Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 





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Resignation of the OMA Executive-What Now?

So, the Executive of the Ontario Medical Association has resigned...sort of. The Executive is resigning to sit on the Board of Directors and then will go through an electoral process. At least that is what we are told currently.

This follows after a 55% non-confidence vote in the OMA Executive at a special meeting of the OMA Council but at which other motions failed to win the required two thirds majority to pass. These other motions if they had been successful would have led to the resignations at the individual executive level.

In the face of the quasi-win by the groups challenging the OMA's representative performance, there had been murmurings of requiring the OMA to hold another General Meeting of Council to address the non-confidence vote which had initially been arrogantly passed off by the OMA as a demonstration of support. Another General Meeting of Council would have been disastrous for the OMA. It managed to avoid that through this resignation process.

However, the OMA should know that this result was not the end of this non-confidence wrangling. It is just the beginning.

The Ontario Liberal government should also understand that the advocacy efforts of front-line physicians are not going away. These physicians are not dissidents as they have been labelled by some reporters. They are simply aware that the Liberal government's cuts to front line health care and patient care in Ontario will cause more and more hardship for patients as time goes on. It's not the 1990s anymore.

Fact is that we are up against the demographic wall made even more challenging due to a sluggish economy affected by the shift in aging--a double whammy. Instead of cuts to care, government ought to be planning how to allow more care for more people. Cuts do the exact opposite of what is needed. Even if the deficit is eliminated for 2018, growing health care need will not be eliminated. The pent-up demand for care will be even greater after 2018 due to the current Liberal cuts.

Physicians are becoming more vocal. Despite government-created positions for paid "Physician Leaders" to push through the government's self-serving and short-sighted version of transformation, many physicians see the negative impact of government's efforts to balance its budget on the backs of patient services.

Physicians I know and have known care deeply about their patients. They see that health care access is becoming more and more difficult. They want to continue to provide much needed services but they may differ on how those services can best be provided. We should be able to differ on the "How" and value different perspectives and approaches and still be united in providing quality patient care.

We must ask the "What if" questions.

What if the government is not forthcoming with more and more funding for care to adequately serve citizens who are dependent on it?

What if government providing  more funding leads to higher debt and greater interest payments resulting ultimately in fewer services?

Billions of dollars going to interest payments every month are one reason why Canada has fewer physicians and hospital beds per population than most developed countries and which results in lack of timely care, delayed diagnoses, and patient hardship--even death.

A couple years ago a fellow physician told me not to worry--all that was needed was a Liberal federal government and the money would flow. They were surprised to discover that the Trudeau Liberals are no health care saviours.

So what now?

I have no doubt that some of the former OMA Executive members will be re-elected to a new Executive. That will change nothing. Some new MDs may find themselves elected and in a position to create change from within the OMA but it is external factors beyond the OMA that have brought us to this point of upheaval. It is only by addressing external  structural health care system issues BEYOND the OMA that substantive, sustainable change can occur.

I'm hoping that a new OMA Executive will understand that their most important role is not to align with the government transformation flavour of the day. Instead, it is to give critical input on how more care for more patients can be realistically achieved while supporting our human providers who deliver that very necessary care.

We need to be asking the hard questions.

As always, thank you for your continued insights and thoughtful comments.


Reader Comments (788)

What if doctors actively worked hard over the next 14 months to ensure the Liberals aren't re-elected? The Doctor Party could influence the outcome of the next election. Think it can't be done? Just ask former Ontario Health Health Minister Tony Clement, who lost his seat because Dr. Hsu's widow and others made his constituents aware of his role in the MRC auditing Dr. Hsu to death.
May 4, 2017 | Unregistered CommenterStephen Skyvington
<<Hoskins will not be replacing Wynne.>> - MfO

That was a given from the outset. Health Ministers never get the top spot and he would be a disaster. Sousa probably now thinks he could muster a run, but so could Yasir Naqvi.

