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?

Saturday, May 20, 2006

Sheila Found Money For Health Care!

So according to the federal auditor, Sheila Fraser, the long gun registry has set Canadian tax payers back approximately one billion dollars and the on going costs of maintaining it would be approximately eighty two million dollars annually. I heard that of the last 540 homicides in Canada, two were by long guns. Apparently no one at this time is able to point out specific instances were the registry has actually saved a life and Sheila Fraser notes that, even with the additional moneys spent on the “revised” computer program, there are significant problems that preclude reliability on the information that may be obtained from the registry. It would seem that this was an “innovative” idea on the part of someone to deal with homicides in Canada. If it really is the “thought that counts”, the formulators and the instigators of this brain fart could pat themselves on the back; unfortunately, its lives that count.
On many of my previous blogs I have talked about cost effectiveness in medicine, allocation of government revenue, relative, rather than absolute scarcity of resources, and competing interests for government tax dollars, etc. As a physician, I can assure you, and I can outline programs that would save hundreds of lives with the money squandered on the long gun registry. My wife gets notification when it is time for mammograms and pap smears as do most other women in the appropriate age group in the Calgary Region (a good pro-active step in finding cancer early). I have suggested a similar program for regular screening for high blood pressure and diabetes since two thirds of people with high blood pressure either don’t know they have hypertension or are inadequately controlled. Two thirds of people with cholesterol levels that are too high would also benefit from screening and treatment. This idea was rejected by Iris Evans, as I reported previously on my blog. Would such a screening “reminder system” cost over a billion dollars? Possibly; but I can guarantee that it would save thousands of people from strokes, heart attacks, and death.
A few days ago I attended a meeting of the Calgary Health Region and department of Family Medicine, which was to inform family physicians on the Regional state of preparedness of the Calgary Health Region in the event of an influenza pandemic. In the event of a pandemic the Region intends to decrease their active treatment beds for medicine and surgery from the present 2200 beds to 700 beds, setting aside 1100 beds for the treatment of influenza patients. They estimate that because of illness within the care giver population, 400 acute treatment beds will need to be taken out of the system. It seems obvious to me that under this scenario family physicians will be swamped looking after the people in the community that usually are being serviced in those hospital beds but are now either not being used because of staff shortages (sick with flu) or are being used for the care of people critically ill with influenza and its complications. Now comes the “zinger”. Most of the session pertained to the roll of family physicians in the event of a flu pandemic. Suggestions were made on how to clean our offices to decrease spread of the virus, triage our patients to come in at the end of the day if one suspects the flu, show patients directly into an examining room if flu is suspected, etc. The suggestion was made that we have “an alternate relief office nurse” in the event our regular office nurse gets ill (don’t they know that many years family doctors and their nurses don’t get holidays because of a shortage of “relief” professionals). It was acknowledged that antivirals (such as tamiflu) may not be effective and that it would take three to four months to “develop” a vaccine. The plan was to NOT have training sessions and people in place beforehand because the situation may vary somewhat from year to year and the information provided would then have to be modified. In short, I saw little evidence of a concrete workable “plan”(Could lack of funds be a factor?).
Here are some things that I think should be considered if we are to even begin to cope with an influenza pandemic:
1) In the event of downsizing hospital bed use, as suggested to accommodate influenza patients, family physicians will be so busy looking after the “usual illnesses”, we will have no time for influenza patients. Slowing down the office practice with special procedures to deal with influenza patients will simply mean nobody will be properly cared for. Furthermore, patients often simply walk into a medical office without an opportunity to triage them (we should note that at present Calgary is 200 to 300 family physicians short).
2) Influenza centers should be set up in vacant schools or auditoriums to deal with influenza patients and as many patients as possible seen in these centers. These centers would be the primary recipients of medications and supplies needed to treat influenza. A determination should be made as to how many, and where these centers may be located, and a tentative skeleton staff determined for each one.
3) Education of the public should start now. This would not only pertain to influenza per se (such as the use of an antiviral within 48 hours of onset of illness) but would include information about influenza centers, services available there, and their use instead of doctor’s offices and the emergency departments.
4) A core of professionals and lay people should be on “retainer” similar to a military “reserve force” that are kept current on the latest influenza information and the role they would play in an influenza center. This group would be called upon early, both as educators and participants in the first “wave” of a pandemic.
5) Schematics of an influenza center should be drawn up from both a physical and functional perspective.
6) Specifics should be addressed as to the priorization of both antivirals and vaccines.
7) Definitive packages need to be negotiated with governments that would compensate the family of care givers who die as a consequence of working in an influenza center similar to compensation for the families of military men lost in war. We were informed that at present “the powers that be” are negotiating a type of “no lost income” agreement with the A.M.A. and the doctors. I see this as minor compared to the impact of a family loosing one or possibly both parents that are care givers.
Well, the above is a start, and it will cost money; but unlike the long gun registry, I’m sure those hundreds of millions of dollars will save thousands of lives. And if we get a pandemic, you can be sure that some of those lives will be very close to home.


Blogger Lanny said...

Excellent post. Guess cost effective only counts for healthcare.

21/5/06 9:14 PM  

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