UPFRONT

DIAGNOSIS: CRITICAL

Our health-care delivery system is ailing, but there is a prescription that might work

Mary Janigan March 28 2005
UPFRONT

DIAGNOSIS: CRITICAL

Our health-care delivery system is ailing, but there is a prescription that might work

Mary Janigan March 28 2005

DIAGNOSIS: CRITICAL

UPFRONT

ON THE ISSUES

Mary Janigan

Our health-care delivery system is ailing, but there is a prescription that might work

IN THE END, it is the patients and their kin who will ensure health-care delivery is reformed—despite lingering resistance within the medical establishment. Hospitals have become too dangerous for casual use: the ailing should be able to avoid them whenever possible. And because today’s medicine can alleviate the damage of strokes or heart attacks //patients are treated in time, emergency wards should not be crammed with cold sufferers. For those two reasons alone, Canadians have a huge incentive to support embattled politicians scrambling to find the money and the strength for change.

The anecdotal and scientific evidence is striking. While hospitals have always been risky, today’s institutions are wrestling with a global world of new bugs. The extent of the problem is breathtaking. In the past six months, two of my friends have contracted infections while undergoing tests in Toronto hospitals. (One still requires a catheter.) Another friend’s godchild, the victim of a severe auto accident, picked up an infection in an Ottawa institution. Despite the chastening lessons of SARS, despite scrupulous precautions, menacing institutional microbes abound.

The result is a perverse version of beat the clock: some doctors and hospitals dither about new delivery modes while possible threats such as avian flu creep ever closer. “The reality is that hospitals can be dangerous places,” says Michael Decter, chairman of the Health Council of Canada. “You do not want anyone in the hospital unless they really have to be.”

Primarycare teams could handle less severe problems outside of hospitals, and leave emergency wards for real emergencies

Meanwhile, the patients who truly need fast care can slip through the system. There is a disturbing study funded by the Heart and Stroke Foundation and Ottawa’s Canadian Institutes of Health Research. As researchers grimly reported last month: “Overall, less than 50 per cent of patients met the doorto-needle target [for clot-busting drugs] of less than 30 minutes.” Although there were many reasons for delays, you can imagine some poor soul clutching his chest, lost in a queue of cold victims.

Then consider a recent report for the Canadian Stroke Network registry: there were “significant” variations in care among 21 sites. In the bad old days, there was little hospitals could do for stroke victims anyway— except wait and then do rehab. Now, especially if treatment is administered within three hours, dangerous clots can be dissolved with drugs or mechanical devices. But only one-third of registry patients received “any form of organized in-patient stroke care.” The report speculates that “in-hospital delays” could be one of the reasons for the holdup in receiving critical drugs.

As a result, it is not just bean-counters who talk reform. Many savvy provincial health ministers are pushing for the creation of primary-care teams with doctors and nurse practitioners that could handle less severe problems outside of hospitals. That would leave emergency wards for real emergencies. Those ministers also want many routine surgeries shifted to clinics, easily accessed electronic patient records, more highly trained ambulance personnel and local health boards that could ensure hospitals specialize instead of offering all services.

Such changes are tough and costly and often disruptive. But Canadians are on the cusp of better care: it’s up to us to vehemendy support those who could bring it.

Mary Janigan is a political and policy writer. mary.janigan@macleans.rogers.com