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, August 20, 2007

Semi-Private Rooms for Sale in Canadian Hospitals

I thought I had pretty good insight of the workings of our healthcare system having been a family doctor for forty years, and I suppose as a physician I do. As a physician AND caregiver of my wife who has stage four lung cancer, I have now the added perspective of a consumer of the services rendered by our system, and I come back repeatedly to “How in heavens name do lay people deal with the system when I as a physician caregiver am at my wits end regularly?”.
Having asked this question as we were driving into the parking lot at the Tom Baker Cancer Center a while back, we looked over and saw seven ambulances lined up at the Foothills Hospital Emergency Department. That gave us a partial answer.
The people working within the system, for the most part, are super; but the SYSTEM is in desperate need of an overhaul. Making an appointment to see the patient’s oncologist can take over an hour and usually results in speaking to several different people and finally simply leaving messages. If the situation is urgent, one doesn’t know if one should wait for a return call (which may take a day or two), or call an ambulance. I suspect to some degree access is necessarily made difficult to protect the caregivers. Otherwise the flood of patient needs would overwhelm the staff with resultant resignations, stress time off, sick leave, etc; but making the appointment process complex, is simply ridiculous.
As a patient and as part of the care-giving team, it has become apparent to my wife and me that the system is stressed to its maximum. On her recent admission with a pulmonary embolus, my wife was put into a semi-private room with a more than slightly demented patient in a “lock-down” ward. Likely it was the last bed in the hospital (although if it was, she should not have been billed specifically for a semi-private room), and with her blood oxygen and blood pressure cratering, who is going to complain? It did make for noisy nights, frequent incursions into my wife’s space, including her room mate giving her kisses and suggesting it was inappropriate for me to do so, setting off her bed alarm frequently, insisting for hours she needed to go to the bathroom, etc (we won’t mention the other poor demented soul who shouted and swore throughout the night). All in all, not the ideal environment for a palliative care patient.
The nurses did their best, often showing patience above and beyond the call of duty. As a physician that was significantly involved in administration, I fully understand the difficulties in appropriate patient placement, especially with present bed shortages, but will this ever improve, or is the system on a downward skid? Two things made me think we are on a downward skid. Firstly, of course, the inappropriate placement of my palliative wife in with an obviously demented room-mate. Secondly, on two consecutive days a nurse came in to irrigate my wife’s intravenous. The problem was my wife did not have, and never did have, an intravenous line. In addition, for the first two days the nurses were busy doing output measurements. The problem was that there were no input measurements being done and therefore output was of little value. It is said that to fix the errors made in hospitals we need to look at the “near misses” and find out how they happened and then fix the system that allowed them. These two occurrences are obviously not a nurses fault; they were simply following orders recorded somewhere----orders that wasted the nurses time and clearly were of no benefit to the patient. My wife was in the hospital two and one half days. If this is happening to other patients with the same frequency, there is a major problem somewhere, and may be of more dire consequences.
Within a week of discharge I received a bill for $48 (24 dollars a day) for the semiprivate room. Actually, we got quite a chuckle that the accommodation was termed semi-PRIVATE, when a ward of ten non demented patients would have been more private and restful.
When did hospitals start billing patients for hospital beds? Obviously, unless you are in a four bed ward they have taken the position that anything less is preferred accommodation. Can this be termed a user pay approach to raise revenue for the health care system----extra billing anyone??. In fact, if we were to look at the number of patients in wards as compared to two bed rooms (semi-private), the norm is a two bed room. From our perspective, a four bed room in a “non locked ward” would have been preferable.
All in all, my wife got excellent care from the healthcare professionals involved and I sent the region their forty eight dollars. But as a health care professional of many years and now as a personal caregiver, the cracks and strains in our public system are evident. Will we as Albertans and Canadians address them, or must we wait until there is a total collapse similar to the recent Minneapolis Bridge? My understanding is there was considerable evidence of deterioration years before its actual collapse.
In the mean time, I would suggest the Region charge for meals since strictly speaking one could argue that “necessary” hospital treatment need not include meals. The Canada Health act has already been transgressed more than the Ten Commandments.


Anonymous Lanny said...

Wow. It would have been far more reasonable if they had charged the 48.00 for entertainment.

21/8/07 8:57 AM  
Blogger Al said...

The entertaiment value is for the visitors. If you have it going on 24 hours a day it kind of racks on you!
Hey, I've been thinking about my idea of charging for meals; maybe even opening it up to the business community. It could start many small businesses, be a shot in the arm for pizza places, fast food establishments and so on. People could even have their friends and relatives bring up their favorite dishes. It would force the hospital food to be competative in their quality and pricing too!! And there is, as I've mentioned, the revenue, which the Regions just can't get enough of.

21/8/07 7:48 PM  
Anonymous Lanny said...

Absolutely. I hear in Cuba, the Cubans have to bring their own syringes and drugs sometimes. Perhaps Canadians could buck up and at least bring their lunch. Think of the money saved by the system! Isn't that what we're all working to accomplish now.. saving the system money?

21/8/07 8:13 PM  
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