Practitoners and MDs in a health crisis: Why Less is MORE this time!

September 7, 2017

Lesley MacGregor is a Family/All Ages Nurse Practitioner who has been providing care to her patients across Ontario and Alberta for the past 18 years. Recently relocated to Halifax, Lesley is honored to join the Living Well Integrative Health Center.

Lesley completed her Bachelor of Nursing Science Degree at Queen’s University in Kingston Ontario and after several years working as a Registered Nurse in acute care, public and community health, Lesley completed her Masters of Advanced Practice Nursing - Nurse Practitioner Degree through Athabasca University. Since that time, she has been practicing as a collaborative member of Family Health Teams, Primary Care Networks and working with high risk patients in Home Care. Lesley has been successful in the development and implementation of several specialized health care programs in Edmonton Alberta and believes in a patient/family centered approach to care.

Lesley is registered with the College of Registered Nurses of Nova Scotia (CRNNS) as a practicing member, the College and Association of Registered Nurses of Alberta (CARNA) as a former member and is a registered member of the Canadian Nurses Association (CNA).

Lesley’s professional areas of interest include multidisciplinary collaborative health care delivery models, program development and evaluation and care of the Frail Elderly.

Lesley is a proud wife and mother of two beautiful and busy daughters and enjoys a healthy lifestyle inclusive of clean eating, regular physical activity and practicing Taekwondo. Although many of you will have heard the province announce its "innovative" plan to introduce NP's to NS in an effort to meet the primary health care needs of Nova Scotians, few of you would know that real action is stalled and as such I hired Lesley myself and pay her from my wage in order to help me meet your needs.                                                                                                                                                                                         My patients are aging as am I. Society is becoming more complex and stressful and the effects that is having on mothers, children and teens are shocking. The elderly are virtually ignored and "mental health" is not only considered separate from our physical health, it is not considered. All this comes at a time of fewer resources and limited budgets where the "human factor" as I call it is given little value and doctors are remunerated for quantity not quality of work.                                                                                                                                                                                                                       We have the second longest wait times in the country and the most elderly per capita. We also have what is a crisis characterized by a gross shortage in doctors that has been underreported and no real concrete plan to alleviate the need. We are now doing harm when once we took an oath to do no harm by virtue of not being able to meet people's needs; even those with doctors.                                                                                                                             Hiring Lesley was a bold but well thought out plan to help me alleviate some of my overburden of care, so that I too can remain healthy and do what it is I love so very much. It is also because it is the model in which I was "raised" so to speak as a doctor in an innovative medical school (McMaster) and later at Women's College Hospital in Toronto. Here it is considered innovation despite the NP role having been developed, endorsed and funded by the federal government back in the 60's! We all joke about the maritimes being 10 years behind the rest of the country but that is a reputation I'd love us to shed.                                                                                                                                      It has been a hard sell to patients primarily as they didn't understand (as I didn't share) how very much more work has been generated for me in this time of health care crisis and that my own family feel they come second to my practice. My health and wellbeing has suffered because I do care. As errors within the strained system rise I do check and second check everything in an effort to ensure all is well. I am told, I care too much and that I make work for myself. I have been told that if I were to adopt a brick wall type cynicism that it would protect me from the hurt I experience as a physician being a part of a system I am not just dissapointed by, but feel fails my patients and me. The ministers don't follow up yet they admitted to me in person the NP situation "is bad" and that they are "working on it".                                                                                                                                                                                     Working on it from our end appears to come in the form of multiple audit letters being sent to my patients (sometimes a few in a week) questioning as to whether or not they saw me or Lesley and for how long and when etc etc. I have no qualms about their inquiry. It is anticipated as a doctor. What is problematic is that it has created a sense of mistrust between my patients and Lesley as well as with me as it introduces a question as to whether or not I am cheating the system. I pay her half what I make in an hour and if you are seen as my patient and I do not lay eyes on you, I do not bill the encounter. I still review the chart and the information (doubling the work as Lesley is capable) but I do not bill and this means I am paying for your visit to my office that I can accomodate in a more timely fashion only by having hired Lesley.                                                                                                                                         Lesley despite her 18 years experience requires more supervision than my 4th year medical students. Imagine how she feels after lengthly study and a rich work history. I write this so you may all understand just a few of the immense challenges that I meet as a family doctor in a practice that has been nationally endorsed by the College of Family Physicians of Canada yet is being sabotaged by the local authorities. Despite meeting their criteria and being named "a success story" of collaborative care (see older posts), I don't meet their criteria for a tiny stipend which would offset some of the loses incurred through my subsidizing of my patients care by having Lesley or by virtue of not being paid when I spend a half hour instead of 10 minutes seeing you.                                                                                                                                                                                                                                       Please know I would never betray the trust i've built in our relationships by providing you with care by anyone less than amazing. It was through the study of medicine and the privilege of caring for you all that I have deepened my understanding of what it is to be human. And yet I am not afforded the same care and consideration that I work so hard to provide my patients with; care that would enable me to be more healthy within this system where I value authenticity. I must practice what I preach.                                                                                                                                                                                     I appreciate you taking the time to read this. I will continue the fight for what is fair and right by my patients and in the interim I ask that you have patience and also consider that having Lesley is not having less by not having ME, but makes your care so much more than being about illness. It is the rare time that less is not more! Having a team enables me to do preventative care, to make the time you need and to accomodate for those unanticipated emergencies that we all meet in our lives if not more than once.                                                                                                                                           Living Well was born of vision it does NOT generate a profit. Our beautiful space was created through collaboration, creativity, contributions and curb-side finds. I am humble and it has created us a medical "home" environment. The programs that I offer I am taking from my billings and paying practitioners to see you and provide you with expertise I do not have but that stand to serve your health needs  by providing you with the opportunity for making healthy changes that enable you to not need another prescription or that allow and enable you to be more healthy and self-sufficient even with an "illness". We are able to live well in sickness and in health.                                                                                                                                                                                 Although it is difficult, I ask that we all CONSIDER CHANGE as it is the only way to to be healthy amidst a system and a society that isn't healthy and that is more invested in putting out fires than preventing them. A system that values quotas and numbers over people. That is not quality if life, it is survival mode. In Canada we should settle for nothing short of thriving for ALL persons. Thank you for your time and consideration, I truly care deeply for you all and am grateful for the privilege of caring for you, I am grateful for the trust you endow me with to share the ups and downs the joys and losses. I live a better life for it, one with more meaning and purpose. I greatly appreciate you understanding that I too am only human and nothing separates us as humans other than thoughts that we are different. I hope that we can face the changes together in a manner that is kind, patient, compassionate and that does require some comprimise and more work on your part to engage your health.  There are handouts in the wait room that will provide you with more advice on how to do your part.                                                                                                                                                                                       By being open, honest, kind, communicating and engaging change together we can become more healthy not less and the process will be more tolerable and pleasurable as we are in it together. More is not less at Living Well and it is "better together" 

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