On the other had, Tony Clement lost his seat because he is Tony Clement.
May 4, 2017 | Unregistered CommenterMerrilee Fullerton
The 3% growth in hospitals isn't covering costs. The "efficiencies" continue. Squeezes are coming.
Liberals trot out a pittance of a dementia strategy 13 years after they first came to power.
No mention of long term care as part of the strategy. Big mistake.
May 4, 2017 | Unregistered CommenterMerrilee Fullerton
Dr. F:

You are correct - but Quebec always goes about doing this things differently, n'est-ce pas?

Technically, Dr. Couillard announced his resignation as Minister and Member of the National Assembly on June 25, 2008. So when he came back to run for the leadership, he was "clean" or as clean as you can be after being part of the Security Intelligence Review Committee. Which is where he met the one and only Dr. Arthur Porter and that, Dr. F. is a whole nother thing!

MfO...I had heard that most hospitals won't see 3%, but rather some will see 2% with some others receiving "special allocations". Not even coming close to what the OHA had lobbied for in the run up to the budget. Or what the OHA calls "a good start".

And back to you Dr. F, the dementia strategy is at least being (under) funded! Imagine if you were in the mental health and substance abuse space!?! These providers keep getting shafted no matter what political party is in the Pink Palace.

You could probably power a large community hospital for a year on the heat recovered from burning every copy of a mental health and substance abuse strategic plan dating back to the 1987 Graham Report!

And now reports that British Columbia public health officials have found naloxone-resistant fentanyl (acrylfentanyl), we may be in for a more challenging fight. Ontario still doesn't have a coherent pan-provincial strategy for naloxone-treatable fentanyl!

When are we ever going to learn? I still can't get over the upcoming retirement home pilot announcement!

The system will bumble along, margins growing, with dumps of money as each crisis demands it. More droplets of money to small vocal splinter groups,as their votes get aligned. Taxes,and fees,will rise. The rich WILL pay.
Bumbling along is considered a success in Health Care.

But it continues meeting the needs of most people most of the time. Fortunately those needs tend to be low acuity and low complexity. Throwing money at the newsworthy shortcomings seems to be the only strategy adopted by all the Ministers.
May 5, 2017 | Unregistered Commentereklimek
There is the story of the Little Durch boy , Hans Brinker, who walked to school along a dyke and who noticed a small leak in the dyke and , realizing the danger, put his finger in it to plug it.

Another person came by, saw what was going on and called for help who sealed up the leak.

The lesson is that if one acts quickly and in time even with limited resources one can prevent a trickle from becoming a stream from becoming a torrent from becoming a whole scale disaster.

The Ontario health care system , a government poorly designed, poorly built and poorly managed dyke , facing rising waters, is springing leaks.

There are Hans Brinkers, medical practitioners , virtuous health care bureacrats and volunteers, all over the province who are plugging the leaky dykes with their own fingers --- the government is essentially unaware of the extent of the leaks and it denies the fragility of the dykes, it dumps $$$'s at random along the dyke at ideologically important (to them) sites, leaks or not---it is only a matter of time before the leaks turn into streams into torrents and the whole structure swept aside.

The government , will , of course, blame the Hans Brinkers.
May 5, 2017 | Unregistered CommenterAndris
"I still can't get over the upcoming retirement home pilot announcement!"-ELB
Perhsps denial, perhaps wilfully disregarding what is coming.. left for the next government to deal with..
May 5, 2017 | Unregistered CommenterMerrilee Fullerton
Central has been advised to get them out of the hospitals but they can't get home. Voila! Put them in retirement homes,in that many have no family,and minimal complaints will come in.

Remember the problem is the doctors will not be redistributed as we wish, and the patients will not die promptly, as needed.
Maldistribution of employee skills has been resolved in many industries, but not in Health Care. You dont need a deep conversation or study to know why a recent graduate is not going to an underserviced region. Seems if I recall correctly our Minister did not stay in medical practice long. Maybe some one might ask why. Did anyone expect a Rhode scholar to stay and man either a mobile refugee relief facility or a wlakin clinic in the basement at King and Yonge?

That ill people do not die promptly is a testament to our health care . We really can keep some one alive, and now suddenly that's a problem? You really want to reduce end of life costs without MAID? You know what to do. The chronic overutilizers are the drain on resources.

