Objectives
Describe practice settings Canada, Detroit
& Denver and the type of patients that I
saw.
 Present patients of mine in each place and
time that benefited from a team approach
to their care (particularly chronic diseases)

London, Ontario (Not England)
1982-1992
London, Ontario 1982-1992
London, Ontario 1982-1992
Medical Care
London, Ontario 1982-1992
Fee for service (solo FM practice)
 1500 patients but still a micro-practice
(Low overhead and just one staff but could
easily see 25 patients a day)
 Young practice but a lot of home bound
elderly

Type of Teams Promoting Care
London, Ontario 1982-1992
Practice staff:
 + Receptionist was an extension of me.
Knew patients well and promoted care.
 - No other office staff enabled to take
responsibility for prevention or care.
Support of Chronic Disease Management
 - no disease specific team support in the
office. (No educators, counselors etc.)
Type of Teams Promoting Care
London, Ontario 1982-1992
Support of Chronic Disease Management
 - no disease specific team support in the
office. (No educators, counselors etc.)
 + wide range of specialty support and
services to access many times at no cost
to patients. Collegial shared care for every
patient with my office as the medical
home. Cardiac rehab, nutrition counseling,
pulmonary rehab etc.
Type of Teams Promoting Care
London, Ontario 1982-1992
Support of Health Promotion
 - I was on my own in providing prevention.
 + community health education initiatives
largely government promoted.
Immunizations free and vaccines readily
supplied to all practices.
Type of Teams Promoting Care
London, Ontario 1982-1992
Support of Community Care outside the
Office Walls

+ extensive system of home care support
services, mostly without charge. Low turnover so
could depend on staff to provide good
information on your patient. Government
insurance paid a significant premium for house
calls. Meals on Wheels available. Public health
nurses provided home assessments of new
moms and babies.
Type of Teams Promoting Care
London, Ontario 1982-1992
Special Support: Palliative Care



+ Many family docs cared for their palliative care
patients at home. Special palliative care nursing
staff experts in symptoms control.
Specialized palliative care unit with some
inpatient beds but more importantly physicians
and staff who consulted on problems by phone
through assessing patients at home.
Cancer Center Neuro-Oncologist Pain Specialist
available.
Type of Teams Promoting Care
London, Ontario 1982-1992
Special Support: Palliative Care


- You were in charge and it could be emotionally
draining (but more often some of the most
“memorable” care you gave.)
Out in middle of night to sign death certificates
Journey from the Forest City to the
Motor City -1992
Crossing “Borders”
Grace Family Practice Center &
Residency Team
(Weird) Teams in Motown

Meet Jack Kevorkian
at the Peking House
restaurant at lunch
time. Palliative care
consults with “Dr.
Death”
Journey from the Motor City to the
Colorado -1999
Crossing “Borders”
Medical Care in Colorado -1999 to
Teams in the AFW Clinic
Team Huddles helping team based care
 CINA EMR disease management
 Nutritional Counseling
 Diabetes teaching
 On-Site behavioral science co-consults
and co-management.

Conclusions
Gave a glimpse of a Canadian primary
care practice.
 Described the types of patients seen
 Gave a glimpse of the strengths and
weaknesses of team care in London,
Detroit & my current my practice.
 There is a team member that can help, in
the office, in the community and in the
bigger health care system.
