What is the difference between feeling well and being well? As a student of hospital administration, more years ago than I care to admit, it was suggested that there is little difference. I recall that piece of information being delivered during a seminar on the topic of patients and our responsibility to them as managers-to-be in hospitals.
We were a small group of 13 students, taking this extra specialty course work while earning our MBAs at a well-known mid-western American business school. .
The Canadian Medical Association (CMA) website includes a primer on Canada’s universal health care system. Appropriately, it begins with the story of Tommy Douglas, Premier of Saskatchewan before becoming the first leader of the New Democratic Party of Canada. Thanks largely to Douglas, by 1971, “all the provinces had established their own comprehensive medical insurance plans.”
Unfortunately, my American classmates and the American professors teaching our courses, were not particularly impressed by this major accomplishment in healthcare services in Canada. To their American ears, the concept of socialized medicine sounded similar, even identical, to a communist ideology.
No amount of explanation could convince them that this was not a communist plot to deter capitalism, the backbone of America. Over the years, I encountered this rhetoric many times. Once, at a convention of the Ontario Hospital Association many years ago, the President of the American Medical Association railed at the assembled hospital and healthcare leaders from across Canada.
He ridiculed the scarcity of resources and the associated waiting times for services like lithotripsy and MRIs. He insisted that Americans had better healthcare. The speaker was wrong. Canadians spend about 55 per cent of what Americans spend on health care and have longer life expectancy and lower infant mortality rates.
When the speaker was asked how he could reconcile these inconsistencies, he insisted it was because illegal immigrants showed up at emergency rooms to have their babies. He blamed them for skewing the statistics on maternal heath and morbidity.
All these decades later, I remember the dismissive response. And all these years later, I recall a saying about statistics: “liars can figure and figures can lie.” Yes, there are significant problems with the healthcare delivery system in Canada. But the overarching difference between our system and the patchwork of healthcare options in the United States emphasizes one word: universal.
While many Americans have access to healthcare, all Canadians do. It may not be as quick or as convenient as we would like, but our finances do not affect our accessibility.
In healthcare, as in most other disciplines, words matter. With the rapid developments in research and technology, the lexicon for healthcare is expanding at a rapid pace.
As one example, the distinction between forms of healthcare issues has blurred. No longer do the classifications of treatment as either active or chronic apply. In the past, the distinction was based on expectations of returning to full health. But health was defined as absence of illness, which made the definition a circular one.
Still, entire hospitals and healthcare institutions and campuses were built to provide active treatment. This was further divided into primary, secondary, tertiary and quaternary care, based on the degree of specialization involved. But the goal of active treatment remained to return the patient to a state of health experienced before the acute episode.
Chronic care was at the other end of the spectrum. Here, the goal was not to cure, but to maintain a state of health that acknowledged deficiencies, while encouraging patients to return to a less than complete absence of illness. Chronic care often included long periods of rehabilitation services and/or recurring episodes of the initial healthcare issue.
These categories were developed to address physical health conditions. Mental health followed similar lines, although the fit was not always a good one.
More recently, active and chronic care no longer suffice. A good example is a diagnosis of breast cancer, a broad term encompassing the various forms of the disease. For many breast cancer patients, advances allowing more precise diagnoses and more individualized treatment plans have improved survival rates.
The Canadian Cancer Society (CCS) reports that overall, breast cancer survival rates have improved more than seven per cent between the periods 1992-1994 and 2015-2017. The CCS currently shows a five-year net survival rate for women ranging between 23 and 100 per cent, depending on the stage at diagnosis. Comparable rates for men are 23 to 95 per cent.
In addition, improved diagnostic and treatment options have also changed the nature of the disease to a chronic-like condition. This acknowledges that even if remission is not unexpected, it can be addressed repeatedly with ever-improving treatment modalities.
Is breast cancer a case of active or chronic illness? Even a few years ago, this was not even a question. The same is true for many other cancers and conditions formerly with an either/or classification of active or chronic.
What are some of the newer terms for healthcare diagnoses and treatment? AI suggests: Precision Medicine, Digital Biomarkers, Polygenic Risk Score, Liquid Biopsy, Companion and Radiomics as diagnosis-related terms.
It also suggests Targeted Therapy, CAR-T Cell Therapy, Gene Therapy, MRNA Therapy, Digital Therapeutics, Regenerative Medicine and Wearable Therapy, in addition to Telehealth/Telemedicine, as treatment-related terms. The lists are impressive, backed by research in cross- and interdisciplinary studies.
The challenge to the public in general, and to patients more specifically, is to define these advances to assure informed consent, while not suggesting improbable and/or unlikely cures. This goal is complicated by the dissemination of opinions, rather than facts, circulated via social media.
In an article addressing this issue entitled “Can you trust Dr. Google?”, the CDATH (Canadian Agency for Drugs and Technologies in Health, recently renamed Canada’s Drug Agency or CDA-AMC) describes “how to tell if it’s legit.”
It lists six tools to help evaluate the information provided. It also suggests a list of pre-screened health websites compiled by the Medical Library Association. Still, the article concludes with a caution worth repeating:
There will be some credible websites that don’t meet all the (six) criteria. Likewise, there will be unreliable websites that look very slick and seem to meet all of them. Ultimately, the only way to know if online health information is accurate is to find the source and read the scientific study being referenced…
It may not be easy, but it can help you understand the words that matter.
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