Category: System

Senore Graciano pointed over his shoulder and craned his neck around.  “My new hospital,” he pointed.  “Very big.  Very nice,” he said, steering with one hand.

I smiled, nodded and did everything to show I saw his hospital as our van leaned through lane changes in the roundabout.

“Do you have to pay for healthcare?” I asked.

Mr. Graciano frowned and tilted his head.

“Is medicine free?  Do you have to pay to go to the hospital?” I asked.

“Oh, No! No. It’s a free,” he said.  “You no pay,” he shook his head and frowned.

“Do you have to wait?” I asked.

“Si! You wait very long time,” he smiled and nodded.  “Many months.  Very long time. But, if you pay private,” he shrugged his right shoulder and flung his hand toward me. “You no wait.  No problemo.”

No problemo, indeed.

No problem, except that it’s illegal for Canadian citizens to pay for healthcare.  Correction: it’s illegal for Canadians to purchase necessary care, except for Quebecers, injured workers covered by WSIB, diplomats, professional athletes, RCMP staff, citizens with expired or invalid health cards, refugees…  They all pay.  They don’t get to the front of the line, like professional athletes and WSIB patients, but they all pay.

European countries have universal healthcare.  Italy, Germany, England, Sweden, Switzerland, they all have universal healthcare.  Even the United States now has universal healthcare.  Canadian Medicare is not unique because it’s universal.

Citizens around the world have freedom to choose between government run, tax funded healthcare versus privately run options.  Only Canada and North Korean prevent citizens from purchasing healthcare. That’s what makes Canadian healthcare unique. Despite other countries having better universal care for less expense, Canadian Medicare eliminates freedom to purchase necessary care for the average taxpayer.  Purchasing healthcare in Canada might weaken the state system.

In the 1960s, Canadian Medicare impressed the world.  We figured out a way to provide medical care, and it worked well for most of the 1970s.  Medical care changed over 40 years, but Medicare has not.  The five first principles have been eroded, while quality and service lag behind other countries.

Why are Medicare zealots so anti-freedom?  Why, as members of so-called ‘progressive’ political parties, do they fight progress?  Why do patients put up with it?  When will we consider that medicare freedom might actually improve patient care?

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)

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)