Sunday, January 06, 2008

Brampton Civic - Ontario's canary in the coal mine?

Dr. Merrilee Fullerton has left a rather prophetic and disconcerting comment on my previous post - Maybe Hospitals should be banned in Ontario:

The problems at Brampton Civic are simply a sign of what happens when you build new facilities without the proper staffing to staff them (there is a shortage of physicians despite what some "experts" have fed the politicians for the past decade).

I've worked in Ontario health care for the past 20 years and would say that we have only another 5 years before the system collapses despite huge amounts of money poured on by the Liberals.

Build as many hospitals as you want....but if you don't have the health care workforce to support them then you will be out of luck for your care.

The National Health Service in Britain is looking toward "self-care" whereby patients essentially look after themselves for their chronic diseases....which will swamp us in the next decade.

The problem is that in an attempt to save a system that won't work with the pending onslaught of chronic disease and elderly and new treatments, the solution the NHS comes up with is that patients must look after themselves! a system which doesn't give the patient medical access! What kind of system is this?

And we know Ontario copies what the NHS does quite routinely so this is what we have to look forward the current system at any cost while patients are left to fend for themselves without recourse in their own province.

Strange. Very strange.

What good is a universal, accessible, portable, comprehensive system when as a patient you are left to provide "self-care"?

We pay taxes all our lives in good faith and at the end of our lives will be told: Sorry, you will have to provide "self-care".

As the NHS goes, so goes Ontario.

Dr. Fullerton's blog can be found here.

Wake up, Ontario!!! Five years. Can we afford to wait until the next election?

We're talking about your health, your hospitals, your life.

And the lives of your family members.

Is there anything else more important?

* * * *
Monday Update: Maybe some of that Health Care tax actually is going towards health - Crack pipes, that is. See Halls of Macadamia - McGuinty government ponies up.

I don't know how much more of this I can take. It is beyond depressing.

Tuesday Update: Curing Canada's doctor shortage - National Post.


Raphael Alexander said...

It's not about this:

"The problems at Brampton Civic are simply a sign of what happens when you build new facilities without the proper staffing to staff them (there is a shortage of physicians despite what some "experts" have fed the politicians for the past decade).

It's not a staffing issue. It's an immigration issue.

Joanne (True Blue) said...

Raphael, let's assume for a moment that what you say is true.

So what can we do about it? We still have to deal with the results of the problem.

Or at least our elected officials should be dealing with it.

Maybe if we hadn't aborted our country to death we wouldn't have the problem that you're referring to.

Oh, boy. This post should draw a few comments.

Lee said...

Lets look at the staffing issue.
Im going to give a real life example of where i think the health care system is going awry.
I have a friend who was having pains, bloating etc in her stomach. She went to the doctor who examined her, ordered blood tests, xrays. Sent the patient home to await the results of the tests. The doc suspected an ulcer. The blood tests came back, all was fine, nothing on the xrays yet. Sent patient to another facility for a mammogram, and ultrasound. Ultrasound didnt show anything. We are now three weeks into this case. Still no feedback from xrays. Doctor informs patient that xrays and ultrasound might not show the ulcer anyway, so he ordered a scope to be done. we are now 4 weeks into this case, no resolution, three visits to the doc, one visit coming up with the specialist to do the scope procedure.
I looked online and found that the best way to detect an ulcer is a barium xray.
So heres my problem:
After three visits to the doc who suspected ulcers, they still havent done the one thing that works best for detecting an ulcer?

were not short of docs, their time is being wasted.

Joanne (True Blue) said...

Lee, I'd love to hear Dr. Fullerton's response to that one.

My own thoughts are that these days everyone who is sick needs a health-care advocate - a friend or relative who will do the online research, go with the patient to the doctor's, ask the questions, take the notes, etc. etc.

i.e. Self-care.

Lee said...

Did you know that there a whole division in the health care system called PAIN MANAGEMENT?
Good Grief!!!
You know what the best way to solve a problem with pain is?

Lee said...

Sorry Joanne, lol
I get kind of carried away.
Im trying to kick a filthy habit(NY resolution) and its hard on the nerves.
Ill be ok, i think...............

