Opening the Front Door of the Healthcare System: Primary Care with Dr. Tara Kiran and Sandra Epp
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Does the answer to improving the primary care system lie in the ideas of patients and the public?
In this episode we discuss Canada’s primary care crisis and how the OurCare project is involving the public in reimagining primary care.
TRANSCRIPT
Misty Pratt
Over 6.5 million people in Canada don’t have regular access to a family doctor or nurse practitioner. That’s more than one in five adults, and those numbers vary significantly between different provinces and territories. In some areas, one in three adults don’t have ongoing access to primary care. Yet, experts say it’s not just a matter of throwing more money at the problem. Primary care needs to be restructured in a way that allows for better access and better-quality care, especially for underserved and marginalized groups. I’m your host, Misty Pratt, and this is In Our VoICES, the podcast that brings you the health data, without the drama. Joining me on the podcast today is Dr. Tara Kieran, a family physician and researcher at the University of Toronto and St. Michael’s Hospital and an ICES scientist. She leads the OurCare project. A national conversation about the future of primary care in Canada, and she hosts her own podcast, Primary Focus. We also have Sandy Epp with us today. Sandy is a patient engagement advisor in Manitoba and project analyst in quality assurance in the healthcare space. A heads up that we discuss suicide in this episode. If you or someone you love is in distress, there is a suicide crisis helpline here in Canada when you dial 988. Please take care. Tara and Sandy, welcome to In Our VoICES.
Tara Kiran
Thanks for having us.
Sandy Epp
Thank you very much.
Misty Pratt
So, Tara, you’ve said that primary care is the ‘front door’ of the healthcare system, which, I love that metaphor. But what do you mean by that?
Tara Kiran
When I say primary care is the front door, what I mean by that is that it’s the place that you should be going for most things in your healthcare journey, when you first start in that journey. You know, if you have something emergent or life threatening, of course you need to go to the emergency department. But for most other things, you’re going to be accessing the care first through your family doctor or primary care team. What do I mean by that? Well, let’s say you have a new problem, you should be able to go to the primary care team. You have an existing chronic condition, let’s say high blood pressure or asthma, or you may actually want to stay well, for example, by making sure that you’re getting your cancer screening or immunizations. All of those are things that would be done through the family doctor’s office or primary care team. In addition, that primary care team is also navigating and supporting your journey through the healthcare system. So you know, if you end up going to the primary care team and it seems that you need more care, you need to see a specialist or have more tests, the primary care team, your family doctor, for example, would be the one to actually refer you to others in the healthcare system who would be able to support you and then see you back in the clinic to say, “Okay, this is the findings from your results. You know. This is what various specialists say. You know what matters to you. Let me help you unpack that”.
Misty Pratt
So, it sounds like they’re really a touchstone for all of your care and all of your wellbeing.
Tara Kiran
Yeah, I think that’s what it’s like when primary care works best.
Misty Pratt
Right, so why is it not working very well right now? What are some of the key issues that we’re seeing with the current crisis?
Tara Kiran
There’s actually so much to unpack there, but what I often think about actually, you know, from a simple point of view, is that we can think about it as both a supply and a demand issue. So, demand for primary care is growing. We have a growing population. We have an aging population. People are living longer and as they are living for more years of time that in those years, they actually have more and more chronic conditions that need to be managed. At the same time actually, there’s actually many more treatments available to people in our society right now and so there’s complexity around even thinking about for a single chronic condition, what treatments are available, and how can we support you to be well. At the same time, we actually have a real problem with the supply side. So, we know that Canada has actually not trained enough doctors in the system, period. So, when we go back to the 1990’s there was decisions to actually reduce medical school enrollment, and that decision that was made nationally, now is having a lot of impacts that we see. So, when we compare the number of doctors we have per capita in Canada now, it’s much less than many of our peer countries. So, our peer countries generally, they’re often like, 1.5 to 1.8 times as many doctors. So, we don’t have enough doctors and then on top of that, you know, the doctors often are not choosing to train in family medicine, and even if they are training in family medicine, they’re actually choosing to work in other aspects of the system. Partly that’s because other jobs are available, because we just don’t have enough doctors, but it’s also because the practice of family medicine has become more challenging. The pay is not as good as it as other kinds of work in medicine, and you know, their hours are long, there’s a lot of responsibility, you don’t often have the supports, and you know you are by yourself, working with, often without a team, and often like as a small business owner. So, you’re responsible for, actually just setting up everything. And you know actually, we did a recent ICES study that I should mention, that was published just this past May, and it did find, in fact, that more and more family doctors, people who trained as family doctors, are choosing to practice in the hospital setting compared to in a traditional family practice setting. And we suspect it’s many of those reasons I mentioned, largely pay and working conditions, that are driving that kind of trend.