Absolutely no politician could possibly be reelected taking action on this file. Thats why it is the "third rail".
May 5, 2017 | Unregistered Commentereklimek
The reason patients are ALC is not because they can go to a retirement home. They are often ALC because of incontinence or dementia or frailty.
Retirement home isn't suitable.
May 5, 2017 | Unregistered CommenterMerrilee Fullerton
What is the third rail you mention?
Surely, you don't mean it is how we will care for our aging population.
May 5, 2017 | Unregistered CommenterMerrilee Fullerton
Dr. F's commetns are spot-on. The majority of residents in retirement homes are not ill, incontinent or suffer from serious frailty or dementia. They pay a significant amount of money on a monthly basis to live in a spotless, quiet and comfortable environment and have decided to do away with the daily grind of meal preparation.

Retirement homes are mainly staffed by custodian couples who also live in residence. They coordinate activities, day trips/outings, schedule food serving and cleaning staff and keep things running smoothly and quietly so their "guests" are kept blissfully sheltered.

But let's be clear about one thing: there is not a lot of registered or unregistered professional care staff on-site.

I suspect it might be possible that some of the "guests" (who are paying the full shot) may take exception to sharing their space with voucher-supported sick people as they selected to live in a retirement home, not a long-term care facility.

If there is any push back from a majority of "guests", management may decide to walk away from the pilot voucher program so as not to jeopardize the majority.

I don't debate your point. Most people with chronic care needs end up in hospital EDs, looking for end of life support services, for issues that can not be dealt with, for the most part by home care.

No one will address it.
Driving the loop:

1. We have a declining dependency ratio (fewer people in the public tax base, supporting more).
2. We have a shortage,and maldistribution, of health care providers.
3. GDP, is, at best,flat.
4.More people are being defined with chronic disease, and expecting their "free care".

I'm missing the long term planning for a "universal" solution!

It would seem we need to declare a "lifetime"limit on the use of public resources?
"Most people with chronic care needs end up in hospital EDs, looking for end of life support services"-mfO
In my experience this is not an accurate depiction of what brings people with chronic conditions to hospital.
In my experience they are ER bound because of acute on chronic conditions. Their COPD, heart failure, or cancer, or mental state is affected by an acute event that they can't sort out on their own or with family.
Their physical frailty accompanied by a fall or incident requires a hospital visit due to level of pain or degree of suffering or due to deleriium related to the event or medication.
Sometimes families just can't cope anymore.
It will take only a tiny percentage of the growing 85 year old group to make hospital gridlock even worse.

No, the answer is not retirement homes in the case of the very frail or for those who have advanced dementia. They need more support.
May 6, 2017 | Unregistered CommenterMerrilee Fullerton
"End of life support" is not the right term to be using for patients seeking care even if they are elderly and frail. "End of life" care in many cases may only be perceived in hindsight.
Treating patients for heart failure or for pneumonia or contusions and fractures does not constitute end of life support.

Expect more patients screaming in hospitals as ALC patient needs are unmet.
May 6, 2017 | Unregistered CommenterMerrilee Fullerton
The third rail is the electrified rail for powering the railroad.

Every and any added demand could be called a " tipping point".

Demands are approaching lmitless as fewer and fewer are contributing. Those older folks come to the office and are as disappointed as the 45 year old with failing health.

Please recall the biology of survival means successful propagation not long life.

Now it is routine for degenerative disc disease to be both unxpected and shocking in a 50 year old. It must be as a result of my ... work ... accident. .... or some external if not compensable issue. Not really, is my routine resonse.

Ontologically when you are no longer contributing to gene survival the organism is not adaptive. It Is no selective advantage to see great grand children. In practice if you are old enough to have a grandchild good for you. It is unlikely you as an individual were selected or meant to thrive beyond this point. But we will keep you alive.
May 6, 2017 | Unregistered Commentereklimek

Some day the political structure must recognize "biology", not "sociological desire".

We are not biologically equal. Has to do with "gene pool", not race,ethnicity,gender, etc.The sociologists don't get it.
On the topic of aging, I could not resist this article..

KATHMANDU, NEPAL—An 85-year-old Nepali died Saturday while attempting to scale Mount Everest to regain his title as the oldest person to climb the world’s highest peak, officials said.