Joanne (True Blue) said...


Sounds too logical and doesn't involve enough meds.

Joanne (True Blue) said...

Maybe better go get your blood pressure checked, Lee.

No, on second thought, don't go to the hospital!!!

Joanne (True Blue) said...

What's interesting is that we've got this whole little underground private health care system going on right under the nose of the Ontario public health care system, in the form of Naturopathy, etc.

Since this is not funded by OHIP, only rich people and those with great health packages can afford it.

Or the rich can go to the States.

So we already have two-tiered health care here.

Greg said...

The real problem is that our health system is governed by ideology, instead of medicine or science. The liberal government with approval of the liberal media has decided that our system should be socialist. Big surprise, socialism doesn't work. Our health system is free, but rationed. Hmmm, socialist and rationning, why does that remind me of the grocery store soviet style?

ladee-j said...

I agree totally with "not enough staff to staff hospitals". I also work in healthcare as an emerg RN and the system is crumbling. Not only do we lack docs but also Nurses and many will retire within next few years including myself this year. Our small hospital is unable to recruit any new nurses who will actually stay if they have to work weekends and nights. Maybe our hospitals will all function on a 9-5, 5 day a week concept soon.
Looking at other health disciplines, we are severely short of trained MRI and CT techs and also Ultrasound techs so putting these wonderful machines in your hospital or community is no guarrantee you will have any better access.
It is a very scarey future and the future in Ontario is around the next corner.

Greg said...

'Self Care', reminds me of that TV commercial where the guy is sitting at the table with a butcher knife in his hand, and his doctor is on the phone telling him where to make the incision. 'Shouldn't you be doing this?" LOL

Joanne (True Blue) said...

It is a very scarey future and the future in Ontario is around the next corner.

I always appreciate input from people who are actually in the situations that we discuss on this blog.

Ladee-j, do you have any suggestions or solutions?

Anonymous said...

Joanne I'm not sure that Naturopathy should be labelled as one of those 'only for the rich'. I chose a Naturopathy immune booster as an alternative to the flu vaccine.My choice, my cash...less than 2 packs of cigs.(no, I don't smoke)
And read the fine print on group health coverage. Some will pay up to $500.00 on Naturopathy.
It's very available.

Joanne (True Blue) said...

Hmmm, socialist and rationning, why does that remind me of the grocery store soviet style?

Good point, Greg. ;)

And read the fine print on group health coverage. Some will pay up to $500.00 on Naturopathy.
It's very available.

That would assume that you had group health coverage.

Ruth said...

Self care is here now. People are sent home with tubes everywhere instead of staying a extra few days in hospital. Then the VON or St. Elizabeth have to come every day, but that doesn't come out of the hospital budget. The average person doesn't know or want to look after all this stuff on their own after surgery.
We used to be able to stay in the hospital until we were able to look after ourselves. If we can't afford the RN salaries, then have more RPN's or even PSW's in the hospital setting to do the patient care. I realize that after a RN spends all that time at University now, she wants a 9-5 job. There has to be a solution to this mess somewhere.

Lee said...

Good point , Ruth.
Wasnt the RNs training much different in the past, say, 30 years ago?
There used to be RPNs, candy stripers, student nurses all over the hospital back then. Whats happened to all those people?
Whats happened to the orderlies?
I can remember when our hospital had a student nurse residence next door to the Hospital, and the students spent a great deal of their time on the floor.
Now it seems to me that they go to college , graduate, and when they get to work they say "you want me to do WHAT?"
We have RNs with a college degree slinging bedpans, while sick people are waiting for attention.

Ruth said...

I continually tell people that I think our hospital care was much better in the 70's than it is now. Where is all this money going? How long have we had the unions running our hospitals?

Anonymous said...

state-run serives like healthcare and education real need a governance shift to be of value.

Until we get a gov't that's not afraid of the "p" word, we'll keep spending and seeing little value in service for that taxdollar.

Raphael Alexander said...

Kevin Trudeau has some natural cures for ailments which are pretty good, although there's some question as to whether he's on the level. Health Care in the U.S. is dominated by the FDA in collusion with big pharma. I don't know if that's the case here as well.