Misty Pratt
And going back to that ICES study about the care that’s being offered, or about the choices doctors are making about where to work, they talk about comprehensive family medicine. And so, can you just say a little bit about what does that mean? Like, what’s a comprehensive family doctor going to do for me?
Tara Kiran
Yeah, so I think of that comprehensive family doctor, the best way of explaining that is kind of like your traditional family doctor that you might see in a family practice. So, you know, this is someone who’s looking after all of you. You know, whether that’s depression or high blood pressure or sore throat, they’re able to kind of do all of that. They’re looking after you on an ongoing basis. So, it’s not just a one off you’re just going with, like the sore throat, and then you might never see them again, but rather, you know you’re having visits with them. Maybe, you know, two or three visits this year and another two or three visits next year, and each visit might be different. Usually there’s some aspect of prevention as well as looking after those chronic conditions and dealing with new problems as well. And another phrase that I like to use is full-service family practice. At the very basic level it’s providing like a full breadth of services within a clinic setting on an ongoing basis. And so, what we see is that fewer family doctors are doing that kind of work, full-service family medicine, and more and more are choosing to do what’s called a focused practice. The most common kinds of focused practice are like working in an emergency room or working in something called a hospitalist, where you look after patients who are admitted to hospital. Addictions medicine, actually, is also a growing trend, but the ones working in the hospital, actually, were the most common type of focused practice that family doctors ended up working in.
Misty Pratt
And so, it sounds like comprehensive medicine is the doctor is essentially getting to know me as a person and potentially my family as well.
Tara Kiran
Yeah, that’s right. That’s a really big part of family medicine is building relationships over time and getting to know the whole person in the context of their family and in their community.
Misty Pratt
And speaking of family, Sandy, I do want to bring you into this conversation. What do you see from a patient perspective? And maybe you can speak a little bit about your own experience. What’s it like being in our primary care system right now?
Sandy Epp
As a bit of background, I have two almost adult children. They’re turning 18 and 20 this year, and they both have a number of health and mental health problems. So from my perspective, over the last five to seven years, I’ve been hit with a number of medical challenges trying to help them navigate their way through the primary care system, and that’s what got me involved in this OurCare panel is because of the fact that my youngest began to experience severe gender dysphoria and ended up coming out as trans. Was suffering from suicidal ideation and needed help immediately. And we went to go see the primary care physician, and we were basically punted off in a referral to another clinic, and they had a 12 month waitlist. And, at the same time, my eldest was experiencing chronic fatigue, pain, an onset of a tic disorder, and so we went to their family physician, and they did a bunch of tests. We weren’t sure what they were, what they were for, and they were punted off to a referral, and that was 12 to 18 months waitlist. So, my kids were both in crisis, and we were sitting on a waitlist. So one of the big issues that I found, and Tara mentioned it, was lack of available providers who were able to provide timely, convenient, relatable care, they weren’t able to take care of my kids issues, and rather than being able to provide us with something to help us in the interim, we were just kind of shoved out the door on a waitlist, and so that that added a host of other stressors into our lives.
Misty Pratt
Did you ask the doctors why they couldn’t care, in the interim, while you were waiting, why there couldn’t be some follow up in between?
Sandy Epp
Well, they just, they didn’t really have any answers, you know, like they the one doctor for my eldest with regards to the tic disorder. They said that there is a Tourette’s clinic, and so. We have to refer you to this treatment center, and then they’ll put you into the Tourette’s clinic once you’ve been triaged. And there was only one of those centers, and it was unfortunately during COVID, so everything was already reduced, and they didn’t think to offer suggestions in terms of other types of supports. So, with us being in crisis, I didn’t have time to sit back and think, what questions can I ask to make this go faster? I was just like, help me save my kids. I don’t know how to save my kids. So being put on these waitlists, the only way I got traction was by calling and following up and calling and following up and taking half a day to go and meet with one provider and then calling another provider. And so, it was just, it was a lot of added stress, because there wasn’t enough understanding of our particular situations to offer us other types of help.
Misty Pratt
Yeah, that sounds super hard, and it sounds like it would have had an impact on your own, as you said, work life, missing time to have to continually do this follow up and try to get your foot in the door.
