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, July 27, 2006

Blood Needed To Demonstrate Indifference

Three cheers for Dr. Chris Eagle, one of the Calgary Health Region’s Executive Vice Presidents. With reference to the Lundy miscarriage case he apparently made the statement to the press “We lost the human touch on this” and “This was a failure in the sense of being able to provide humanitarian assistance”. Right on!
Iris Evans, our provincial Health minister, apparently stated: “I’m hoping we don’t see this happen again. It’s something we can’t promise even if we had the right number of beds”. This statement unfortunately is likely also true.
In today’s Letters to the Editor in the Calgary Herald a writer states if Ms. Lundy wanted privacy she should have stayed at home, since first trimester miscarriages are common and no big deal.
All of the above illustrate clearly what my concerns are regarding our health care system in Canada. We have indeed dropped the ball, lost the human touch, and failed to provide humanitarian assistance, as Dr. Chris Eagle states; but not just in this case where a woman sits in an emergency department waiting room and bleeds onto the chair and the floor around her. This has happened in our health care system overall as the years have gone by. In this case, the episode was acute, visual, personal, in a public place, and because blood and reproduction was involved, the news media saw fit to put the incident on the front page. But I would ask Dr. Chris Eagle and the public this: “How much compassion and “human touch”, how much “humanitarian assistance” are we giving our elderly who wait in pain for their joint replacements, our cardiac patients awaiting investigation and intervention, or our cancer patients waiting for investigation, a treatment plan and treatment itself?” which is an ongoing, continuous state of affairs in our health care system.
Our Health Minister, Iris Evans, states correctly that this could happen even with adequate hospital beds. Since this is an attitudinal problem, she is probably correct, but having said that, we should be even more concerned. As Dr. Chris Eagle points out, technical problems have technical solution; what does one do about a pervasive attitude of indifference? This attitude stems from cost effectiveness being the “god” in our system, and it has replaced compassion, caring, and humanitarian assistance. These things cannot be measured, and to the “bean counters” and beaurocrats, they have no value. To the patient and old time family docs like me, it is often the most important part of medicine. Patients waiting for joint replacement may only have a few years left to live. They may spend half of their remaining life waiting in pain for their orthopedic or other procedure. In the mean time I, as their physician, give them anti-inflammatory drugs (for pain relief) that increases their risk of a heart attack, stroke, high blood pressure, kidney failure, and gastrointestinal bleeding, or I may give them opiates (codeine, morphine, etc) which increases their risk of falling, mental confusion, delirium, constipation, etc. Where is the compassion, the human touch, and the humanitarian assistance in that scenario?
Lastly, the letter to the editor states that women having miscarriages in the first trimester should stay at home. The case in question concerned a woman who miscarried at three month. Although miscarriages in the first trimester are common, fatal bleeding can occur; the farther along the pregnancy, the greater the risk. To me, the letter indicates that the public is at present making a choice; what is the risk, and what is the emotional price I will have to pay to get appropriate treatment? The lady who suggested in her letter to the editor that Rose Lundy stay at home with her “three month pregnancy miscarriage” is either not aware of the risk or is willing to accept the risk for her personal and emotional comfort and privacy. What a choice. I thought our Universal Health Care was to do away with those difficult “uninformed risky” decisions! Oh, that’s right----if they are based on money!
But our elderly people are making those kinds of difficult, potentially life-threatening decisions every day. Do I take the prescriptions for the pain in the hip that needs replacement and take the risks as described by my doctor, or do I live in pain for the next year or two? Do I go to the hospital emergency as my doctor recommended for stabilization of my heart failure and sit there for hours, or do I insist that my doctor initiate treatment as an out-patient and see if I improve. Many, many times, I have been begged by my patients to NOT send them to the emergency department. “Isn’t there SOMETHING you can do without sending me to the emergency” was a common statement made by many of my ill seniors.
So it would seem it has come to this; if you want caring, compassion, understanding, and a humanitarian approach, stay at home and accept the risk of dying. If you want practical, cost effective medicine that minimizes your risk of dying, go to the hospital, but expect to be approached in a calculated cost effective way. Will my risk concerns then be addressed? Sorry, only if they are cost effective and within the budget of the provincial government and your Health Region, but you will have the “perception” all is well. Ignorance truly is bliss.


Anonymous Muttering In Manitoba said...

"To me, the letter indicates that the public is at present making a choice; what is the risk, and what is the emotional price I will have to pay to get appropriate treatment?"

In Manitoba, the emotional price involves a very long wait in the Emergency waiting room and possibly being examined and treated in a crowded corridor, and later, extended waits for diagnostic tests and appointments with specialists. But not to worry, your health care is free!