There are a number of problems with overcrowding in our health care system, but I think the best way to alleviate it is to shake off some of the rust through the implementation of two-tier health.

Anonymous said...

I'll give you a hint to where the money is going...look to the lhins

Ruth said...

From the LHIN website - "While we don't directly provide health care services, we were given the mandate for planning, integrating and funding health care services. We oversee two-thirds of the 37.9 billion health care budget in Ontario."
How has this service helped the patient care post surgery? In other words, it's arranging the home care, so the patient can look after themselves at home.

Anonymous said...

ruth, the lhins are actively pursuing self care for chronic disease.

also, you will be hard pressed to find any info on how much these people are paid...with our tax dollars

Joanne (True Blue) said...

In other words, it's arranging the home care, so the patient can look after themselves at home.

Which is exactly what the good doctor was warning us about.

We need some good investigative reporting here, and I'm afraid I'm not the one to do it justice.

Ruth said...

You are right, we sure need someone to investigate.
I've heard of two many of my neighbours that have been sent home from same-day surgery that shouldn't have been.
Why should someone having breast cancer surgery not be allowed to stay for a few days just for the emmotional part of it, if nothing else.

Anonymous said...

Is it a coincidence that one of Canada's worst hospitals is also in a city with a very high concentration of immigrants and visible minorities? (real conservative)

Greg said...

Recently posted at Instapundit - FORGET NATIONAL HEALTHCARE: Try Wal-Mart healthcare. "I will never go to a regular doctor for a minor, routine illness again. Sick and wanting an appointment immediately, I went to one of those medical clinics in Wal-Mart. I got in almost immediately, everyone on the staff was extremely friendly, and it only cost $59."

Anonymous said...

The best test for an ulcer is endoscopy. Not a barium study. Sorry, maybe you can find that on the internet but that just makes it an example of why you should not get your healthcare off the internet, and why you need doctors, not "health care advocates who can surf the net on your behalf." Internet is full of junk and with people who know the answer to your problem who have never seen you, but for only a few bucks....

Look, the ultrasound was likely done to rule out gallbladder issues and pancreas issues (scopes do not detect pancreatic cancer, which is one of the worst of all cancers). There are other causes of GI pain and bloating besides ulcers. Do you think a barium study picks these up??!

Naturopathy? Please.... you may as well get the magnets and the tin foil hats.

The real problem in the case noted above is the delay in getting a specialist (gastroenterologist)to assess and if appropriate to do a scope in a timely manner. That's a system issue.

Why? Scoping usually requires hospital facilities. Hospitals have a limited supply of this. Also, endoscopy is very expensive. Scope everyone with stomach pain, and you will bankrupt the healthcare system in a couple of years.

I had to have a good laugh about that "don't treat the pain, treat the problem" business. Some problems are not actually directly treatable. You can't make a worn out back normal. You can't fix metastatic cancer. You can't fix reflex sympathetic dystrophy quickly, or the pain of a nerve trauma, or many other things. Pain management specialists help all these people.

Anonymous said...

Oh, and hey Greg.... regarding your friend who paid 59 bucks for the Walmart doctor?

That's more than your family doctor gets for doing you entire annual physical, the highest type of visit for family doctors. Routine assessments pay MUCH less.

And when your family doc sees you in Toronto for a blood pressure reassessment, they get 17 bucks. How much does the Walmart guy get.

An when you friend has a "real" problem, say for example you now have asthma, and you have to change your BP meds because they can make the asthma worse, and the wal-mart doctor can't take care of it, where do you go....

Your family doctor still has to deal with whatever complicated issue comes along. For about 30 bucks. Meanwhile the walmart doctor walks away to their next easy 59 bucks.

Joanne (True Blue) said...

Walmart doctor? I thought that was a joke!

realist said...

Thanks for the excellent forum for discussion Joanne..

First, to the person who was mentioning about "waste" in health care with respect to the friend with a suspected ulcer: medicine is not black and white...there are many grey areas. As a physician I try to do the investigations that are the least invasive and with the least potential to do harm to the patient that may show up the problem. Sometimes we go fishing for one problem and find another.

