Archive for ‘Health Care’

July 13, 2011

Health: It’s not always about the money

There are many places where money would make a difference. However for many of the problems in the health care system it’s about organization, not money.

It seems that health care is the last hiding place of old fashioned, non creative thinkers. On the right we have those who feel only privatization can solve issues, an approach proven elsewhere to be expensive and, yes, inefficient.

On the left are those who feel any suggestion of change is an attack on the public nature of medicare. To them the words ‘competition’ or ‘efficiency’ smack of privatization. They often do. But not always. One can have competition for models of service delivery within a public system and still be fully compatible with, and even advance, the public system. I myself called for such an approach almost twenty years ago in a paper submitted to The Premier’s Council.

In my dealings with many levels of bureaucrats at the Ministry of Health and Long Term Care in Ontario over many years and in many capacities I have become dismayed by the level of understanding of the issues and the unwillingness to look at creative solutions. I say this from a sympathetic point of view. I support the general conceptualization of the Ministry bureaucracy and its attempts to control and administer a complex care system.

But, wow, some of the minds there just defy reason.

I’m thinking about writing a series of articles on health. More about that later.

Right now I would just like to recount a story that exemplifies the issues I am talking about.

Last Friday my father developed some pain in his leg. He called me and, because I don’t like to manage my parents’ medical conditions, I told him to call his family doctor and get in to see him. He called. His physician is on holidays with a message on his machine advising patients to go to the Emergency Department (ER) if they have a problem. Very helpful.

So, reluctantly, I told my father to go to the ER. He went to Sunnybrook ER at about 2:30 Friday afternoon. Friday afternoons are always busy because doctors leave their offices early and people worry about conditions that have festered for days but suddenly they realize a weekend is upon them and their doctor won’t be available.

When he was finally admitted, past midnight, I wasn’t too surprised. But some of the details are interesting.

First, they found a slightly abnormal kidney test. They didn’t know if it was a new issue or a longstanding one. Well, after all the hype about Electronic Medical Records, one might think they could retrieve previous results to compare. Nope.

They had the same question about an abnormal heart rhythm they discovered. Was it new? Can’t check.

So, they admitted him for some minor tweaking of his medication and for observation. Needless to say, they also spent money repeating tests he has recently had done as an outpatient. He was released on Monday.

I spoke to the physician looking after him. Had they called CCAC (Community Care Access Centre) to arrange for some in-home help for him and his frail wife (both of whom are 91 yr old)? No. Why? Well he is going home today and there isn’t time to arrange it before he leaves hospital. Why did they not look after it on the weekend? Social Services division doesn’t work on the weekend!

Here’s another example. About four years ago I cut my hand in a bicycle accident. So I wrapped it in a towel and had my son drop me off at Toronto Western Hospital ER. I walked in and went to what appeared to be the check in window. No one was there. I wandered around for a little while and then decided I had the right spot. So I sat down to wait.

After about 20 to 30 minutes I noticed someone had returned to the kiosk. So I went over to ‘sign in’. I showed my bandaged hand and told them that I was going to need stitching up.

They took my name, address, OHIP number, etc and told me to sit and wait.

And so I did for a couple of hours. I’m not complaining about the waiting… I expected that.

What happened next is the issue. They took me into a cubicle, unwrapped my hand, pronounced that stitches were necessary and that I needed to soak my hand in antiseptic for 20 minutes.

If you were running an Emergency department, don’t you think you might deal with this first? I mean….laceration, soak in antiseptic, suture. So wouldn’t you have the person sitting waiting with their hand in antiseptic rather than stop and have to do it later?

This is what I mean when I talk about organizational skills rather than money.

Not only is it better medical care and kinder to the patient, but it is also MORE EFFICIENT to properly triage, to think ahead and to prepare your care in an insightful and orderly fashion.

There are but trivial examples.

Now don’t get me wrong. If you gave me money to spend on the health care system, I would find places to spend it. And I really should say that there are a lot of good and caring people in health care. And some of them are really smart and are making a difference in the provision of services.

But with some of the people running things right now, I’m not so sure money would make as much of a difference as it should. I don’t think I have met a more uptight, unwilling to change, watch my backside group of people anywhere like some of those in administrative positions in health care.

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