Who is Stationed on the Front Line?

A woman in her early forties hurries into a medical clinic. She is relieved to be out of the rain and does not notice the sign above the door of the newly opened facility. She is directly by the receptionist down a bright hallway into Room 2. Inside the room, sitting behind a tidy desk is a man with a pleasant smile and approachable looking face. The man waits for the newcomer to sit down and asks, "What brings you to the integrated health clinic today?" The woman is taken aback. She is surprised to be in front of a doctor without having to wait and falteringly begins to express her problems, not knowing how or where to start. "I've been working so hard recently...I haven't been getting much sleep - I have young children and it's only me to look after them. I've felt very down...quite depressed". "I am not a doctor" says the man, directing his eyes to the sign on the desk which reads "Integrated Triage", "but I can give you an appointment with an occupational therapist in five minutes". The woman thinks there has been a mistake - she is not having troubles with her job, although she has been struggling a bit recently. The man goes on to explain that an occupational therapist can help her to identify where she is having difficulties in different areas of her life and provide her with strategies for resolving her problems. The woman feels relieved that someone can see her so quickly and gladly accepts the appointment.

Ok, I've snapped out of my fictitious world, but as a student, I feel I have an obligation to conjecture with a dose of idealism. Entering into the second year of a Master of Occupational Therapy program, I feel that my eyes are being opened to the potential of this health discipline. Occupational therapists work with people who have a range of disabilities within a variety of settings: hospitals, rehabilitation centres, schools, long-term residential care and in people's homes for clients living in the community. The focus of the profession is on supporting people to engage in meaningful activities following disabling physical impairment - whether this means dressing, shopping in the community or fulfilling parental obligations - it all comes within the discipline's scope. Most occupational therapists work with people who have health issues. The dream scenario described above projects forward to a time in which occupational therapists and other health care professions can work in a more preventative manner; i.e. seeing clients prior to serious health problems occurring. I believe that occupational therapists and other health care disciplines can play a vital role on the front line of health care service provision as part of an interdisciplinary team.

Health Canada and the BC Medical Association recognise the importance of shifting the health care focus towards an emphasis on greater primary care. There is also recognition that primary care needs to be more interdisciplinary in order to operate efficiently. Having a unified team available at the first port of call seems not only to make sense - it seems blindingly obvious. As patients, we are conditioned to visiting the doctor when we have health concerns. Sometimes, it may be more appropriate to see another health professional, but we do not have that option readily available. How can GP’s be expected to work effectively when they have an unrelenting stream of patients listlessly flipping through glossy magazines in the waiting area? If other health care professionals can ease the burden of the GP's by providing discipline-specific expert advice, this has got to be a preferable situation.
Despite the good intentions of educators to push the interdisciplinary agenda, from my experience there is scant evidence of health care students getting together to carve out a model that could translate into 'the real world'. The two opportunities I have had to collaborate with my future colleagues in nursing, physical therapy, pharmacy, medicine etc. have been inspiring and enlightening experiences. As representatives of our respective professions, we sat around a table explaining to each other exactly how we would approach the treatment of a fictitious patient. Misconceptions, of which there were many, were dispelled. We felt empowered, unified and emboldened as we contemplated the prospect of entering into the often maligned health care system – together as a team. There are also emerging frameworks that have the potential to foster greater collaboration between disciplines. The World Health Organization (WHO) has changed the way in which ‘health’ and ‘disability’ are conceptualized. It is recognizes that all humans experience variability in health condition over a lifetime. Therefore, disability is not seen as something occurring to the minority, but something that everyone is subject to. Viewed this way, health and disability can be measured on the same continuum rather than the more traditional view of distinct ‘healthy’ and ‘disabled’ populations. WHO’s International Classification of Functioning model depicts a holist view of health determinants rather than focusing solely on the physical body and symptoms. This biopsychosocial model provides a blueprint for health care professionals to work from, where everyone can identify their area of expertise and see the continuity between scopes of practice. Importantly, it provides a means of communicating in a common language, allowing for improved interdisciplinary understanding.

The initiatives to change the emphasis of primary health care and foster greater interdisciplinary collaboration are in place (e.g. Enhancing Interdisciplinary Collaboration in Health Care), but the momentum is slow. There are various interdisciplinary primary health care units around the country and reports show improved satisfaction from all stakeholders, including patients. When I qualify as an Occupational Therapist, I want the option of working within a primary health care setting to provide vital services to all people in the health continuum. Ultimately, change is an economic issue, but it is also a philosophical and ethical one. We have the ideas for developing a more efficient and inclusive medical system. Now is the time to make it a practical reality. It is either that or a less rosy outcome to the above scenario: the woman is discouraged when she is told she must wait at least 45 minutes to see a doctor so she decides to go home. Her problems are unresolved. What happens next?