Rehab and Community Care Medicine • Summer 2021 • Primary care

Deficits in coordinating care with timely flow of information. Delayed access to specialists. Long wait times for procedures and treatments. Lack of resources for patients to manage their own health. These are but a few of the many signs of a health system in high stress. And then came the pandemic.

COVID-19 has confronted us with the glaring deficits of our current health care system and brought us to a critical juncture where we need to consider not how quickly we can return to “normal” but what we imagine a “new normal” might look like.

Currently, primary care sits at the periphery of our hospital-oriented health care system with serious information flow bottlenecks. As one family physician stated, “I know my patient has had a stroke when they show up in my office with half their face paralyzed.”

We have frankly lost track of what wave of COVID-19 infections we are at, but what is more concerning are the waves of deteriorating health that we are seeing. This includes issues with common health conditions such as diabetes, cancer screening and vaccinations where patients are getting neglected or delaying care. The fear and anxiety about the pandemic, as well as the social isolation and economic hardships incurred are exacerbating or causing major mental health issues. Mental health has always been the purview of primary care but now it is both paramount and overwhelming. The ongoing lockdown measures are amplifying social isolation and loneliness. These two issues, which are now a pandemic of their own, are associated with a range of negative health outcomes.

Many are working to develop strategies to address the issues caused by isolation and loneliness especially for our aging population. Primary care with the tools of telehealth, community engagement and family medicine could play a key role in implementing these strategies. Primary care needs to expand beyond its usual borders to include social prescribing— an innovation where health care providers can “prescribe” community engagement in various activities. Imagine what it would do for an older person battling social isolation if they become involved in the arts, physical activity, volunteering, befriending a young person, perhaps to tutor them by Zoom, if in person is not possible. Imagine. That is where innovation starts.

This innovation would need to flip the orientation of our health care system to ensure that primary care is at the hub for provision of care. We believe that primary care is well positioned to create a human-centered, digitally powered approach to health that more closely embraces WHO statement that, “[h]ealth is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This is our opportunity to build back better.

Laurette Dubé is the James McGill Chair in Consumer and Lifestyle Psychology at the McGill Centre for the Convergence of Health and Economics.

Gillian Bartlett was the Research and Graduate Program Director in Family Medicine at McGill University and is now an Associate Dean at the School of Medicine, University of Missouri.

Alayne Adams is an Associate Professor in the Department of Family Medicine of the Faculty of Medicine at McGill University.

Catherine Paquet is an Associate Professor at the Université Laval and is affiliated with the Research Center of the Centre Hospitalier Universitaire de Québec.

Amalia M. Issa is a Professor at the University of the Health Sciences in Philadelphia and Adjunct Professor of Family Medicine at McGill University.