Shawn Whatley, Author at shawn whatley md

Ontario Election Forgot Healthcare

Politicians avoid healthcare. Aside from platitudes and cow towing to Medicare, we never hear substantive debate about healthcare in Canada.

No surprise, we’ve heard very little about it in the Ontario election. We need debate. We need courageous politicians who will dig into the issues.

Hudak wants to scrap the LHINs. I can’t blame him. With a limited mandate, LHINs struggle to demonstrate their value add. Too bad Hudak didn’t have more substance to his healthcare vision. He knows he can’t take on the unions and expect to win an election.

Wynne wants to give nurses what they want: more power but no more responsibility. She doesn’t want to get them to do what’s within their scope of practice already. Wynne’s just buying off the unions.

Howarth thinks ED wait times require more money, more providers… Regular readers of this blog know that EDs do not need more money. Hospitals need new governance, less pandering to unions. Howarth does not know EM care or process. God help EM services if the NDP wins the election on this platform.

With only a few weeks and one debate left, maybe we can get party leaders to talk about healthcare. Let them know what you think. Ask them for debate. Let them know you think it’s important. Shoot them an email or send a letter to the editor. Ask them to be courageous!

(photocredit: news.nationalpost.com)

Caring For Medical Records, Not Patients

After 40 minutes in line, six of us dragged our stuff to the constipated customs agent. “You did not complete this form correctly. The address is blank. Go fill it out correctly”, he said without breaking his scowl.

“We rented a farm house in Sheffield,” my wife said. “We will call when we get close so the landlord can guide us to the property.”

“You need to fill in the exact address,” he said, still frowning. “Go stand over there and fill in the address.”

Ah, the joys of dealing with a chart-filler after being up all night on a sold-out charter…

Medical Records, Not Patients

We do the same in medicine. Medical records demand as much work as patients, sometimes more. Providers soon learn that detailed notes offer the best protection in court regardless of what happened in real life.

We force patients to provide answers:

“When did it start hurting?”

“Have you ever experienced this before?”

“I don’t know,” is not an answer. Patients must do better; we need to fill in our forms.

We force patients to run our medical records gauntlet after they’ve been writhing in pain all night. We believe that charts improve care.

A group of us reviewed an integrated care plan for medically complex patients last week. It was utopian: spots for every possible allied health provider, boxes for lifestyle issues and social determinants of health, room for every possible past medical concern, and a ton more all in a few dozen pages.

Our medical records Frankenstein cannot be put back in the womb. It can only get bigger, and scarier.

Inevitably, we use standardized charts, cut and paste. Just listen to a surgeon dictate a note for an uncomplicated appendectomy. Other than the patient’s name, it sounds almost identical to any other.

Does a long, officious chart add value for an individual patient? Do one or two unique details buried in pages boiler plate benefit patients, or providers?

Lawyers, bureaucrats, and health coders love long charts that miss nothing. But do they add value for patients?

(photocredit: boomersinfokiosk.blogspot.com)

Leadership: Who’s in Charge of Medicare?

If you let them, physicians tell about the days when MDs lead healthcare. They remember medical staff associations deciding whether to hire another surgeon, not administrators or bureaucrats.

After 40 years, most doctors know better. They hold hat in hand, look at their feet, and speak only when spoken to. Well, some do…

Even mentioning this topic requires courage. It’s politically incorrect, dangerous. Un-Canadian!

Medicare axiom: doctors are not in charge.

Sure, doctors write orders. But everyone gets trained to double-check and question every order, and that’s generally a good thing. A tiny step separates double-checking orders from questioning the relevance of physician opinion in everything.

Inside Medicare we hear, “Do we really need a doctor for this leadership position? Patient care improves when doctors are not in charge!”

But what do people outside healthcare think?

What do patients and families believe?

Who do courts identify as being most responsible for outcomes?

Everyone outside of healthcare assumes doctors lead Medicare.

Health systems discover, over and over, that great outcomes require physician leadership (see comments here, here, here and here).

When things go bad, the boss takes the blame. When companies flounder, CEOs get canned. When bad things happen from overcrowding or long waits, doctors get sued.

It’s well known that doctors have done a pitiful job of leading at times. They have been arrogant and condescending. We can be sure of this by watching TV and listening to our mothers tell stories about nursing in the 1970s. (#sarcasm)

Responsibility, not behaviour, determines authority. Behaviour should not dictate that a whole class of providers remains in authority, or subservience.

Leaders who behave poorly should not lead. They should lose their authority. But you cannot remove authority and leave responsibility unchanged.

We need to teach physicians to lead well. Then, we need to put physicians back in charge of healthcare.

Of course, we need diverse senior leadership teams in bureaucracy and hospitals, from varied clinical backgrounds. But those teams must have 30-50% physician members. Currently, doctors hold <10% of leadership positions in Medicare.

Until we figure out a way to give final responsibility for medical care to other providers, we need doctors playing a major role in all aspects of Medicare leadership.

(photo credit: spectator.co.uk)