Ultrasound is a non-invasive technique for checking a multitude of problems without putting the patient at much risk. Also, there are many masquerading diseases that could seem like an ulcer but could actually be a GI cancer or tumor in an adjacent organ. Good idea to rule these out as well.

An x-ray using barium will not necessarily show the culprit either. Endoscopy could allow visualization and allow a biopsy of the lesion, if it is found, at the same time.

From an immigration standpoint, we need more people in Canada to support our aging population. It is reported that our dependency ratio will not be improved significantly even if we bring in over 2 million more immigrants over the next few years. (The dependency ratio compares those individuals who are most likely to be dependent ie below 18 and over 65 compared to the likely working population)

Immigration has its own set of associated issues but it is a necessity because Canada is not producing enough "home grown" kids to support our tax needs in the future.

Third, there are several other hospitals also under provincial supervision for a number of reasons mostly resulting from staffing issues ie inability to cover emergency....MedEmerg was brought in (a private company that looks after ER physician staffing problems)in at least one case to try to patch things up.

Fourth, Nursing positions and Medical student positions were cut back in the early 1990s by the NDP government in Ontario who then drove physicians and nurses out of this province with a variety of short-sighted measures.

Fifth, some of the protesters at Brampton Civic would like to believe that the problems there are associated with it being a P3 partnership. This has nothing to do with the problem. Similar problems exist elsewhere where there isn't a P3.

The short-sightedness of political decisions made 15 years ago are showing up now.

One of the solutions is to allow more innovation in health care and I don't mean just in developing new meds or technologies. I mean innovation that allows entrepreneurial physicians and nurses and technologists to try new ways of accessing care.

New methods of access using IPods or other IT is entirely possible. Of course, government would never allow anyone to bill for a patient consulted via IPod or allow a doctor to bill for e-mail discussion with a patient.

And so it doesn't happen.

With 30% of the physician workforce over 60 years of age, and a potential for thousands of physicians and nurses to retire int he next few years, things are going to get much more difficult.

Of course, if government were to loosen up a little, give these people a reason to innovate and use some creativity, then they might just stay.

Greg said...

I said it was posted on Instapundit - an American Walmart obviously. And you are making mhy point for me. The reason our Doctors get squat for their services is because it is socialized rationed medical care here. Thats why they can only spend 10 minutes with you and can't necessarily give us the time needed to adequately diagnose problems. They have to churn through as many $17 appointments as they can in a 12 hour day.

realist said...

the Wal-Mart clinics in the US, some also known as minute clinics, are staffed by nurses.

Joanne (True Blue) said...

Thanks for the excellent forum for discussion Joanne..

You are more than welcome to chime in there anytime, Realist.

We deserve to know the truth. It has been hidden by media and government, but we need to be informed.

Anonymous said...

I live in an underserviced area for doctors. I used to be pro-active about my health, always went for yearly physicals, etc.

What's happened now though is that in order to make an appointment at our orphan clinic one only has a window of opportunity of 10 minutes if you're lucky when the phone lines open at 9:00am each day. Miss that either keep trying every day until you get an appointment, or show up at emerg. wait however long it takes to be seen, and contiue to stretch the system.

Instead of taking care of myself and my health, it's so frustrating to be proactive that sometimes paying for service elsewhere, or alternatives are allowing me to continue to be proactive and be less dependent on an overworked healthcare system.

I am not alone.

Greg said...

I don't believe the truth and our current Ontario premier have ever met.

Joanne (True Blue) said...

I am not alone.

This is all so disheartening.

When I first posted this story, I was grateful to have a doctor's input, but the discussion has taken a life of it's own.

What can we do? With the current Liberal government having a majority, it's unlikely that they'll feel the need to do anything until the next election draws closer.

Then it will just be more rhetoric and fear-mongering.

We need a politician with guts. Someone who isn't afraid to speak out.

If John Tory latched onto this issue in a big way, I might even consider supporting him.

Ruth said...

A few of us here can discuss this on a Sunday night, but until it gets out to the media and the general public, nothing will change. We need the talk shows to take it up or somewhere that the busy population might get to hear it.
Otherwise, people just go about their life thinking their world is doing fine and voting Liberal every election so nothing will change.

Joanne (True Blue) said...

