Cool heads make hard choices for the greater good, in war. Innocent people die. Others survive. War is utilitarianism writ large.
Healthcare experts often sound like military.
“As for urgent patients in pain, the public system will decide when their pain requires care. These are societal decisions. The individual is not able to decide rationally.” So said a past VP Medicine from BC.
Here’s a personal story from someone in pain, shared with permission.
Wait Times
The story of my knee: Everything that is wrong with health care wait lists.
Seen in urgent care….referral to orthopedic clinic day. That guy looks at X-ray and says….hmmm. Knee replacement….I’m a shoulder guy. Take NSAIDS and see a knee guy if it doesn’t clear up.
So I need to wait to see the family doc….then I will need to wait for an ultrasound and mri. Then, if I need surgery I will have to wait for that…
In the meantime there has been about a thirty percent improvement in range of motions and sens of stability one month post incident.
I can’t do anything but rest it and very mild physio until we are sure of diagnosis. There is definitely a hamstring injury but why?? Is it strictly secondary to osteoarthritis or is there something else going on too? We wait to find out.
Waiting has the following complications….I can’t move. Muscles atrophy to the point that they ache.
(I suspect this is a reason many post menopausal women get a fibromyalgia diagnosis – ligaments loosen and all hell breaks loose)
Good knee is getting screwed up from doing all the heavy lifting. And back aches from being off balance.
When I can’t move I get constipated.
When I get constipated then I get UTIs and need antibiotics. Lack of activity and treatment plan make me anxious and depressed. Soon I will need more drugs to treat that.
I’m also dying to take a Tylenol 3 to be blissfully pain free for an hour or two but then I will develop addiction issues and need even more medical care.
Possibly become unemployed or bankrupt and have to live on welfare.
How does rationing access save money?
The health professionals are all great….you just can’t see them when you need to. The MOH is crazy if they think this is a good plan.
Debating Wait Times Data
Evidence based medicine says anecdotes mean (almost) nothing. In fact, personal stories are worse than nothing: They might twist our sense of reality.
Thankfully, most doctors still rely on one anecdote at a time, as they try to learn about the patient in front of them.
The Annual Fraser Institute Wait Times Report ruffled the usual feathers, worn ragged from ruffling. The Institute said that patients wait a median of 20 weeks for care: the longest ever. When Fraser started reporting wait times in 1993, patients waited 3.7 weeks.
Critics scoffed at the report. They said it relied on physicians voluntarily reporting wait times. Physician recall is sketchy at best.
Never mind that the highly regarded and widely quoted Commonwealth Fund study, which compares international health systems, also relies on voluntary self reporting by patients and doctors.
That study ranks the US healthcare system dead last. So let’s not quibble about methods when favourable results are at issue.
The Fraser Report is far too kind. In my area, patients would love to only wait 20 weeks instead of 100 weeks for joint replacement. Furthermore, the worst waits are left out. If a service does not exist, it has an infinite wait. Infinite waits ruin statistics.
Privileged Access
True believers insist Medicare proves that the dream of “equal access for all, regardless of ability to pay” can work.
But access is not equal. Privileged patients get faster service, and those who can afford to pay, leave Canada for care.
What’s worse, those with the power to improve the system are often the ones who leave.
Danny Williams, Premier of Newfoundland, flew to Florida for his heart surgery.
Belinda Stronach went to California for breast cancer treatments and reconstruction when she was a Federal Minister.
Prime Minister Jean Chretien used the government jet to fly to the Mayo clinic, twice.
Other politicians have gone to the USA, too.
The Liberal government deserves credit for tackling emergency wait times. They focus on 90th percentile, or the longest time patients wait for emergency care. The 95th percentile would be even better, but 90th beats median or average waits. Hopefully, we will see more reporting about patient suffering, and death, under wait time extremes.
How to Rescue Medicare
Medicare could be great. Roy Romanow, of the Romanow Commission, said that Medicare will be as sustainable as we want it to be. Those on the Left interpret this as a call for more funding and centralized control.
But more money will not save us. More control will destroy us. Medicare needs management based on different principles. Government must stop trying to run Medicare like a Soviet car factory.
Government exists to govern, not control.
If we do not improve Medicare soon, it will get pushed aside as a failed idea, a casualty in the war of ideas.
PS. I plan to post a series on core ideas we need to rescue Medicare, in the New Year. Stay tuned!
Photo credit: http://www.hacksawridge.movie/