Saturday, December 11, 2010

Triage, Part Two: Diagnosis

Nation, as outlined in my previous post "Triage", I'm trying to have an adult conversation with you all, as Albertans, about the root causes of the strains on our health system, which is either the worst in the country or the best, depending on the metric you use and (generally) the political party you support or oppose the most.

The comments in response to that original post have been extraordinary, and I want to thank you.  (See, Twitter? It IS possible for partisans to talk with each other like grown-ups!)

If we want to FIX the system, if we want to make it better, or to perfect it, we need to first identify what is truly wrong with it rather than dwelling on the sensationalist coverage of the symptoms - we know there are beds in hallways. We need to know WHY, and "Ed Stelmach is a bad man" is probably not the reason (nor, in my experience, even close to true. But that's just my opinion, and you don't have to share it.). We need to diagnose the malady before we come up with solutions. And I think we've gone a long way already towards doing that.

The original post stimulated some good debate in the comments section, and some great and well-thought-out and reasoned responses, even if I disagreed with some of them. Ultimately, though, this isn't about what *I* agree with, but rather what WE can come up with, as Albertans, to fix the system that we, our kids and our parents have to use. 

The discussion is timely, and it hasn't escaped my notice that the health care debate has shifted in some circles, due in large part to economic concerns, to a debate about "should we privatize ALL delivery, or just SOME delivery?".  While I'm open to having that conversation, I've got to respectfully submit that there is, in fact, a third option there: To privatize NO delivery (also known as, the status quo). I don't know if it's the correct answer, or the one most Albertans will support, but pretending this kind of delivery isn't an option because of the system's current condition is akin to Stephen Colbert's ironic "George W. Bush: Great president, or the GREATEST president?" interview question asked of presidential historians. 

Given the list of issues below: If ALL of them were addressed, and the system STILL didn't work with a full public delivery of services, THEN I'd say we were likely alright to discount it totally as an option. Once you've had the electrician over, checked the fuses and breakers and wiring, maybe it IS the light bulb that's the problem.  But given everything that's wrong with the system right now, we can't say that the appropriate response to a city-wide black-out is to change your house's lightbulbs to fluorescents.  Delivery is part of the debate. But it's not the whole debate.

According to you, these are some of the root causes of our systemic health-care issues: 
  1. Not enough experienced & trained medical professionals, incl. family doctors
  2. Misuse/overuse of the system for non-essential services
  3. Lack of care for the poor
  4. Limited access to non-trauma Urgent Care Centres
  5. Organizational instability/Governance issues
  6. Acute care beds being taken up by people well enough to leave but who have nowhere else to go (lack of long-term beds)
  7. Lack of personal responsibility for maintaining health/education regarding healthy & preventative living
  8. Over-medicalization of seniors
  9. Lack of home care support for seniors/disabled
  10. Lack of a team approach
  11. Front line staff bogged down by distant/out-of-touch/large bureaucracy
  12. Rising costs created by increased use of technology
  13. Lack of public education about which health care provider is appropriate in a given situation
What I'd like to do, in the comments section of this post, is to start to talk about solutions. If it gets to be too hard to keep the conversations straight, I may do individual posts for each problem - however, none of these problems exists in a vacuum (problems 2, 7, and 13 are related, for example).

In your comments, kindly identify by number the problem for which you're proposing a solution (e.g. "Re: Issue #1. Recruit doctors and nurses from across Canada by making ours the best paid in the country.") 

Don't be afraid to change the rules.  Big problems require big solutions.  I've got some of my own, such as increasing the role (and, subsequently, the education required & pay received) of Nurse Practitioners, to help deal with Issue #1.  I'll get into that in the "Comments" section, though.

This isn't going to be easy, but nothing worth doing ever is.

My favourite comment on the original post has to be this one, from Roberta:

"The whole system needs a relook from the bottom up – but it has nothing to do with who pays. We need to completely examine what we’re doing and why."

Alright, Nation.
Let's fix it.