I imagine the problems in the Calgary region are related to the City's growth. Is health care better in Edmonton, which is growing more slowly?

27/7/06 2:14 PM  
Blogger Al said...

Edmonton has some areas such as radiation for prostate cancer that are considerably better than Calgary, but for the most part many of the issues are the same (joint replacement waiting times are similar). They were smarter during the downsizing period and kept their old hospitals and now use them as transitional care and other levels of care. At one time Calgary had 3.3 acute treatment (hospital) beds per 1000 population. The "experts" at that time said there was 20% fat in the system. Now we have 1.7 acute trearment beds per 1000 population-----kind of overshot the mark by destroying the General hospital (800 beds), selling the Holy Cross Hospital (400 plus beds) and selling the Grace hospital (100 plus beds) and not planning for years down the road to build new facilities----they were simply going to "innovate". As you can see from my curriculum vitae, I sat on many committees and frequently raised serious questions as to the direction the region was going. I can't see that any of it was a big surprise.
I am familiar with the new projects going on in the city (new hospital, etc), and the next big crunch will be finding staff for the new facilities. The growth of Calgary is the political rational for our problems; the real problem is the relative decline of medical personel. We need to be recruiting actively now and attempt to get the physicians back that have left, and we need to be making a better effort at retention of the existing personel----training new people is going to take too long(how are we going to entice young people to go into medical related fields?) I find that many young people are getting degrees in "Health Science" but this seems to be a degree that has little practical value (they are not trained to do anything in terms of interventions, they seem more inclined to tell other people what to do).

27/7/06 6:01 PM  
Blogger michie said...

Many times I've avoided the Emergency room. Sometimes I've gone to either Emergency or a walk-in clinic (less wait time and I'd at least get some sort of an opinion) and at both places I've been misdiagnosed only to get sicker. Unfortunately I had no way of knowing if what I had was serious or not. Is it a life-threatening illness or a virus that will pass in a few days? There is no way of knowing.

If I was pregnant and had abdominal pain, you can bet I'd be in the hospital ASAP and wait for an expert opinion. I know of people who have hemhorraged and almost died from early pregnancies. However, you can bet that I would NOT expect to be treated (i.e. neglected) and totally humiliated in my attempt to get the expert opinion!!!

There are help lines you can call nowadays but even these aren't that helpful or comforting when it comes to the most important thing you own, your health and life.

28/7/06 8:32 AM  
Anonymous Karen said...

The whole situation is tragic, and my heart goes out to Mrs. Lundy. The other unfortunate thing is that now our nurses in calgary, who are extremely compassionate, caring and talented individuals, are being vilified for this tragic event, and demoralized for a decision that not many of us would have the courage to make. Triage is very difficult, particularly when you have many sick patients in your waiting room with few beds. I think, as much as we need to make changes in our province, we need to make sure that we don't forget that the staff at the hospital are human, and that tragedy happens, much to our chagrin. White being outraged at the system, ensure that it is not directed at the front line, particularly the nurses. No nurse should have to hear, "So, how does it feel to kill a baby?" as is becoming common around the Peter Lougheed emergency room. The nurses are not to blame for the incident, and should not have to face the d
being given to them by the public.

23/8/06 6:01 PM  
Blogger Al said...

I agree with you Karen, as you can tell from my follow up blog "Surviving as a caregiver".
I sat on committees some eight to ten years ago when there were no triage people in the emergency departments, and our wait times were in the range of 1 and 1/2 hours. I had insisted that a physician be the "triage" person if we went in that direction. Nurses are trained primarily in caring for and treating patients, they are not trained significantly in the area of diagnosis and complications of diseases. To triage appropriately, the triage person must be able to make a presumptive diagnosis as well as other possible diagnoses, and the relative risks that accompany those situations.
The suggestion that a doctor be used was turned down for several reasons:
1) cost
2) Medical-Legal liability.
It sounds strange, but the hospitals are likely at greater risk of legal action against them if a doctor does the triage. The process requires quick assessments, and althoigh a doctor will make the correct diagnosis more often than a nurse, when the doctor is wrong, the doctor and the hospital are more likely to have a judgement against them in a court of law because the doctor is "The apropriately trained person for the job". The courts always use the criteria "was the standard of care provided considering the training of the provider". If the nurse makes a mistake but provided the care a nurse would provide, the hospital and the nurse would not be held accountable, even though harm came to the patient. If a doctor made a mistake in triaging, no excuse would be accepted by the courts, not even the "time" element. Under these circumstances, doctors would be loath to act as triage people.

24/8/06 9:03 AM  

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