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?

Sunday, February 12, 2006

Who is Your Advocate When You Get Sick?

It has been my experience that in medicine, where a need develops, a service develops shortly after to fill that need. Apparently at one time physicians provided a wide variety of services for patients; manipulation, massage, counseling, and nutritional guidance were only a few of these services. With the advent of microbiology and many scientific discoveries, doctors, as a group became more “scientific” and likely less “humanistic”. Manipulation and the therapeutic value of “the laying on of hands” seemed insignificant compared to the exciting new advances in medicine. Subsequently, because of neglect in this field by medical practitioners, independent practitioners of chiropractics and massage came on the scene. As knowledge in these fields expanded and teaching of these practices in medical schools disappeared, physicians eventually abdicated their place in these areas.
Even in the areas of physical examination and the eliciting of signs and symptoms, the young physicians of today would have trouble competing with the physicians of 70+ years ago. Some of the books that are one hundred or more years old, describe examination techniques and descriptions of signs and symptoms that are incredible in their detail. Today we rely on X-rays, CT Scans, and MRIs. An excellent physical examination will not protect us in a court of law and since a CT scan will, we take the short cut to the CT scan and save time and worry. The end result is the development of, the use of, and the promotion of, technologies that may be marginally better at considerably greater cost, and the loss of our very cost effective clinical skills.
But I digress. The point is that where there is a need, a service will develop to fill that need. Holistic Medicine and naturopathic medicines are some of the fastest growing areas of medicine today. Could it be that our traditional medical system has become so preoccupied with scientifically proven and cost effective aspects of medicine that we have totally forgotten about the human aspect of medicine? Faith, the placebo effect, and the doctor patient relationship (confidence in the provider), may be three of the most cost effective modalities for treating human beings in today’s world of medical science. Yet we in traditional medicine are rapidly moving away from them. Little wonder a plethora of other “private” health care providers are cropping up, giving, for the most part, very personal care and choice. Most midwives’ fee for maternity care is four to five times as high in some parts of Canada as that of an obstetrician. Are they better trained? Absolutely not, but midwives probably give more “personal care” and time, and obviously some people are prepared to pay for this aspect of their care.
The foregoing has simply been a preamble to the point I am about to make. As funding constraints in our tax funded health care system continue, and the system demands more efficiency and cost containment, we will see an ever widening gap in both access to health care resources and access to varying modalities of health care services, between those that must stay in the system and those that can afford to “top off” their care. This is exactly what the original Canada Health Act was meant to avoid.
At present I foresee a huge opportunity for some enterprising physicians and lawyers to set up a private company called “Patient Advocates Inc.”. This company would be hired by patients who have complex medical problems, would review the medical situation presented, review all investigations and reports to date, advise as to what other tests might be advisable, and where the best medical treatment could be obtained, both in and out of the present Canadian Medical system. You see, in a situation that may be a life and death situation, many of us may want to make the judgment of cost effectiveness based on our resources, not on the systems. We will want someone to spend the time with us to go over all possibilities and we will want “involvement” on an ongoing basis. Family doctors served this purpose at one time. Now most family doctors (if you can get one) don’t go to hospitals, don’t do cancer care, and aren’t included often in the “loop” of the care of seriously ill patients in our regional programs. Even if they were, they probably don’t have the time needed to go into the details (they don’t have the time because there aren’t enough of them, and there aren’t enough family doctors for many, many reasons). Let’s face it. Wouldn’t you pay a few hundred dollars to completely understand all the pros and cons of your possible life threatening illness, help you consider all the odds from you’re perspective, and help you develop an approach that you feel comfortable with? Time is a commodity that our present health care provider within the system doesn’t have. Most of us understand that time is money. Physicians outside of “Universal Medicare” will have the time (because they will have control over their lives and practices) and will be able to provide a variety of services.
The system is crumbling. The solution is to focus once again on what Canadian Health Care can and should do: look after the poor, the frail elderly, and the chronically ill. We have the resources to do an excellent job of that; if we allow those that are able to, look after themselves. We can’t be everything to everybody!

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