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?

Tuesday, March 14, 2006

A Useful Future Program

For those of you readers who may think that I am simply critical and never constructive, today’s blog has to do with a program that I have mentioned previously. This program is directed at the two thirds of hypertensives and the two thirds of hypercholesterolemic patients that are not, or are inadequately treated. It may also help in terms of the epidemic of obesity and diabetes in Canada today.
I have sent this information to theAlberta Health Ministry and have sent it to the Calgary Region Medical Staff Association.
Critics will wail about an infringement on privacy but note that already governments at all levels have infringed on our personal freedoms in a more aggressive way. We have seat belt laws and helmet laws that are restrictive, punitive, and protect only the individual, and are supported by our medical associations and our tax dollars. This program would not be punitive but would be more like our immunization programs, which also are strongly supported by our medical associations and our tax dollars. This program would help identify people at risk for diabetes and cardiovascular disease so that information can be individualized and appropriate interventions suggested.
Our Health Minister, Iris Evans, stated in her letter to the Editor, Calgary Herald, Mar/11/06, “Opening opportunities in the private sector will also help recruit and retain health-care professionals that will result in increased capacity and access”. This is the first time I have seen this type of statement in the Mainstream News Media although I have attempted to put it forward for ten years. Mostly all we hear is the idea that the public system will loose all their professional workers and be left destitute if there is a private parallel system. If the powers that be are as slow to implement this, my latest suggestion, at least my grandchildren may benefit. This is the letter that I have sent to the Provincial Health Ministry and the Calgary Health Region.

In my last letter to Vital Signs I raised the issue of “Fidelity” in health care. As previously mentioned this term relates basically to the “systems” application of our medical knowledge. I mentioned also that when family physicians attend seminars on cardiovascular disease, we are always impressed with information pertaining to the number of untreated and under treated hypertensive and hypercholesterolemic patients.
It is my understanding that at this time considerable money is being offered by various levels of government for innovative approaches to health care in Canada. May I propose the following?
The idea of reviewing a person’s health at a particular age is not a new phenomenon in Alberta. For years physicians have been examining 75 year old citizens to establish their ability to operate a motor vehicle. My suggestion is to set up a similar process to screen for cardiovascular disease that needs a treatment approach. The system need not be nearly as complex as the driver’s scenario. In fact I would suggest starting with the following: 1) Blood pressure reading 2) Weight and waist circumference 3)BMI 4)Smoking history 5)Family history for diabetes, stroke, and MI. This approach would require minimally trained people as “examiners” and could be repeated every five years starting at age forty or fifty. A weighting system would be attached to positive answers and a threshold applied at which point information was forwarded or handed out to the person as to the need for intervention and resources available. Each year a new age group could be added to the screening program e.g. Fifty year olds in 2007, fifty five year olds in 2008, sixty year olds in 2009, etc. Within five years the core group of people at risk would be covered.
A computer generated reminder system would annually remind the “at risk” group that they should be under medical observation and care.
Immunization programs, to date, have been demonstrated to be the most cost effective interventions in medicine. I would suggest that the system that I have outlined above would come in a close second through the resulting early detection of diabetes, people at risk for cardiovascular events, and the appropriate timely interventions. This program could be contracted out to the private sector but funded provincially. Referrals resulting from this “screening” would, of course, be dealt with by the public system.
Would the public oppose this imposition? Possibly. But the expectation of getting something for nothing needs to come to an end. The generic public education attempts to date are falling far short of their intended mark. Perhaps it is time the province and the medical and nursing professions took a combined stand on prevention that has some “bite” to it. The last time we did was many years ago with immunization. Let’s take a similar stand and develop a similar program for the epidemics of diabetes, obesity, and vascular disease.
Respectfully submitted,
Dr. Al Wilke.


Blogger Lanny said...

I believe that people would welcome this. This would be pro-active and as there are so many that don't have family doctors, etc.. this would be a good opportunity to do some basic checks and give them a bit of a "wake-up"call.

15/3/06 2:45 PM  

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