Sandy Epp
Yes, very much so.
Misty Pratt
Big burden.
Sandy Epp
Yep.
Tara Kiran
I think what Sandy is describing too. I mean, I’ll just highlight two points there. One is just the challenges around access in this country is something that we heard again and again, and it’s for primary care, but it’s actually for a lot of other aspects of care as well. And I guess the second piece is, you know, when we’re thinking about the primary care problem, it doesn’t exist in isolation. And so, part of the challenge in primary care often is that we as family doctors find it really hard to be able to get the specialist support we need. Some of that is because our specialist system is not integrated or aligned kind of with the primary care system, I think, in the way it should be. But some of it comes down to we just don’t have enough specialists per capita compared to other countries. Right now, in family medicine, one of the most challenging aspects of our job is getting a referral for our patients, and until we can get that referral, we have to support them, which we want to do, but often can be outside our own scope. So, we can support them in the ways that we can, but we are generalists and don’t have specialized knowledge in every area. The bottom line is that we are left without being able to provide patients with the care they need.
Sandy Epp
And one thing I wanted to add to that is the fact that, like for my eldest, who had this fatigue disorder, they didn’t know what was causing it. And so, we were referred for some medical tests, some neurological tests to see if it was neurological related. We were referred to the Tourette’s clinic for the tics. We were referred to adolescent treatment center for the possibility that it might be depression related. We were referred to a rheumatologist along the way, because it started to turn into a pain syndrome. And for all of those, they had three months, six months, 12 months, 16 months related waitlists, and so it can go almost two years before you actually end up with a diagnosis, which, for them, at that time, ended up being, “I’m sorry, you have fibromyalgia”, which, as some people know, it’s kind of a catch all for we don’t know what you have, but you’re basically in pain all the time. So, in terms of like the primary care issues, the one that I mentioned was the lack of providers available. Another one is the lack of communication between care providers. So, in Manitoba, we don’t have a patient chart that’s necessarily available to all care providers. So, with both of my kids, every time we met with another physician or another person, we had to retell the entire story. And the more complicated the health issues, the longer the story is, and the doctors or physicians, they’re only blocking you for a certain amount of time, so you get rushed through the telling of your story, you miss particular dates or specific moments or thoughts, and the provider who’s seeing you isn’t getting a full picture because they’re only seeing what they’re interviewing at that time. So I think that the communication between providers working as a team, if that was improved, then we might be able to have a better picture into what the people are experiencing when a patient goes in to see a new physician for an issue that is much more complicated than a standard, you know, sprain, or something along that line.
Misty Pratt
So, Tara, going back to then, when you decided to start to explore this whole crisis, you noticed that this one voice was missing, Sandy’s voice here as many others as well. Tell us what you did to bring that voice into the conversation and a little bit about what OurCare actually was.
Tara Kiran
Yeah, so I’ve been a family doctor for more than 20 years and a researcher for about 15 years, and I noticed during that time, you know, when I was around the table talking about primary care reforms, often there really was this voice missing, in the voice of the very people the system should be designed around, patients and the public. I’d also done a lot of work engaging patients and the public by that point and had recognized how valuable it is in helping us to look at things differently and also help us to get all on the same page as to where it is that we want to go. And that’s why we started OurCare. OurCare really is the largest national initiative to engage patients and the public about the future of primary care in Canada. Over 16 months, we heard from nearly 10,000 people across the country, and they told us about their experiences of care, but also, more importantly, what it is that they wanted to see in a better system. So all in all, actually, over the 16 months, we published about 17 reports, but that includes our final report, which came out in February 2024 and that really just brings everything together. We released something called the OurCare standard, which really summarizes what it is that every person should be able to expect from the primary care system. It’s six statements, but those six statements really distill the essence of everything we heard over those 16 months.
Misty Pratt
Yes, we’re going to definitely talk about those six statements, because I loved them. First, I do want to hear from Sandy, who participated in the OurCare panel in Manitoba. So Sandy, can you tell us a little bit, what was that experience like?
