Once again, we hear that our health care services here, as across the country, are overwhelmed, mostly with pediatric respiratory cases. In the hospitals, emergency rooms and intensive care units are swamped. An emergency room filled to 200 per cent? Patients on stretchers in corridors for more than 36 hours? How could this happen? Why are we overloaded again? Have we not learned from the pandemic?
Unfortunately, the answer might be more complicated than we would like.
The health system is not a factory in which you control what comes in and what goes out. When people are injured or sick, the health system must deal with the patients who come to the door.
And the health system is a big creature. It is so big that anyone trying to draw a chart of all its interconnected components would produce a very abstract piece of art. Some say a cat would lose its kitten in there.
This big creature is made up of parts that . . .
push and pull according to their own needs. Health care employees paid by the public system who do as they are told but are no longer satisfied with working conditions and salaries. Doctors who are self-employed, fully paid by public funds and working in different venues, but not wanting to work the old norm of 80+ hours a week, with no home life. Successive ministers organizing, re-organizing, managing doctors’ time and tasks, adding structures, subtracting structures and introducing all manner of novelties in trying to provide good health care and avoid overwhelmed hospitals.
Unfortunately for health ministers, trying as they do to plan for all parts of this complex maze, there is no doubt a major challenge in predicting pressures on the system as none of us plans to fall sick and thus become a patient. And there might not be enough time to implement, test-drive and refine even well-made, thoroughly thought-through plans before the next onslaught of patients needing care.
Today, if you or I get sick, on reflex, we seek out a doctor to take care of us. But what are our options in getting access to that doctor? Through an appointment at their office, a multi-doctor clinic, or a CLSC? Or should we simply go to a walk-in multi-doctor clinic, an emergency room at the CLSC or the emergency room the hospital? With so many options, how come it is so hard to get to see a doctor?
Well, doctors are multi-taskers who split their time between many duties: hospital, emergency room and their office. While some maladies can wait for an appointment to see the doctor, some cannot. Patients need walk-in clinics for those ‘in-between’ situations when they are not quite sick enough to need an emergency room but are too sick to wait days for an appointment but. And, of course, anyone who does not have a family doctor clearly needs a walk-in clinic.
CLSCs were supposed to serve as walk-in clinics, but, over the years, the health ministry has not been using them to their full potential as multi-service providers, and they had to count on the presence of doctors as an important component. But when the CLSCs were introduced, there was a lot of resistance coming from many doctors who owned private clinics (still the case to this day) towards those public clinics. The reintroduction, no so long ago, of privately-owned multi-doctor clinics, such as Medicago and Lotus, was supposed to relieve some of the pressure on ERs by providing an outlet for those patients not really needing an emergency room and who had no family doctor. Now we have the novelty ‘’call the 811 number’’, a sort of triage by phone still directing many people toward the emergency room.
Hence the question regarding the extent to which the organization, re-organization, management of doctors’ time and tasks, added structures, subtracted structures and introduced novelties have actually helped to alleviate the pressures in the system?
Right now, I would say not so much. But what system could adapt to people still getting sick with highly contagious covid, influenza and RVS? What system could adapt to health care workers also getting sick and in short supply? What system can work with doctors being pulled between their public duties and their private practices with not enough hours in a week?
We have a system that, on a good day, can provide adequate service under normal conditions, but which gets overwhelmed when extraordinary things happen. What we need is a system designed around the assumption that extraordinary things are becoming increasingly ordinary and is capable of taking them in stride.
Meanwhile, sadly, reality is complicated and we are caught in the middle of a complicated storm.
Josey Bouchard is a teacher, municipal councillor, volunteer on the Board of Directors of the Pontiac Agriculture Society and spokesperson for Pontiac Voice, a health services advocacy group
in the Pontiac.
