Sometimes the truth is unbearable

The other day, I heard a story about a patient with an abnormal mammogram that required a specially focused, coned view that had been delayed for months. This test then led to the need for a guided biopsy, but the hospital was struggling with enough staff so it too was delayed for many more months. After the biopsy was done, there was yet another delay in getting the specimen analyzed by a histopathologist. More excuses were given. She eventually found out that she had breast cancer. Thereafter, she needed staging to find out how far the cancer had spread and, of course, this took additional weeks because the system has many patients scrambling for limited resources. Because of the delays in her healthcare, her cancer had spread to bone and lung. She needed complicated treatment protocols; her prognosis was much worse than if there had been prompt action. In fact, she passed away 30 months after the initial mammogram, 12 months after staging and treatment start. She had wasted 18 months on the waitlist. Ridiculous! Read: At BC Cancer, doctors are afraid to speak out, while patients wait and wait and wait I had a patient with terrible COPD who had been in and out of the ED over the last year. He needed a CPAP device that is not covered completely by OHIP, so he did without. He needed certain medications (not covered so he could not afford them). He needed respiratory rehabilitation but could not get to the necessary location. He needed better nutrition but that was not covered. Over 18 months, he was in and out of hospital for five-and-a-half months, including the intensive care unit, and eventually died. He died because the system failed him over and over again. It didn’t matter how many house calls I made, what medications were changed, how many specialists he saw. Whenever we looked for solutions, we often heard that it is not covered, that it is not possible in the community, that there is a wait for this care. He was often left feeling that the system didn’t really care. Heartbreaking! The waiting game I have patients who need joint surgery who must wait nearly two years, all the while insidiously becoming disabled, deconditioned and losing money as they lose mobility. I have patients who pay to get their children diagnosed for mental health issues but cannot access psychiatry, counselling or supportive services so it becomes all about ED acute care. I have diabetic patients who need specific medications to improve their conditions, lose weight, improve fitness and nutrition but who cannot afford these medications and services. So, over the next decade, I will deal with their neuropathy, kidney damage, heart attacks and blindness until they lose a limb and eventually lose their lives. I have older patients who are sent to the ED from the nursing home for all kinds of unclear medical issues. They are discharged with limited home-care supports only to come back in a week or two. I have hundreds of stories like this; I welcome your stories. Healthcare is sick care. We deal with emergencies (if, that is, the EDs are open), not prevention. We deal with acute care and then discharge people with limited rehabilitation services. We spend so much on tertiary care and so little in primary care. We overtreat older people. We spend nearly 50% of the healthcare budget on those over 65 years old. That number is going to 70% in less than 20 years. We make patients wait until their health gets worse; then we treat them. We wait for the heart attack; then we stent them. We wait for the amputated leg; then we fit you for a prosthesis. We take older patients into hospital, do a whole bunch of tests that do nothing for their quality of life and then discharge them without home care, without home physiotherapy. We let the woman mentioned above get metastatic breast cancer and then we treat her with radiation and chemotherapy. Nonsense! Am I angry? You bet! Read: Let's create a 'Healthcare Bill of Rights' for Canadians Six million orphan patients and climbing in Canada. A healthcare system born in the 1950s and bled to death to balance the four humours like they did in medieval Europe. This is why we are ranked near the bottom of the Commonwealth healthcare ranking score. But policymakers stand in the way. You cannot be a flat-fee physician (Family Health Organization) in Ontario unless you have six doctors working within five kilometres of one another. No exceptions. Only the Ministry of Health knows the right way forward. How’s that working? The solution Success is simple. Every Canadian needs a family doctor working in a team with allied healthcare workers in an interconnected EMR system. Pharmacists with expanded scope, working in a team with family doctors, is part of the solution. More nurse practitioners working in teams with family doctors is part of the solution. Thoughtful expansion of the scope of midwives, podiatrists, optometrists, and other allied health professionals working with family doctors in a team is part of the solution. Hiring more paramedics to evaluate and manage patients in the community (and not bring patients to ED) is part of the solution. Improving health literacy in every age group to help the population make healthier choices and manage their basic health needs is part of the solution. If you want the Canadian Sick Care system to become a healthcare system, please share this article. Dr. Alykhan Abdulla is a comprehensive family doctor working in Manotick; board member of the College of Family Physicians of Canada; and Director for Longitudinal Leadership Curriculum at the University of Ottawa Undergraduate Medical Education.

Sometimes the truth is unbearable

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