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?

Thursday, April 13, 2006

Iris Evans, Minister of Health and Wellness, Nice, but-----?

Yesterday I received a very nice letter from Iris Evans, Alberta’s
“Minister of Health and Wellness”. On previous blogs, I have advocated a provincial program whereby on their 40th birthday, Albertans would get a notice from the government suggesting that they see a health professional and have a basic assessment as to risk for cardiovascular disease and diabetes, and this should be done every five years (not unlike notices seniors get at age 75). I pointed out that statistics show that 65 to 70 % of people do not know they have high blood pressure or are inadequately treated. Similarly, 65 to 70 % of people with cholesterol levels that need intervention are not being attended to. I pointed out the cost effectiveness of such a program in preventing strokes, heart attacks and all the complications of diabetes. The screening would basically be very simple and not need a health professional to administer. Blood pressure, waist circumference, BMI, and family history would be the key, with blood work done on those with two of the four risk factors mentioned above. Patients at risk would be referred for intervention as required and given appropriate medical information. This program idea and its rational, was sent to our Health Minister, Iris Evans.
Childhood immunization and influenza immunization in the chronically ill and elderly have proved to be one of the most cost effective things we do in medicine today. The news media repeatedly reports the “epidemic” of obesity in the world today, especially in the U.S. and Canada. Interestingly, Dr. A Tremblay, Professor in the Department of Social and Preventative Medicine at Laval University, reported in a paper published in Nov./2000, that the papers and scientific research published on obesity have been increasing over the last twenty years at the same rate that obesity has been escalating unabated. In other words, we talk about it, but nothing is being done about it. The increasing incidence of diabetes in the world follows the same increase as obesity, only ten years later. There is no doubt as to a cause and effect relationship.
It is suggested that a one point drop in blood pressure of Canadians could translate to 480 fewer deaths from stroke per year, 1,580 fewer deaths from heart attacks, and possibly hundreds fewer cases of vascular dementia. If we screened for those people at risk, and effectively intervened, the impact would be incredible.
So let us look at Iris Evan’s (Minister of Health and Wellness) reply. She states:
“There is no doubt that the indicators you have outlined are key factors related to an individual’s health status and potential risk for developing certain chronic diseases. This type of preventative care should be provided as a component of an individual’s ongoing, routine care where a strong patient-physician relationship is a fundamental component”.
Iris, you’re not paying attention! The point is---it’s not happening, for many reasons, not the least of which there are fewer and fewer family physicians, and walk in clinics provide primarily “episodic” care, not continuing and preventative care.
She then goes on to do the sales pitch thing: “Alberta is in the process of implementing a number of province-wide initiatives that will support and facilitate the above. ( I think she is referring to the doctor-patient relationship). For example, a key goal of the Primary Care Initiative is to increase the focus on health promotion and disease prevention in the care of the patients at risk for chronic illnesses”. Now, I’ve been hearing that for twenty years, and as Dr. Tremblay reports, we talk more about it, but what do we DO about it. The key issue is: “How do we pick up those people at risk early on in the disease process and spend our money in a cost effective way with the people that will benefit the most”? That is what my suggested program is all about---fidelity---getting the right treatment to the right patient at the right time. We have all this great medical knowledge, but are severely handicapped because of access problems to the people that would most benefit. We generisize and generalize our message to the population at large instead of targeting an at risk age group----40 year olds and up. We don’t do that with childhood immunization, seniors flu shots, or drivers exams, why are we ignoring an at risk age group that are in their most productive years of life.
Iris Evans, our Health and Wellness Minister, finished her letter with: “The Government of Alberta is strongly committed to disease prevention and early detection as a key strategy in health renewal and reform. I appreciate your interest in health promotion and prevention for Albertans. Thank you for writing”.
It was a nice letter. I kind of felt like our kids must have felt when they had an issue and we as parents would take the “there, there, you’ll feel better in the morning attitude”. But she did respond, and she was nice----but mostly platitudes, no analysis of the program I proposed, and nothing new on the Government’s part. Guess it’s time to get back into my gardening. At least there, my efforts bear some fruit.


Blogger Lanny said...

Unfortunately, I don't think any of these programs talk to family physicians when considering reform. This is critical. Academia, specialists, and politicians will not have realistic input into the problems out there. They talk about education being the answer... your idea definitely is a focussed and targeted education where it is needed.

13/4/06 8:37 PM  
Blogger vicki said...

This comment has been removed by a blog administrator.

14/4/06 6:58 AM  
Blogger vicki said...

As A health care worker I have noticed we are in 'damge control' instead of maintainance and prevention. Your insight should be shared with more professionals. Health care costs would be lowered if we were individually more responsible for our own health.I see people in a stress lab basically saying "Doc...fix me"
How about "show me what I need to do to help myself"?

14/4/06 7:04 AM  
Blogger Al said...

Thank you for your comments. As you know there are several steps that people go through from "being told they should undertake a process" and when they actually set out to do it. Any thing that we can do as a society to "speed up the process" to actual healthy living is going to help, and targeting those at risk makes it more cost effective.
It was one thing to put "warnings" on cigarette packages and T.V. ads saying smoking was unhealthy, but I found a face to face visit with information and a program for change was most effective. Especially if the patient's respiratory function tests were not normal. I would show the patients graphs showing the expected decline in the future and a projection when they could expect to be on oxygen. I would compare this to a graph that showed the advantage of quiting smoking. These were not scare tactics but information based on the best available medical knowledge. When I retired I had very few smokers in my practice.

14/4/06 6:49 PM  

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