The Long and Short of it

The long and the short of it…

I remember the visit I had with the optometrist. He checked my vision and said
“Yup, your glasses look OK right now. No changes needed.”
When he asked if i used them for driving, I said “No”, and he looked at me kinda funny.
“You don’t wear your glasses when you are driving?” he said.
“No, I need them mainly for reading…… “and it struck me how stupid this sounded.

This is a story about short-sightedness. Not me. The healthcare system.
Recently I have been doing locum work in the office. My 3 internist colleagues have waiting lists that stretch out for a year. A year. What sort of practice allows that? You have either (a) died (b) have forgotten your symptoms (c) have been admitted to hospital for expedited care. But these people show up, and are thankful they are being assessed. I tell them the system is broken, and they nod and look forward to a full clinical review. Most times, something appears – poorly controlled blood pressure, the need for a stress test or echo, or updated lab work. Sometimes they leave with ample reassurance, which is therapeutic.​

But the ‘system is broken’ message is universally accepted. They understand that
politicians are elected on a 4-5-year ticket, so planning and responsiveness to change uses this measure. But to train a physician, then make a GP or specialist, then embed them in a healthcare team – takes 10 to 15 years. Who is it that has this LONG-TERM VISION, one that transcends politics and looks at the needs of Canadians?
Canadians – a population that is growing in numbers, and in age. And with these two facts, so too is their burden of degenerative disease and dependency on tests, drugs and surgical treatments. The extended family of yore is no more – the daughter moved to Ottawa, the son to Auckland – and they visit maybe once a year. Imprisoned in a condo unit with similar-fated souls, they exist in a delicate balance, until one falls and breaks her hip, or the other becomes demented and disabled. It is no surprise that this situation is unfolding: the surprise is that we haven’t made serious arrangements to deal with it.

On the contrary, with a fixed number of doctors being trained, and multiple hoops
for foreign trained doctors to jump even to enter Canada, we now have a ‘crisis’ in
manpower/womanpower. There isn’t a mad rush towards private healthcare (which has some issues) mainly because we have an archaic system that outlaws any such solution. It seems that, given the choice between extended debility and isolation and even premature death, the modest Canadian would rather throw his lot behind a dated system, and eschew any semblance of modernity. Today I read of a daughter who hired a caregiver to sit with her demented father IN HOSPITAL, such was the challenge to care posed by inadequate staffing levels.

​I wrote to Ms. Patti Hadji, the then Federal Health Minister, and was told it was not
her problems, healthcare is the responsibility of the Provinces. So, I wrote to Mr. Adrian Dix, Healthcare Minister for BC, whose deputy replied a few months later. “Primary care networks will fix everything” was the response, which surprised me. Since then, things have gotten a lot worse.

If healthcare is known as the most COMPLEX industry on earth, why is it run piece-
meal by provincial governments? Will we ever get a solution to isolation, drug-
dependency, frailty and poor accessibility without radical change? Radical reform is
needed, not now, but yesterday. Can you imagine the auto industry still investing in the future of the internal combustion engine, or an import business that doesn’t use shipping containers? Well, healthcare needs some serious overhaul, for sure.

I had suggested that we have a National Think-Tank. Around the table, there would
be representatives from 4 agencies – (a) patients (b) doctors and nurses (c) support staff, eg. pharmacists and community workers (d) administrators, economists, government. We identify problems, ask questions, and steal solutions (from anywhere in the world). Then we implement these potential solutions in various communities, and adopt those that work (this is called Quality Improvement). I would do this work for FREE. The most radical aspect of such a Think-Tank is the involvement of patients. You know, patients, the people who actually FUND healthcare - and who deserve to be heard loud and clear.

Let’s admit we have a list of work ahead – climate change, fossil fuels, opioid
epidemic, homelessness, mental health, etc. In the UK, they have come to realise their
sewage treatment capacity is inadequate, but – surprise, surprise - flushing out to sea is not a reasonable option. School buildings made of substandard concrete (RAAC) need replaced, who knew? This lack of foresight will bite us in the bum.

​Let’s not be myopic. If for no other reason than our grandkids and beyond.