Survival Of The Fittest

Wow, the headline for the Jan.22/06 edition of the Calgary Herald reads: “Coed Hospital Rooms Come to Calgary”. Two other articles in the same edition speak of personnel and bed shortages. All this the day before a federal election. It seems as the Titanic is sinking, someone is finally noticing!
The headline article admits that bringing in coed beds will not increase bed utilization (unless the plan is to put two people in one bed!), but merely save some nursing time required to shift patients around in the existing beds. Who would have thought that saving a small amount of staff time would make headline news? Or is it the fact that people’s dignity and privacy in our health care system is no longer recognized as important?
The editorial in this same edition recognizes that medical manpower (is there such a word as “personpower?”) is the prevailing issue in the future. Unfortunately they suggest methodologies for Crisis management as solutions for long term medical personnel shortages. They rightly state: “It’s a proven fact that when faced with crisis, people and organizations are able to accomplish feats never imagined in their day to day work lives”. But what happens when a crisis scenario IS their day to day work life? By this I do not mean the fact that we are dealing with sick people and occasionally have to make life and death decisions. This is difficult but we are trained in these areas. The crisis is: knowing what NEEDS to be done and not having the tools, capacity, or capability to deal with it! On a daily basis Emergency physicians send people home they would rather admit to hospital, specialists keep people in regular beds that they would feel more comfortable treating in Intensive Care beds, and your family doctor would rather get your C.T. scan next week instead of next month to rule out cancer and other pathologies.
These kinds of abnormal stressors in the workplace will have several effects. Health care providers may simply quit, some will eventually become physically or mentally ill, and some may simply become emotionally detached to survive. Enrollment in medical related vocations and professions will decrease. My understanding is that nursing schools in the U.S. have had trouble in the past few years filling their training spaces.
The article goes on to talk about active recruiting of volunteers and retired health care workers (in the case of physicians it is more of a conscription program) as a solution for the periodic “blips” in demand that occur. Twelve such “blips” supposedly occurred during the first three weeks of Jan/06 in Calgary---at least half of the time. These were only the times recognized by the hospital system to be “crisis” times. The truth is that the system is in sub-acute crises the majority of the time. The question we must ask is why the system is in almost continual “survival mode”? Why can’t we do planning to take our health care system out of the Intensive Care Unit? And is it really a just society that drags retired physicians and nurses back into the work place?
The third article was by Don Braid and the headline was: “Rockyview ER Jammed with the Wrong Patients”. Nothing could be farther from the truth. Calgary hospitals track their emergency department visits and categorize them from 1 to 4 with “1” being patients that need life saving intervention and “4” being people that could have waited and seen a community physician or did not need to see a physician. The number of category “4” patients attending our emergency departments has been continually falling over the past ten years and now likely represents less than ten percent of patients. After all, who would wait for hours if they were not genuinely worried or need care? Besides, I thought the original premise of our Universal Health Care System was that people concerned about health matters did not have to make the difficult choice of “should I get help or not”. No matter how we educate our patients should they be expected to make the differential diagnosis between “flu” and “pneumonia” and not get a medical opinion when in doubt? This dilemma was to be remedied by the Canada Health Act.
Have no doubts, our emergency departments are filled and stacked up with very ill people. Often, our EMS people and vehicles are stacked up with no place to unload their patients. The problem is in lack of resources to deal with sick people at all levels. Community physicians send patients to the emergency departments because they do not have the resources to deal with them in the community and emergency departments overflow because emergency physicians don’t have beds and personnel to take on the care of patients that need admission. It is totally wrong to blame our sick people for the present overcrowding in the emergency departments. Canadians need to look back at the very popular T.V. series “MASH”. This was a medical unit dealing with casualties in a war zone. We seem to be moving progressively in the direction of a MASH unit----if it’s a life and death situation we’ll do what we can, but to a large extent, luck, and survival of the fittest will be the primary determinants. Luck if you get into the system or program in time, good survival genetics and good self preservation capabilities if you don’t.