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?

Monday, April 24, 2006

A Glimmer of Hope?

Although I am swamped with planting, transplanting, fencing, and the usual spring activities on my acreage, it wouldn’t seem right for me not to give “kudos” to Mark Milke for his piece in the Calgary Herald today. Unlike some of the generalities floated about by the opponents of a more open health care system in Canada, Mark Milke actually quoted some statistics and mentioned countries by name that had parallel health care systems. He looked at doctor patient ratios in other countries and it is evident that if Canadian doctors didn’t have a superb work ethic, our risk lists would be much longer and even fewer people would have a family doctor. This actually has been the third article in the Herald over the last three weeks that were supportive of allowing doctors the opportunity to work both in the private and the public system. Perhaps there is a glimmer of hope.
But it is just a glimmer. There is tremendous competition in the world today for well trained physicians, and tremendous competition for young people who have the potential and ability to become physicians. As Mark Milke points out, Canada, at 2.1 physicians per thousand population, has one of the poorest ratios in the industrialized world. As the baby boomers age and begin to significantly impact health care needs, our need for physicians will be impacted more than the countries that already have better manpower ratios than ours. The news media and other people often say the solution is to bring in foreign doctors, but the availability of foreign graduates is becoming non-existent, to say nothing of our problems in this country to insure their capability.
Lanny, at lannysblog.blogspot.com, writes “Shortage of Doctors, no one wants the Job”. She relates that, like in the U.S., where Mexican workers are being brought in to do the jobs that Americans don’t want, Canada is scouring the earth for physicians to come to Canada because we don’t have enough of the home grown variety. A sad state of affairs.
Perhaps we need to ask ourselves that very question; why would anyone want the job? This week I scratched my eye while transplanting Dracaenas. After an hour the eye felt better, but after three hours, it was becoming increasingly painful. Normally, a corneal scratch heals within 24 hours, and certainly shouldn’t be getting worse, so I made my way to a government urgent clinic in my area (it was 9:30PM). The physician there did a thorough exam, identified what appeared to be a scratched cornea, reassured me there was no foreign material in my eye (my major concern), applied antibiotic ointment and put a patch over the eye for comfort. During our conversation he related that he had worked five days in his office (from 9:00Am to 5:30PM) and three evening shifts at the government clinic in the past seven days, easily logging at least 55 hours of fairly intensive work that week.
The next morning my eye was worse so I called an ophthalmologist I knew. He instructed me to come in immediately. It turns out that I had a viral infection of the cornea. The scratch seen on the cornea was actually infected corneal surface tissue. Through the years, we family doctors have been taught that this type of virus leaves a certain pattern and is recognizable by this pattern. Apparently, this pattern is not that common anymore. The more common pattern after a corneal scratch is a transverse abrasive looking bar (like I had the night before). The specialist scraped off the diseased tissue, gave me three prescriptions that I was to get immediately, and advised against patching the eye in the presence of infection.
The purpose of revealing this episode is not to malign in any way the care I received from the initial physician or the government clinic. After all, I am a physician as well and was not aware of this changing pattern of viral disease of the cornea. How does one keep up with these advances? As a retired physician I still receive at least six to eight medical journals a month and probably do more reading now than when I was in practice. How does a family physician keep up in all areas while working 50 to 60 hours a week and perhaps taking a turn on call as well. The major reading we do is in the more vital fields of cardiology, diabetes, and the more life threatening aspects of medicine. All the while, we are berated for not emphasizing preventative medicine in our practices sufficiently, and in one way or another, doing an inadequate job of managing the “health care purse”.
One of the phrases that “burns” me the most in reports and journals is: “The family physician is in an ideal position to-------“. Yes, we are in an ideal position to do most things. The problem is there are fewer and fewer of us, and the knowledge in medicine is expanding at an incredible rate. As we push this group to do more and more with less and less, family physicians will become fewer and fewer.
As I’ve said before: “All normal living creatures move to comfort”. Perhaps Lanny is right in her blog. We have finally created a work environment in the field of medicine where nobody wants the job.


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