Sandy Epp
I found it incredible. Honestly, I thought it was an incredible experience. We started off the process with a few remote sessions where we were basically just educated. We had different care providers coming in, different leadership individuals who came in and explained what primary care was. I realized how much I don’t know by learning the pieces that I did. So, it was incredibly eye opening, and I really appreciated the knowledge that came from that and and the panels. One of the biggest things that stood out to me is because of where I was in my journey, I was feeling very frustrated because I was having such a hard time getting help for my kids, and it started to become almost like it was an adversarial relationship between me and primary care providers. I had to fight to get someone to help me. And I think the biggest thing, and I’m going to get choked up a little bit, but the biggest thing that stood out to me in all of it was listening to the care providers and seeing the frustration that they had because they wanted to do better. They wanted to help more. They were under so much stress and pressure because they were hamstrung by what they could provide and what they could do and how fast they could see patients, how well they could treat them. And so, it helped me kind of reframe my position as to, my care providers are not my enemy. I don’t have to fight them. They want to help. It’s just in some cases they can’t. So how do we make this better? And so that was one of the biggest things for me, is it helped me to realize, wait a minute, we’re allies here.
Misty Pratt
You’re not alone.
Sandy Epp
The next thing was, is that I realized that even though what I was going through was horrible, meeting with all of the other people on the panel helped me realize that A, I wasn’t alone, and B, a lot of my situations were a walk in the park compared to what other people have experienced in their health care journeys. And it helped me realize that there are so many wide ranges of voices that aren’t being heard. My story was was very personal to me, and it was crisis for me and for my children, but when I hear what other people went through, it broke my heart for them. And I became very aware of the fact that I have a privilege that a lot of people don’t have. And so I think of what we went through, and I think of what would that have been like if I was an inner city mom who didn’t have a computer, who didn’t have a vehicle, who didn’t, who was working two jobs to try and make ends meet. I honestly believe that my son would have taken his life if I hadn’t been able to give him the care that I was able to give him because of my privilege. Sorry. So, to me, the meeting of these people and hearing their stories was like, this is not acceptable. I know it’s not the care provider’s fault. I know it’s not the patient’s fault, and I just, let’s find some solutions. And so that that common bond that we shared, it really became very important to me. Sorry.
Misty Pratt
Did it make you feel hopeful?
Sandy Epp
Well, I think they talked a lot about the pit of despair when you’re going through the process of developing these standards and coming up with recommendations for a solution. You go into this pit of despair when you realize how big the problem is but going through that process and starting to break down possible recommendations and possible solutions, and hearing other people’s ideas, and some of them were incredibly insightful. Some of them were so very simple and and finding ways to offer solutions, and then having people sit down and listen to us and say, “Okay, we’re willing to hear you. We want to act”. So, we’re seeing change, and we’re seeing positive effects already from that experience that we were in. It didn’t just become a report on a shelf. It’s already seeing action and taking hold. So that’s that is very encouraging.
Misty Pratt
As we’ve been talking about, out of these consultations and panels, these six standards emerged for what primary care should look like. And I don’t have time today, I wish we could go over all of them, but I will link in the show notes for everybody to read on their own. But one thing that really jumped out to me, there was this explicit mention of building publicly funded family health teams, and I wonder if it’s safe to say then there’s no desire for a private system operating alongside our public system?
Tara Kiran
Yeah, I think people were pretty clear that they wanted publicly funded primary care that meets their needs. We heard that over and over again. We didn’t once have any recommendations around growing private options. Which is actually remarkable, given that there seems to be quite a narrative about that in the media. And we randomly selected people who had very diverse backgrounds, who voted for different parties, who had never met each other before, and despite all of that, there wasn’t any recommendation to say we should move to a two-tier system. What we found is pretty typical of public consultations in Canada that affirm the value that people in Canada hold around ensuring that everybody has access to health care, regardless of their background or where they live. It’s a very deeply held Canadian value. I think the other reflection point I have, sometimes though, is like, who is driving this narrative around public-private? It’s not everyday people or the vast majority of people in Canada. I suspect it’s actually people who have private interest, financial interest, in driving that two tier system. When you gather people together to think about what’s best for the country, they don’t come to the conclusion of two tier. And again, I think some of that is goes down to the values, and some of that also goes down to, I think, the magic that happens that Sandy described, when people are sitting with other people who have different experiences, they’re able to really put themselves in those shoes and think through, you know, really, yeah, what is best for everyone, not just selfishly, maybe myself.
Misty Pratt
So do you feel like this narrative in the media, it’s not really playing out then day to day for people. So, people are not generally seeking out these private options?
