Doctors performing surgery.
Doctors performing surgery. Credit: National Cancer Institute / Unsplash Credit: National Cancer Institute / Unsplash

There is something especially debilitating about being sick away from home. We all resort to wanting someone to bring us meds and hot water with lemon and honey, and more blankets. We want to be coddled. And comfortable.

But the bed is unfamiliar and the view from the window is of pouring rain.

Can anything make us feel better? Perhaps the thought of the healthcare system we could take advantage of back in Canada.

Perhaps not.

With a diagnosis of a bad head cold, laryngitis and COVID, the Portuguese healthcare system responded promptly. I could book an immediate virtual appointment with an English-speaking and European-trained family doctor. She then sent me two prescriptions. The cost for this service: 49 Euros (about $70 Canadian).

Off to the local pharmacist; there are many in the small town where I am staying. A pharmacy is just that. A place to purchase pharmaceuticals. No cosmetics or grooming items. Just drugs. It reminds me of the local pharmacy we used when I was growing up in Montreal.

Total for the drugs: 8 Euros (about $12.50 Canadian). With travel health insurance, I don’t worry about the cost.

I fall asleep knowing that while I toss and turn, Canada’s Prime Minister and Premiers will meet to iron out funding for healthcare. I have a collection of 15 articles on the topic, suggesting amounts between $47 billion and $100 billion over 10 years. I am hoping to use them for background on this column.

READ MORE: Could new federal health money usher in needed reforms?

Twelve hours later, I read the news and I focus on a comment by The Globe and Mail columnist Andre Picard: “[The] meeting of the countries’ top leaders was little more than a gathering of pencil-pushing accountants, each trying to burnish their bottom line rather than actually improve health care.”

There is little left to say. For months, politicians, think tanks, professional groups and those who specialize in healthcare policy and strategy have been speaking out about the desperate situation we find ourselves in.

With the exception of politicians, everyone agrees that more money is not the answer.

Everyone agrees that we can no longer fix what’s broken with the current system. Unless, of course, we no longer want roads or airports or schools or other public services funded through taxation. We could use the entire provincial and federal budgets on healthcare and still not have enough money.

Or, we could have a strategic plan that transforms the goals of the Canada Health Act. A plan that has time and outcome measurements built in to ensure the money is well-spent. A plan that investigates why we need so much healthcare in the first place. Perhaps because we spend almost nothing on preventive healthcare. Perhaps because Canada actually has a sickness plan, rather than a healthcare plan.

In all the back-and-forth about funding, I saw almost nothing that involved patients. Talking heads, yes. The public? Not so much. Politicians might do well to remember who elects them.

In all the back-and-forth about funding, where was an accounting of the inordinate number of administrative and management personnel who “work” the system? If any jurisdiction is willing to publicize the funds not directed to clinical purposes, I have not found it. My requests for such data were largely ignored.

We are no further ahead than we were before the hype-fueled healthcare meeting held on February 7. As a reminder,

  • Despite promises from several provinces to increase the size of medical school classes, very little has happened. It takes some 10 years to train a family practitioner. During this time, a high proportion of “boomer” doctors plan to retire. By the time the potential students graduate, increases in population and a growth in the ageing population will have created an even greater deficit of family doctors.
  • And what about geriatricians? They are the specialists who help us stay healthy as we age. They are the ones we should also be investing in, to help reduce the stress of the “family” in family practice. Currently, the National Seniors Strategy shows just over 300 geriatricians in practice. This amounts to one for every 5,600 seniors.
  • Similarly, the Canadian Paediatric Society counts some 3,600 paediatricians in Canada. As with geriatricians, many are sub specialists and consulting physicians. And both groups work best in multi-disciplinary settings.
  • The appeals of these specialists to increase numbers have thus far fallen on deaf ears.
  • Despite other promises to speed up the certification of foreign-trained physicians, this is not happening. It is too long and too expensive a process, particularly for physicians from war-torn countries who cannot easily produce all the documents required and who cannot afford not to work in Canada in order to essentially go back to medical school.
  • We need to revamp not just the payment model for physicians, but also the expectations of the physicians themselves. Remember your last visit with a doctor. Most of the time, the physician sits at a computer terminal, typing away while you wonder what they are typing. Perhaps their complaints that they didn’t go to medical school to spend time inputting data. There must be a better way.
  • We need to reconsider whether using family practitioners as gatekeepers is still a good idea. In most jurisdictions, this is the only way to get a referral to a specialist. Can we start treating patients as intelligent, thinking individuals who can figure out that being pregnant merits dealing with an obstetrician? Or that needing cataract surgery requires an ophthalmologic surgeon?

These are just some of the issues for family physicians. Similar lists could be written for:

  • Nurses and other healthcare professionals, including nurse practitioners and doctors’ assistants, medical laboratory and other technicians and technologists.
  • And have we forgotten dentistry and optometry?
  • What about healthcare aids and personal care workers?
  • Social workers and the host of mental healthcare workers?

Canada has one of the lowest rates of hospital beds per thousand population.

  • Is this such a bad thing?
  • Can we direct funds to keeping people out of hospital, instead of filling ever more beds?
  • With improved technology and non-invasive surgical inventions, do we need to keep people in beds overnight?
  • What about AI and its implications for patient care?

Canada also has one of the highest rates of institutionalizations of the elderly.

  • Why do we do this to our seniors?
  • Can home care and aging-in-place reduce the need to institutionalize? (Hint: the answer is ‘yes.’)

And what about records-sharing?

  • We need to fix the records-sharing problem once and for all. It is bad enough that healthcare providers in the same city cannot access complete records from all providers. It is even worse that patients are routinely denied access to their own medical information.
  • We live in a data-driven and data-reliant world. Surely we can stop relying on hand-written files and fax machines to transfer information. It’s time to stop using “confidentiality” as an excuse.

OK, we can’t do everything at once. But choosing even one of these issues to start the process of healthcare transformation would be better than the prospect of negotiating 13 bespoke agreements with the provinces and territories. That is sure to add more administrative costs to the system, pulling even more funds from clinical priorities.

I rely on America author Dave Barry to conclude: “If you had to identify, in one word, the reason why the human race has not achieved, and never will achieve, its full potential, that word would be ‘meetings’”.

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Evelyn Lazare

Evelyn H Lazare is a healthcare planner, strategist and executive. Lazare has led nation-wide healthcare organizations in Canada and has consulted to an array of healthcare and related clients in both...