We need the talk shows to take it up or somewhere that the busy population might get to hear it.

Good point, Ruth. We could certainly suggest the topic to our local talkshow hosts.

Caveat said...

The simple fact is that socialized medicine (like socialized almost everything) doesn't work. How could it?

Like many policies advocated by the Liberals, the experience in areas which have tried them has been that they are complete failures on every level.

I'm afraid that you can't offer a 'free' service to everyone that is not only extremely expensive but also changes rapidly. Science is not static. And there, I believe, lies the rub. How can you possibly expect a huge, slow-moving, burgeoning bureaucracy to provide a creative, leading edge, constantly advancing scientific discipline such as healthcare?

The simple answer is, you can't.

I suggest the only way to make this work would be to completely eliminate the MOH bureaucracy and just pay every bill for services without question. Given the average 10% employee theft rate, even if there were dishonest doctors, nurses and lab techs (and there most certainly are)I think you'd still be ahead economically and more importantly, scientifically, if you just gave the people who know the subject the freedom to do the work without the interference of uneducated, obstructive bureaucrats. It would likely become successfully self-regulating very quickly.

It would certainly be worth a try because the 'system' we supposedly have now does not appear to be working.

I'm just glad that I rarely, in fact almost never, feel the need to consult a doctor.

Anonymous said...

Look, does everyone live in the same quality house? Or do those who have the means live in mansions, and others in rowhouses? Is there a law against this?

Does everyone eat the same food? Or do some dine at North 44 regularly, while others get what they can from the Scott Mission? Is there a law against going to North 44?

Does everyone get the same education for their children, or are some able to buy better education in private schools? Is there a law against private schools?

So, are you telling me that there is a "moral right for everyone to have the same healthcare", a.k.a. the Canada Health Act, while food, shelter and education are not equally important.

Health care > food and shelter. Does that make sense?

Why do people work? The main reason, I believe, to buy the best they can for themselves and their family - houses, food, education, toys, leisure time.... But it is AGAINST THE LAW to do that for health care.

We are all forced into the same increasingly mediocre system simply because of a political scam that was perpetrated on Canad by Tommy Douglas and his ideological offspring.

The only solution is to permit us to spend our own money to buy the health care that we want.

Ruth said...

well said Anonymous, I fully agree. Try to get that message through to our politicians.

Brian said...

I'm leery of the suggestion this one (Brampton) is a staffing issue.

Back in the 80's, when I lived in Brampton, Peel Memorial was considered a terrible hospital. This is back when there where doctors-a-plenty. As one example, my sister-in-law lived 5 minutes from Peel, and went to Humberview in Rexdale (half an hour away maybe) to have her children. She wasn't the only person I knew who did this.

Joanne, if you take a crappy hospital, build a shiny new one and move the same staff into the new one, what kind of hospital will you have?

A hospital like Brampton Civic perhaps?

Anonymous said...

Good point Brian...but at the same time if the provincial MoH wants total control of the 'purchasing and income' aspect, they should be accountable for the 'product'...and if they can't then they should get out of the 'business'.
Private enterprise thrives on 'quality assurance and accountability.'
This is what is clearly missing in 'health care.'

Greg said...

Dalton McGuinty has told a lot of lies in his time as liberal leader and premier, but the most damaging and cynical lies of all involved demonization of privately provided health care. With the collusion of the Star and other media, Ontario voters have been scare mongered into thinking all health care must be provided in government run hospital ghettos. As if world renown facilities like the Shouldice Clinic never existed. This pack of lies they used to get elected the first time should be held in infamy as our system continues to deteriorate. The lack of innovation mentioned in earlier posts can be traced directly to these lies.

Joanne (True Blue) said...

This pack of lies they used to get elected the first time should be held in infamy as our system continues to deteriorate.

We need to keep calling them up on it.

Write letters to the editor to educate the Ontario lemmings.

Great info here on how to write an effective letter.

Brian said...

but at the same time if the provincial MoH wants total control of the 'purchasing and income' aspect, they should be accountable for the 'product'

Anon, I agree 100%. My point was only that this has been going on in Brampton for 25 years. It was not good enough then, and it's not good enough now.