What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Friday, February 10, 2006

On a Personal Note

Every time I drive by my neighbor’s farm, I miss him. He was an old timer that lived just down the road from me and every time I go to town I have to drive by his driveway, so I get to miss him frequently. He was the kind of guy that never said no to a helping hand, seemed to have a broad knowledge of many subjects, but never tried to impose. Coffee was always a quiet and thoughtful time when we just enjoyed time spent together. We shared interests in horses, gardening, and talking about times past.
One day, on my afternoon off, his grandson phoned and told me my neighbor was sick. When I asked for clarification the twelve year old told me: “grandpa is lying on the kitchen floor and can’t get up”. I told him to call “911” and that I would be right over. When I arrived, my neighbor was in shock. By this time probably 10 to 15 minutes had elapsed and he was still lying on the kitchen floor and was semi-conscience. The fire department arrived shortly after I had, and were unable to register a blood pressure. The EMS team arrived some five minutes later, and my friend’s blood pressure was now 40/0 and he was able to answer questions. He had no pain anywhere at this time and it was not clear what the cause of his shock was. It was 1:30 P.M. The ambulance transported him to the hospital after securing an adequate intravenous site.
Knowing that documentation and preliminary assessment would take some time, I followed some 30 minutes later. I spoke to the Emergency Physician and related the history and my examination. On examining my neighbor on this occasion, his blood pressure had improved slightly (was being given copious amounts of I.V. fluids) but he was now complaining of some low back and right abdominal discomfort. It was clear to me at this point that the cause of his episode of shock and persistent low blood pressure, related to something that had or was happening in his abdomen. I again spoke to the Emergency Doctor and related my findings and that I thought the patient should have urgent abdominal imaging. He stated he was ordering an ultrasound of his abdomen. Since the patient seemed once more to be stable, I returned to review the ultrasound about an hour later. Apparently, the patient had again had a precipitous drop in blood pressure, so instead of doing the ultrasound, a C.T. of the abdomen had been ordered by the attending emergency physician, but so far had not been done. My neighbor’s blood pressure was starting to stabilize once again, so I left and came back at 6:00 P.M. I was told that the C.T. Scan machine was down and the patient was now booked for 7:00 P.M. for the scan. Having accomplished little to date, and having no authority over the care being given, I once again left and telephoned the Emergency department at 7:45 P.M. I was informed by the nurse that the patient was on his way by ambulance to another hospital and on follow up, the patient was in surgery at 8:30 P.M. for a ruptured Abdominal Aortic Aneurysm. He survived his surgery but died about a week later from multiple organ failure. One can’t help wondering if the results may have been different if he had been diagnosed six hours earlier. Six hours of shock prior to major surgery isn’t an ideal preoperative scenario!
Not only was I devastated by having lost a good friend and neighbor, but I was more than a little perturbed by the care he had received under the circumstances. Accordingly, I wrote a letter of complaint (as we are supposed to do when we as practitioners see pitfalls in our health care system) to the chairperson of the Regional Quality Assurance Committee (responsible for medical practice standards). My concerns were the following:
1) I felt the Emergency Physician did not take my concerns (and first hand observations) as a professional in medicine, seriously enough.
2) Any type of imaging, in this scenario, including an ultrasound would have been more beneficial than significantly delayed “ideal” imaging.
3) When the ideal imaging modality is not immediately available at one site, a patient should be transferred to a site where it is available.
Four months later I received a reply to my letter. They thanked me for my input but felt the care was appropriate.
At that time in my practice I had given up my hospital privileges; if I had them, I would have taken over the care on the first visit I made to the Emergency department at 2:30 P.M. that afternoon. Would it have made a difference? We will never know. One thing I know for sure, imaging of some kind would have occurred long before 7:30 P.M., and as a consequence, a diagnosis.
What precipitated today’s blog? I read the Calgary Herald Editorial headline this morning: “Better Health Care is the Test”. They were commenting on Dr. Kim Wilmot’s new endeavor. One of the statements in the editorial is: “Surely, any reforms to health care should be designed to improve service for patients, not just help doctors make more money”. Then they go on to say: “The service (referring to the taking on of private patients by Dr Wilmot and providing 24 hour call for a fee) will mean better service for some patients, but its not targeting a trouble spot in the system”.
Doesn’t the Calgary Herald Editorial Board know that all too long we family physicians have been bending over backwards to cope with ever increasing demand, and “trouble spots” in the system? Walk-in clinics were a response to the volume of urgent and minor issues but did nothing for continuing care and long term management of health risk factors. Refusing new patients has and had been an attempt to maintain the quality of care provided to our patients although it meant a decrease in income to those physicians. How long should the medical practitioners be enablers to a system that is progressively deteriorating? The numbers of new graduates that take up family medicine continues to go down for good reason. Perhaps the Herald should examine the reasons.
I have known Doctor Wilmot for all the years of his professional life. He maintained his hospital privileges when most of the family physicians had dropped theirs. He worked as a Hospitalist Physician for years, looking after patients in hospital, that were not his. At the same time he looked after his regular family practice and his special interest “holistic practice”.
I would say he has done his share in trying to keep our “sick” health-care system alive. Dedicating his time to a smaller group of patients is maybe what we all should have done many years ago. So the thought crossed my mind as I drove by my departed friend’s driveway today: “If he had been a private patient of a doctor like Dr. Wilmot back then, would he and I be having our morning coffee this morning and discussing which vegetables and flowers to grow this spring?”


Blogger Lanny said...

I really think too many people watch television shows like ER and assume people get rolled in and required tests requested by doctors are taken immediately to diagnose and treat emergency life and death cases.

You never see someone in a life and death situation on that show wait for tests for hours and then state their machine is broken. This shows that real life in Canada's health care system is very scary. In spite of the fact that this man had a doctor pressuring the system to look after him... think of all those lives that have been lost because the general public doesn't know what "should" be done and how quickly.

This situation was monitored by you, an informed professional and still failed. If you can't get things done in this system, what can the average person do? Also, how many doctors have experienced the same thing and received "thank you" letters for their time without reviewing the system.

Also, in Information Technology in companies, we have back up computers and systems in case of failure so that a company is not without it's network for a period of time.... why are there not back up systems like CT machines etc in hospitals for life and death situations. Surely this is more critical!

10/2/06 3:58 PM  
Blogger Al said...

It may have something to do with the fact there is competition in business. Our health care system is a monopoly and spin doctors are probably cheaper than real ones. (then again, maybe not, but you certainly need fewer of them, what with M.S.M.)

10/2/06 10:04 PM  

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