Tara Kiran
I think that people definitely seek out private options if they can’t get into the public system. Right? You know, we had the most dialog about this in Quebec, which is a province where they have some of the biggest access issues when it comes to primary care, and where there is some of the most available private pay care. And people did use private pay care, but they said that they wish they didn’t have to. But you know, if they aren’t able to get any care, they will do what they need to to get care for themselves and their loved ones if they can afford it, which, of course, is not an option for everyone. And I think also people recognize that often, when you’re paying for care privately, it’s actually limited what it is that you’re getting in return.
Sandy Epp
One of my biggest concerns with the idea of blending public and private falls along the same lines is that people with the least amount of privilege will end up suffering the most because those who have the financial wherewithal to pay for private can avail themselves of the best care, and because of the fact that people who are in the private practice can charge their own wages, their own fees, a lot of the people who may have the specialties, who have the advanced education, they may find it more profitable for them to go into the private system. With my son there was one point where we were looking at top surgery, and my son was in crisis mode. He was seriously contemplating taking his life every single day. And when we were referred for top surgery, we were told that there was a 12 month waiting list. And I was thinking to myself, like every day is a difficult day to get through. To go through another year of this. I don’t know how I could do this. And so, I was looking into, can I afford to pay for surgery in Ontario? There was a private clinic there that would have cost me $12,000 and time off work. And as a single mom, I didn’t have it. So, I actually went the route of trying to do GoFundMe and and trying to find ways to raise the money. And it was only from me realizing that I wasn’t going to be able to do it, and calling the surgeon that we were booked with, and basically crying on the phone to the receptionist, she managed to find me a cancelation, and we got him bumped up, and we got him in for the surgery, and the quality of life for him getting that surgery, from that point on, it’s been night and day. I saw my child coming back. So, I needed that, that access, and I couldn’t have gotten it. I mean, I was lucky. I was lucky that I was loud. So again, if I was not someone who knew that I, you know, the squeaky wheel gets the grease. Or if I wasn’t someone who was able to advocate the way I was, would I have had the same outcome? I don’t know.
Misty Pratt
So related to that, another key piece in the six standards, what then was the social determinants of health. How do we integrate that into our primary care system, which is, right now, not just primary care. All of our health care system is very siloed. Everything is just, you know, it’s about your head, or it’s about your lungs or whatever else. And so, I wonder practically, and Tara maybe you can speak to this a little bit. What would it look like in a doctor’s office if we were to truly treat somebody, as you know, not only a physical being and biology, but also their social side?
Tara Kiran
Yeah. I mean, one thing we heard over and over again from people we consulted with was how they wanted a wellness-oriented system, not a sickness-oriented system. And that’s what that standard really speaks to, is that, you know, primary care needs to support overall wellbeing, and they recognize that to do that, we needed to address the social determinants of health. I will say that as a family doctor, my goal is always to try and look at the whole person and address the physical, mental and social well-being of that person. And so, I think that’s where that integration of primary care with the social and community health services comes in, because we know that it’s a whole sector full of other people, professionals, other workers, who can support people to meet their social needs. So, it’s not necessarily about us as a family doctor, doing all those things, but it’s about how do we connect with the community agencies or social services that can support people in those ways? And so, when I say social needs, you know, I’m thinking about income, education, employment, those types of things. And I’m lucky myself actually to work in a wonderful team-based practice in Toronto, where I think we’ve been at the forefront of actually trying to integrate addressing social determinants of health in a primary care setting. So, for example, we now have the social prescribing program that is connected to our team so that we can make a referral and someone from the community can support them to connect with other community resources as needed. We actually have a partnership with a legal aid clinic in our team, we have an income security health promoter who is embedded in our team who supports people to be able to access the benefits that they would be eligible for, and manage their finances and be able to address some of the financial barriers to health that often we see.
Sandy Epp
To me, the healthcare teams. I mean, the importance of healthcare teams is understated. I agree that there needs to be a holistic approach. As a person, I’m not just a summation of my parts, right? My physical health impacts my mental health, which then can impact my physical health. And so, I think that an integration of physical health, mental health, spiritual health, as well as the social determinants of health in general, that’s the best way to try and prevent a lot of the symptoms that end up turning into an acute care crisis. So for me, having healthcare teams that are structured to meet the demographics of their surrounding community, like, if we could find a way to look at, you know, your your needs of a healthcare team in the inner city are going to be dramatically different from the needs of the healthcare team in an affluent portion of the city, or one that’s in the northern reserve. You need to staff the teams and provide the supports or connections based on the people that you’re serving. You know, who are my patients, not just physically, but who are they in all areas of their life? And I know that that feels a little pie in the sky, because who has time, who has time to gather all that information in order to treat a stubbed toe?
