Monday, January 24, 2011

Our biggest fear: the wait

That's right. I'm talking about the hospital emergency room wait time. In case you're not familiar, it is estimated that one can wait anywhere from 6-8 hours on an average day.

This is an issue that people avoid talking about in Canada. Doctors. Nurses. Politicians. Macleans said it best in their most recent issue when, in an article describing Canada's health care system ranking as being probably the worst in the G8, they said that people feel scared to address the issue because of how nationalized it is. National health care- it's a part of being Canadian. Any attempts to change the system, even slightly, has consistently been met with near-accusations of heresy or treason, as if the changes would somehow lead to a ban on ice hockey.

Canada- Our system doesn't work anymore. If I've kept you reading this long, you're about to learn why. I've also proposed solutions for each of these problems. Note that all of my solutions involve money- if anyone can reasonably propose a solution to one of these without spending a cent while maintaing current spending, then you should contact the CMA, health canada, and the public health agency asap. Macleans is hosting a discussion on the future of health care in the maritimes on the 26th in collaboration with the CMA, which will be broadcast on CPAC.

Reason #1: the difference between acute and chronic conditions.
Acute conditions affect people immediately and last a very short time- hours or maybe a couple of days. These are the types of conditions that our health care system is set up for- quick-fix medical interventions. This is reflected in the historial context with which the system was envisioned.
Today, chronic conditions are by far the largest killers of canadians. Chronic conditions are those that last a long time- they can be managable, but they normally aren't cured easily (ie/ heart disease, diabetes, some cancers, and psychological disorders).
Solution: designate specific physicians, family health teams, and nurse practitioners to deal specifically and solely with chronic conditions.

Reason #2- Health Care limbo
Beds. Simple eh? Not quite. Some hospitals are operating at upwards of 180% capacity, largely because of the number of elderly patients in "health-care limbo". This is a situation where people no longer require hospitalization, but aren't well enough to go home, or they do not have the proper resources available at home. The lucky ones are housed in long-term care facilities- LTCs for short. These facilities can drastically increase the number of open beds in hospitals.
Solution: It's obvious- build more long-term care facilities. Now if only there were some sort of elected body of representatives at the provincial level with the authority to propose and implement subsidies or partial funding for such facilities...I'm lookin' at you Liberals of Ontario, this is an easy fix and could win you some votes.

Reason #3- The concept of medicalization
This is a tough concept to understand, but I'll sum it up in lay terms. It means that an issue that was previously not the responsibility of a medical professional is now the responsibility of that professional- there is more to it than this, but it really means that doctors now deal with things that they didn't have to before.

For example: colds and flus. In our politically correct society if I told people not to go their doctor if they have a cold I would be told that I have no right informing people of what to do and that I don't fully understand the risks/benefits or the individual susceptibilities...blah blah blah. So what I'll do is provide a historical view of what people did when they were feeling under the weather. They: stayed in bed, ate soup, drank lots of water or ginger ale (for the flu), got lots of sleep and tried not get anyone else sick. Does this sound familiar? Because that's exactly what you'll be told in the ER if you walk in feeling under the weather. We have medicalized catching a cold- you don't need a doctor, you need bedrest and fluids. And still, this year alone, thousands of people will visit the ER with minor symptoms only to be told to go home and rest, all the while spreading their individual bug to everyone else in the ER.

Point: we need to educate people about what kinds of issues are ER-worthy. Further to this, maybe we should intice young, healthy people to forfit their roster with a family physician to allow someone who needs one to have one. An incentive could be a guarantee that you'll have a doctor when you're 50+.

Solution: When public health officials tell you to stay home if you're sick- stay home. This doesn't mean go to the hospital and infect everyone else. The real solution: perhaps if you don't need a family doctor, don't fill a spot that someone else does need- but this doesn't really help in the long run and is only a last resort.

Reason #4: Unnecessary visits
It's not your fault, I know. You can't get in to see your family doctor (if you're lucky enough to have one) to get an updated prescription or to simply modify an existing one. So of course you're going to go to the ER- that's where all the doctors are, right?
Pharmacisists can now modify some prescriptions in most provinces- it seems to be slow moving though. The point: people certainly don't need to visit the ER for prescriptions.
Solution: Firstly, provide pharmacists with the proper education and training to prescribe some medications- the key here is education and training, because it is equally important to know when something is over your head or when a situation cannot be mediated by prescription drugs alone- this is where the education needs to be focused.
Secondly, create new and reinforce existing IT systems for interoperability between pharmacists, nurses, physicians, nurse practitioners, PT/OTs, etc. Only those professions that are subsidized by the provincial government should have access to these documents. And, of course, always ensure that appropriate privacy and confidentiality measures are in place as outlined by PHIPA and PIPEDA.
Thirdly, subsidize the hiring of pharmacist assistants and allow them more training opportunities to be able to do more in the workplace. This may actually allow pharmacists to have some time to consult with their patients/clients.

Reason #5 Lack of individual responsibility for one's own health
The widespread societal perception that one can act however they please because of the safety net of physicians and medications in the future in utterly embaressing.
I'm going to be a bit bolder than most in public health seem so afraid to be:
-Smoking: QUIT. Enough. I don't buy the argument that you are simply supporting the tobacco farmers. If you want to support farmers how about buying local fruits and vegetables. Which segweys me into the next point.
-Diet: eat better. This one can be tough, but I'm here to help. Look at your plate and make sure that 2/3 of it is vegetables and grains, and 1/3 is meat. Drink more water. Eat breakfast. Cut out empty calories (pop, donuts, and whatever starbucks is calling their triple chocolate fudge "breakfast" cake now). Try consulting a dietician- they really can help.
-Exericse: get more of it. Walk instead of driving where you can. Try biking if it's a bit further. Do something you enjoy and it won't feel like exercise. (and your body will thank you)
-Educate yourself, but use your head. Try learning about health topics or how to eat better, but don't get sucked into the latest tree root from Venus because it's supposed to contain 0.0000001% magic. Be smart about it.

The issues that I've brought up are all Canada-specific. They exist in other parts of the world, but they are some big factors for us to consider as we try to make ourselves a healthier nation, in body, mind and spirit.


1 comment:

  1. I really enjoyed reading this one. Very valid solutions and a true shame there are not more people who think like this. I tried to hold off from visiting the Hospital due to my dengue symptoms because I knew they would just tell me to go home and sleep but my landlady made me, lol. Keep sharing your thoughts Mike!