Empowering Canadians to improve our healthcare system

The pandemic has proven that society grinds to a halt when the stability of our healthcare system is threatened. Social media, despite its many pitfalls, has been a godsend giving physician colleagues an opportunity to connect throughout these long months on the frontlines. As the pandemic has evolved we have been able to easily share knowledge and advice. Despite varying opinions on many subjects most agree that COVID did not cause our healthcare crisis, it is rather the proverbial straw that broke the camel’s back. I have combined observations from my 27 years of healthcare experience with wisdom gleaned from thousands of physician colleagues across Canada to offer concrete solutions to address our healthcare system’s challenges. In my opinion if the following two simple concepts were applied to all aspects of healthcare management and delivery, it would lead to positive and lasting change. Read: The burnout drain 1. FOSTER A SENSE OF OWNERSHIP AND RESPONSIBILITY • Remind the public of the pre-medicare era: Since medicare’s inception in the 1960s Canadians have had the peace of mind of knowing that in times of illness, care would be available no matter their life circumstances. However universal “free” access has insidiously led to complacency and waste and given the false perception of limitless resources. I’m old enough to have parents who lived the pre-medicare period. Never in a million years would my parents (and the adults in my world as a child) have gone to their family physician expecting them to fix their apartment crisis/crappy job situation/fight with their spouse. Nor would they have no showed for a scheduled test/appointment to then expect their physician to move mountains to reschedule. I fully understand the social determinants of health—however we are not miracle workers. We need to teach boundaries setting in medical school and residency. If patients do not want to take responsibility for their lot it is on them not us. I have heard hundreds of colleagues share stories of patients’ unrealistic expectations that lead to the physician assuming responsibility/feeling guilty and often trying harder than the patient to get the help they need to then inevitably want out of this no-win situation . If all of us walk away from medicine then what? In my opinion the pendulum has swung well away from personal responsibility and our training has contributed to us internalizing this need to fix everything for everyone. Governments and our regulatory bodies who feed this dependence and victim mentality also need to recalibrate the pendulum as it is fostering the exodus away from comprehensive care and feeding the beast of turnstile/virtual/silo care. • Advertise the impact of ‘no shows:’ Missed appointments for radiological investigations and doctor visits lead to longer wait times. These numbers should be visibly posted in clinic waiting rooms and published in various media to remind citizens of its impact on resource availability. • Reiterate the poor choices that cause the most strain on the healthcare system: Obesity, lack of exercise, smoking and alcohol overconsumption lead to chronic disease and overwhelmed hospitals. •Remind the public that less intervention is often the best medicine: Up to 30% of tests, treatments and procedures done historically are unnecessary, do not improve patients’ health and can cause harm, all the while wasting resources. • Demand human resource departments address the root cause of employee dissatisfaction: It was recently published that that 15% of Quebec’s frontline health workers were off work—20,000 due to COVID but 30,000 due to burnout and other causes. Absenteeism costs New Brunswick’s Healthcare Department up to $50 million per year. Feeling valued and respected as an employee leads to better work environments and decreased absenteeism. • Ensure adherence to high standards of cleanliness in our hospitals: The state of cleanliness of an institution sets the tone as you enter the facility. If our hospital common areas and wards were pristine this would have a ripple effect on patient and healthcare staff’s sense of well-being. 2. ADDRESS THE CRUSHING BURDEN OF HEALTHCARE BUREAUCRACY • Tie decision making with accountability: Many provinces cross country have centralized health authorities. This has greatly helped with the co-ordination of care and ease of communication throughout this pandemic. However these large organizations inevitability create distance between the decision maker and the decision’s impact. In my area the assessment of elderly patients in hospital awaiting long-term care are done by employees that are outside the hospital setting. These transfers take months partly because the individual assessing the patient has no sense of urgency. These delays have a ripple effect causing bed shortages and emergency room overcrowding. •Decrease bureaucratic intervention to encourage innovation: Review the ratio of administrators to front line staff and ensure that hiring practices always prioritize those involved in direct patient care. Colleagues across Canada have shared numerous examples of innovative projects being abandoned and dollars wasted due to the complexity and inertia of needless bureaucracy. • Appoint non-partisan healthcare commissions that are independent of government: These individuals would be responsible to make the hard decisions no politician wishes to make. This would stop the wasting of healthcare dollars spent to appease voters and mitigate political interference in healthcare policies. As a society we have the power to waste healthcare resources as well as the power to make things right. All Canadians will benefit if we work together to ensure our health care system’s sustainability Dr. Linda LeBlanc is a radiation oncologist practicing in Moncton N.B.

Empowering Canadians to improve our healthcare system

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