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?

Friday, November 24, 2006

Candidates Favorite "Visions" for Healthcare

Before I give my “two cents worth” regarding the candidates for premier of Alberta, I would like to focus more on some areas of medicine that seemed popular with many of the candidates. These were often offered as solutions to the increasing cost of health care across Canada and in particular, Alberta.
1) The electronic health care record.
The experience of practitioners, who have gone to computerization, is that it has actually increased their costs. In Alberta there have been, and are, specific programs to offset these costs, but these programs will end, at which time ongoing costs will be borne by the practitioner. Savings, such as reducing unnecessary repeat testing, are savings to the system, not savings to the practitioner. Improving the tracking of chronic diseases has positive implications for better quality of care and preventative medicine on a personal and global scale, but will mean significant increases in cost in the short term (ten to twenty years), both to the taxpayer and the practitioner. Implementation of “privacy” safeguards will be a huge problem, and have significant cost and administrative implications.
2) This is especially true when putting this together with the other area of enthusiasm, the Primary Care Network (PCNs). Their vision is that, by definition, primary care is the first point of contact with our health care system. Strictly speaking then, the person who answers the phone on Calgary’s present “Help Line”, is a primary health care worker. They fore-see also, community health clinics, where people will be triaged, not necessarily to family physicians, but possibly to physiotherapist, chiropractors, dieticians, optometrists, nurse practitioners, etc. so many, many people will be primary and secondary health care providers, and part of the health care team. Sounds like a real “team effort” so far, right? The caveat on all of the above is, however:
3) Confidentiality. The “vision” is that information should only go to the health care worker if it is needed to perform their duties to the maximum of their “scope of practice”. Whoops!! Whose job is that? Sounds like it may fall in the lap of the family doctor, if there is one. And for heaven sake, how do you set that up on your computer? If you have a moderate sized practice you may have to hire a programmer to set it up, and even then, spend most of your time trying to decide what information to send along to which member of the health care team. Keep in mind, legally, at present, there is pressure to have written consent on the part of the patient before information can be sent along.
Here is the dilemma. I have a patient that is depressed and attempted suicide two months ago. She has been referred to a psychiatrist, and of course it is important that the psychiatrist knows of the suicide attempt. She has a problem with obesity and self image, so I refer her to a dietitian. Should the dietitian know about her attempted suicide? It certainly may reflect how important losing weight may be to this patient. She also is seeing a physiotherapist for low back pain of two months duration. Should the physiotherapist know about the suicide attempt? What if the back pain began with her crashing her car into a cement structure? What if it predated her “accident”?
The bottom line is that in a truly integrated computerized health care system, with the Primary Health Care Networks presently envisioned by the government, we may as well kiss confidentiality “good-bye”. Every health care person that comes in contact with the patient (and many who will not), will have access to the medical information on file. In order for that not to happen, there would have to be a “medical information watchdog” responsible for providing information to care-givers on a “as needed to know basis”. Whoever takes that job had best have lots of insurance against law suites. All in all, a complex, costly “vision”, and a make work project for lawers.


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