Person-centred care, wellness, mindfulness.
This is familiar jargon to anyone who has followed recent trends in health care. In fact, it’s been many years since the provincial Health Department added “wellness” to its name.
“Although it’s touted as innovative and a buzzword, it really is the way of the past,” Dr. Maria Patriquin said in a recent interview. “It’s the way practices used to be established. People didn’t work in silos, in isolation: We worked together.”
Patriquin and her colleagues have put that old-school collaborative philosophy to the test since she opened the Living Well Integrative Health Centre on Windsor Street in Halifax in 2012.
During an open house celebrating that five-year anniversary and the culmination of Patriquin’s professional dreams, she spoke of the challenges, fulfilment and life-consuming hard work that comes with blazing an alternative trail through the thicket of establishment health care.
She’s the first to admit it’s not an easy path to take. An engaging woman with a warm laugh, Patriquin speaks frankly of burnout and frustration with inflexible government bureaucracies.
But she also conveys a fierce determination and passion for guiding people toward a healthy awareness of their own minds and bodies.
A Quebec native who grew up in Nova Scotia, she has practised medicine for 21 years. She studied child psychology at Dalhousie University and earned her medical degree from McMaster University in Hamilton. Afterwards, she received a Women's Health Fellowship from University of Toronto's Women's College Hospital and joined the college’s staff.
In 2000, she returned to Halifax and worked for six years at the North End Community Health Centre on Gottingen Street.
Throughout her career, she’s been guided by the belief that the person, not the illness, should be the focus and priority of health care.
“For me, my raison d’être is the people,” she said. “I’m most interested in the shared sense of humanity. I’m most interested in the compassion and exchange and how that therapeutically has a role. How we can speak to somebody’s skill and capacity and build (their) capacity and strengths?”
Patriquin is trained in mindfulness-based stress reduction, a program developed by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical School.
Other practitioners at the non-profit clinic include Dr. Shauna Archibald, who shares care with Patriquin in obstetrics, nurse practitioner Lesley MacGregor, registered massage therapist Joanne Morrison, physical therapist Robin Stamm, nutritionist Monica Rodriguez, counselling therapist Erin Montgomery, yoga instructor Katrina Crowson and child psychiatrist Dr. Lorraine Lazier.
“(Patients) may come in and initially meet with my nurse practitioner or maybe with me,” Patriquin explained. “We address their issue that they’ve come to seek care for. Then we decide at that time what it is they envision as being important to address . . . or if not, through what I diagnose or identify. Then I help them come toward what might be helpful.
“I consider my role to be more educational, to be honest. It’s equipping a person once I’ve helped uncover or elucidate what the problem is, how they can access the care that’s best going to help them. That will include what I can do, that will include what other people can provide for them and, most importantly, what they can do outside the office. At the end of the day, it’s their issue.”
The College of Family Physicians of Canada has recognized the clinic as a Patient Medical Home success story.
The concept of a medical home isn’t to be confused with an institutional setting. In a Patient Medical Home such as Living Well, the philosophy is to treat patients like friends or family members.
And there's definitely a non-clinical, homey feel to the clinic, which was converted from an older multi-storey wooden home. The walls are painted in warm, welcoming tones and dotted with colourful paintings by Patriquin’s husband, Vasile Ivanov (which, by the way, can be purchased in support of the clinic.)
As is the case in many homes, the challenges that come with paying the bills and keeping it all together can be daunting. Patriquin works a 55-to-70-hour week, but "very little" of the resulting income is left after supporting her practice, administration and a family of five children.
In an attempt to balance her patients' needs with keeping the lights on, Patriquin has had to be inventive with her programs. For example, she offers group medical visits, which allows the clinic to provide care to several people with similar medical conditions at the same time.
One of the clinic's most popular services is Patriquin's mindfulness stress-reduction program. There's a 70-person waiting list — it's covered by MSI, but only for eight people at a time.
Without more government support and a willingness to change a bureaucratic mindset, Patriquin said she worries for the future of true collaborative care in Nova Scotia.
For example, under the current rules, she must personally sign off on every appointment conducted by her nurse practitioner, Lesley MacGregor. "If you allowed my nurse practitioner to practise to her full scope, that's a way you support me. That's how you let this be sustainable. She has 17 years of experience."
With these kinds of small, incremental changes, we can start addressing the huge strain on our health system, Patriquin said.
“I’ll tell you the largest threat to our health system right now is that all front-line health-care providers are burned out — there are astronomical rates of burnout, depression, suicide, substance abuse: it’s unprecedented. Even in my practice, where I have a really broad scope of patients, I’ve never had so many health-care providers in that type of care with me who are off work, ever.
“When people are stressed out, they don’t tend to collaborate very well. This is what I keep hearing of patients’ experience at the hospital. This is what I hear about health-care providers at the hospital ... and I think that’s hugely problematic.”