Jan 31, 2019

eNewsletter article: Honour Greg’s memory by committing to continuity of care

Greg Price was a 31-year-old Alberta engineer who loved baseball, flying his plane, and spending time with his family.

He died in May of 2012 of complications from surgery for testicular cancer. Before receiving his cancer diagnosis, just days before his death, Greg had endured months of delayed investigations and specialist consultations, as well as multiple breakdowns in communication with and between healthcare professionals. 

Greg’s family is sharing their story to help others facing similar obstacles and improve continuity of care for all Canadians. 

Delays and miscommunication have critical consequences

Greg’s journey through the healthcare system began uneventfully in early spring 2011 with a routine physical to renew his private pilot’s license. During the exam, the family physician noted a thickening of the epididymis, which is sometimes associated with testicular cancer. The physician documented the incidental finding but did not order follow-up at that time. Early in 2012, Greg attended a walk-in-clinic for a rash on his foot and received a prescription, but three weeks later, Greg went to back to his family physician for a second opinion on the rash. At this appointment, the family physician decided to refer Greg to a general surgeon to follow up on the thickened epididymis he first noted 9 months earlier. The physician did not realize the wait for that appointment would be 3 months.

In the meantime, Greg sought care at a walk-in-clinic for persistent back pain, and there, a physician ordered x-rays and an abdominal ultrasound. When the ultrasound showed a mass, the walk-in-clinic physician ordered follow-up testing. Greg then encountered a series of hurdles, including:

  • a 19-day wait for a CT scan marked “urgent”; 
  • a missed follow-up of CT scan results when the ordering physician left the walk-in-clinic practice; and
  • a delayed surgical consult owing to scheduling difficulties involving a urologist who was away from the office for an extended period.

Eventually, the lump was diagnosed as testicular cancer, but by then, the cancer had spread to Greg's pelvis and back. Greg had surgery on May 16, 2012. 

While a blood clot is a well-recognized surgical complication, it went undiagnosed even though Greg told doctors he was concerned about that possibility. When he experienced leg swelling once home after the surgery, he and his family made several unsuccessful attempts to contact his urologist. Greg was seen in the emergency department, but soon discharged after the physician on duty reviewed his case and confirmed follow-up with the cancer centre. Greg collapsed at home the next morning and died of complications from a blood clot.

Greg’s story includes obstacles that highlight many common issues patients experience when navigating the healthcare system. For this reason, his story offers important lessons for patient safety.

Lessons learned: Working together to ensure continuity 

Acknowledging the multiple gaps and breakdowns in Greg’s care, the Health Quality Council of Alberta undertook a Continuity of Patient Care Study to review the events that led to Greg’s death and identify opportunities for improvement [1].
The study’s lessons for healthcare professionals are summarized in the following themes: 

  • Getting the whole picture: Ask patients about other health complaints or conditions that are being investigated to obtain potentially important information.
  • Coordinating referral with other professionals: Understand how the referral will be confirmed, who will contact patient with the appointment, and how to communicate about timelines (especially for requests that are urgent). 
  • Ensuring follow-up of tests: Proactively arrange a follow-up appointment for a few days following an important test rather than wait for results to trigger follow-up. Have a process for following up with patients whose physician will be leaving the practice or away for an extended period.
  • Providing informed discharge following surgery: Provide patients with detailed information on how to follow up with heath concerns, including after-hours, for a reasonable period after surgery. The patient should not be advised to visit the emergency department for a non–life-threating situation, unless the follow-up has been arranged with that facility.
The Development of "Falling Through the Cracks: Greg's Story "

Greg’s family enlisted top talent from the Canadian film and television industry to produce Falling Through the Cracks: Greg's Story, a short film that depicts Greg’s journey through the healthcare system, intended for medical students. Greg’s family hopes this film will humanize the patient experience to help tomorrow’s physicians understand the real-life implications of disjointed care and to inspire them to commit to patient safety and teamwork.

“We are extremely grateful to everyone who was involved in this project.  We see the power of the film every time it is shown.  The quality of the film combined with the story told from Greg’s perspective has a powerful impact and opens the door for critical conversations about the future of our healthcare system.” Said Teri Price, Greg's sister.

In addition to the film, educators have created other resources for medical students based on Greg’s experience. These medical education resources are available through the Co-pilot Collective—an online community, created by the Prices, where patients and families can gather to share information and collaborate on healthcare issues.  
Greg’s legacy is also represented by Greg’s Wings, an organization that initiates and supports projects that align with 3 focus areas are inspired by Greg: Innovation + Impact, Roots, Health + Sport.

“Greg loved to learn, was constantly pursuing his own personal improvement, loved a challenge and he didn’t believe in the status quo" explained Teri. "He loved his community, believed in people, and believed that with a bit of grit we can accomplish great things.  We continue to be inspired by Greg and want a future where no one else falls through the cracks.” 

Saegis encourages all physicians and healthcare professionals to visit gregswings.ca or copilot.gregswings.ca for information about the initiatives Greg’s family is undertaking in his memory, and click here to learn more about the film and view the trailer.

The team at Saegis extends our deepest gratitude to Teri Price for her contribution to this article.

[1] Health Quality Council of Alberta. Continuity of Patient Care Study. Edmonton, Alberta; December 19, 2013

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