‘Depressing’ or an opportunity? Health care in Canada

Kelsall_Diane_01 croppedDiane Kelsall is Deputy Editor at CMAJ, and Editor of CMAJ Open. She's currently attending the 2015 Canadian Cardiovascular Congress in Toronto.

 

The opening ceremony of the 2015 Canadian Cardiovascular Congress began with a bang on Saturday October 24th, but by the end of the keynote address from Dr. Chris Simpson, past President of the Canadian Medical Association (CMA), some may have thought the opening ceremony ended with a whimper. The moderator used the term "depressing" to characterize Dr. Simpson's talk on "Seniors Care: The Paramount Health Care Issue of our Time."

All Dr. Simpson did was to point out some clear realities about the Canadian health care system to the attendees. For the first time in Canada history, there are more seniors than children. Despite the billions of dollars thrown at it, our health care system is ranked 11 out of 12 similar nations, just ahead of the United States. In some provinces, health care costs are creeping up to form nearly 50% of the provincial budget, leaving little to address the social determinants so crucial to building a healthy society.

As he crossed the country during his year as CMA president, Dr. Simpson said the story was the same: overcrowded hospitals, people stuck in the emergency department, not enough long-term care beds. And those overcrowded hospitals are toxic and are making people sick. Bungee jumping is a safer activity, he said, than being in hospital if you have chronic health conditions. "The deeper you get into hospital, the harder it is to get out" if you are a senior with chronic health conditions.

Depressing, indeed.

Dr. Simpson talked about the need to change the system itself. To dehospitalize seniors' care. To shift the focus of health care in Canada from acute care to the full spectrum of health: from wellness and prevention through to long-term and palliative care. To keep seniors in their homes. To have standards. To measure outputs. To shift precious dollars into addressing the social determinants of health. And while doing so, to remember the importance of equity, fairness and compassion.

When I trained as a family physician, the principles of family medicine of the College of Family Physicians of Canada were drummed into my head. We were to be skilled clinicians, to recognize the centrality of the patient-physician relationship, to be community-based and to be a resource to our community. I remember puzzling over how I was to be a resource to my community. Did I need to participate in politics? Did I need to volunteer or take leadership in the community? How was I to address the social determinants of health so evident around me?

These principles have been tweaked over time to be clearer. We're now to be a resource to "a defined practice population", rather than to a more ambiguous "community." But as I listened to Dr. Simpson's talk, I wondered if taking good care of my patients was enough.

I left the opening ceremony and went down the hall to listen to the Terry Kavanagh Lecture, the start of the Canadian Association of Cardiovascular Prevention and Rehabilitation meeting, which takes place at the congress. Dr. Paul Oh, Medical Director of the Cardiovascular Prevention and Rehabilitation Program at the Toronto Rehabilitation Institute, University Health Network, spoke on exploring the art of the possible in both our personal and professional lives. The tone of the talk was upbeat. He emphasized the importance of taking care of ourselves, of having a positive attitude in order to be better physicians. Patients need autonomy, mastery, purpose to be healthier, as we do. We need to help our patients to be their best selves, and we can start by being our best selves, he said.

Quite a shift from one session to the next. From the big system-wide picture to the place of the individual--physician and patient--in that larger context.

And this dichotomy continued throughout the day. Speakers talked about national and international guidelines and multi-national trials on managing atrial fibrillation, antiplatelet therapy, lipid management, acute coronary syndromes--and yet the questions from the floor frequently focused on the individual patient. "I have this patient who..." "What do I do if my patient..." And the answers often centred around the  speaker's personal experience with their patients.

So, how do we reconcile these two realities?

The theme of the Canadian Cardiovascular Congress 2015 is "Innovation and Collaboration: Pathways to the Heart." Although the Canadian Cardiovascular Society and the Heart and Stroke Foundation are hosting the meeting, the congress is home to an additional 21 organizations. Cardiovascular nurses, cardiology technologists, radiologists, surgeons, pediatricians, rehabilitation specialists and others are also meeting here. Although some distinctions made at the congress should be abandoned (doctors, researchers, pharmacists and PhDs wear red tags; allied health professionals, blue; nurses, purple; which makes me wonder what colour of tag a researcher with a PhD in nursing should wear), that all these groups are meeting and talking and worrying together about system-wide issues is surely an important step.

While we take care of our patients one at a time, health professionals in Canada are part of larger professional organizations, specialty-specific or profession-wide. We are part of communities, large and small.

In his talk, Dr. Simpson mentioned that Mr. Justin Trudeau, now Prime Minister-Designate had promised him a few weeks ago that if he were to become Prime Minister, he would make health care a priority for his government.

We are not all called or gifted to be leaders, but we can hold our leaders, whether political or in professional organizations, accountable for improving our health care system.

We need to make our leaders understand that, while we care about and for our patients as individuals, we also care about the society in which they live and the health system that is intended to care, not harm, them. And that we will do our part, however large or small, in making that system healthy again.

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