Misty Pratt
Well, you say pie in the sky, but I mean, it sounds like Tara’s team is pretty…
Sandy Epp
I know.
Misty Pratt
Pretty good, pretty ideal, right?
Sandy Epp
Yeah, for sure.
Tara Kiran
I’m very lucky to work in a wonderful team.
Misty Pratt
Yes.
Sandy Epp
Yeah.
Misty Pratt
When I watched the video of the panel, the one panel member who said that the answers to the primary care crisis were probably in the rooms of those gatherings, of the OurCare gatherings, but it was about getting the right people to listen. So, who should be hearing what we’re talking about today?
Tara Kiran
I think it’s a wide range of stakeholders that you know need to immerse themselves in the perspectives of patients in the public. So, I think, of course, we think about our politicians. You know, they’re ultimately setting the direction and authorizing the budgets. But then there’s all those civil servants who work in government, who are not elected by us, but are serving. And then there are all the healthcare leaders. So those could be leaders of organizations, whether they be professional organizations or teams like the one I described I work in, or maybe they’re clinician leaders, like their family doctors or nurses or nurse practitioners and and they’re leading other family doctors. And then I think even professionals and workers within primary care also need to hear that. So, it’s a wide variety of people I think that need to hear this.
Sandy Epp
I think that we also need to work on public education campaigns. Because one thing I found when I was meeting with other people on the OurCare standard, and I was sharing my story, you know, one patient was like, “Oh, well, did you try this”? And I was like; I had no idea that was available. And “oh, did you try this”? I had no idea that was available. And there are a lot of programs in our community and in our province that are available that we just don’t know about. Whether it’s because our providers don’t know or it’s not communicated. So, one of the recommendations in our report was we need to find a way to educate the public as to what is already there, what resources are already there. And it can’t just be a social media campaign. You need to think about the different demographics. How do you let the elderly know what home care options are available to them? How do you let people who have no internet know what’s available? How do you let the social media you know, the people who are focused on their podcasts know? So, it’s trying to come up with this multi-level education campaign to show what is currently there so that we can leverage the resources that are in place and improve our health that way. Because I think we could be further along than we actually are, and it’s because of a lack of knowledge.
Tara Kiran
And I would say as well. You know, we can’t forget how important it is that patients and the public themselves engage in this topic and with each other, with experts. Because ultimately, if we want to see change in the system, we need people to articulate what it is that they want done differently and be clear and loud with their voices around that.
Misty Pratt
So that brings me to my next question of, how can people get involved? How can they share their voice now that this first part is done?
Tara Kiran
One is that I would urge listeners to go onto our website, OurCare.ca. I think by the time this episode airs, it’ll be the fall, and I think probably by the late fall, early winter, we actually should have some updated results based on a new survey that we’re doing trying to understand how people’s experiences of care measure up to the OurCare standard. And a unique part of our website is that we do have a part where you can easily send a letter to your elected representative. And we think this is a really important way of making the patient and public voice known by people who have the power to make change. And then lastly, I can’t help but say that I started my own podcast Primary Focus, and the reason for the podcast is really to try and support all of us here in Canada, to raise the bar of our imagination around what is possible. How is it that we can actually achieve the OurCare standard? I think it’s possible. I think we can look to, you know, innovations here in Canada and around the world in terms of what is going well and build on those. We don’t need to be complacent in accepting the system that we have. We can dream bigger and then make our voice known to change to get there.
Misty Pratt
I have started listening to it, and it’s wonderful. So yes, I highly recommend. Well, I want to thank both of you for being here today. This has been wonderful. I feel like we could talk all day about primary care, but we have to leave it there. But thank you for raising the bar, as you said, Tara, thank you for bringing forward your voices and working on this important issue. I really appreciate it.
Tara Kiran
Thanks for having us. It’s been such a great conversation.
Sandy Epp
And thank you for listening, for asking the patients to hear our stories. Thank you for caring and for the ongoing care that is happening and the change it’s it is encouraging.
Misty Pratt
Thanks for joining me for this episode of In Our VoICES. Check out the show notes for links to research and any other information that we’ve referenced in this episode. A reminder that the opinions expressed in this podcast are not necessarily those of ICES. Please be sure to follow and rate us on your favorite podcast app. If you have feedback or questions about anything you’ve heard on In Our VoICES, please email us at [email protected] and we will get back to you. All of us at ICES wish you strong data and good health.