Min Bahadur Sherchan died at the base camp on Saturday evening but the cause of death was not immediately clear, said Dinesh Bhattarai, chief of Nepal’s Tourism Department.

Mountaineering official Gyanendra Shrestha, who is at the base camp, said the cause was likely cardiac arrest but he could not give details because of a poor telephone connection.

The grandfather of 17 and great-grandfather of six first scaled Everest in May 2008, when he was 76 — at the time the oldest climber to reach the top.

His record was broken by then 80-year-old Japanese Yuichiro Miura in 2013.
May 6, 2017 | Unregistered Commentereklimek
I'm not sure what you mean by "but we will keep you alive".
Futile care is often only appreciated in the rear view mirror.
We cannot know in many instances if the treatment provided will "keep you alive" for certain or not...there are too many individual variables--and many we cannot even identify.
It is perhaps more clear to say that withdrawal of treatments will cause death but even then there is no certainty especially when it comes to the overmedication of the elderly.

We can only do the best we can on a daily basis to make assessments of what would benefit the patient...and even then, the benefits would have to be appreciated by the patient to be truly "beneficial" and "appreciated".
We chase our tails.
May 6, 2017 | Unregistered CommenterMerrilee Fullerton

Not sure where you are going with your concern. Having had the discussion of irreversible brain injury in ICU, I think my observations may be misinterpreted as cold. Please recall I was called for an outside opinion during conflict over care.

We do have the skill and resources to "keep you alive" is where this arises. If we did not, there would be no conflict.

“This decision ensures that the autonomy, independence and dignity of older adults are less likely to be compromised in end-of-life decision-making relating to withdrawal of life support,”
May 6, 2017 | Unregistered Commentereklimek
I'm concerned about how we interpret "end of life".
It can be confusing.
When is "end of life" for an individual?
If the line is moved away from final hours of life or when death is imminent how is "end of life" defined.
It's not a matter of any posters here seeming cold or warm, I'm just pointing out that we are in a murky area with lots of drop offs to be wary of.
May 7, 2017 | Unregistered CommenterMerrilee Fullerton
Understandable. The evidence suggests the last few months are resource intensive. We can prolong life but not restore health.

Does an aggressive-treatment, event-determined and hospital-centred model give appropriate care to the terminally ill and older people who have complex chronic comorbidities?
May 7, 2017 | Unregistered Commentereklimek
Dr Shawn Whatley is the new prez of the OMA

Dr. Nadia Alam is the prez elect
May 7, 2017 | Unregistered CommenterStephen Skyvington
Good lord!

Dr. Whatley I don't know whether to congratulate him or to commiserate him.
May 7, 2017 | Unregistered CommenterAndris
Now we're rocking. Out with the co-managers and sycophants and in with the new guard who will put the membership's priorities over those of corporate OMA.

This is a very good day for Ontario medicine.

OMA Council Elects Dr. Shawn Whatley President, Dr. Nadia Alam President-Elect

Dear Colleagues:

Today, the Ontario Medical Association’s governing Council elected Mount Albert family physician Dr. Shawn Whatley as OMA President, and Georgetown family physician and anesthetist Dr. Nadia Alam as OMA President-Elect.

With today’s Council elections, a renewed and revitalized OMA reinforced its commitment to our members - Ontario’s doctors are moving forward together, building strength and unity.

In addressing Council, Dr. Whatley set out his three-point plan to build a better OMA:
1. Rebuild member trust,
2. Rebuild unity and partnership within the membership, and,
3. Demand excellence from our Association.
“Working together, we need to focus on these priorities, and make our Association stronger for our members and our patients,” said Dr. Whatley.

“OMA members are more engaged than ever, and it is vital that the Association change, adapt, and thrive,” said Dr. Alam. “We need to focus on strategy, fairness, collaboration, and integrity. And we need to build on the progress that we have made together in the past year.” she said.
One sympathizes with the devotion of Dr. Whatley. A skilled sensitive MD. Central will eat him alive because he is trying to be reasonable. He MUST understand, at all times, central HATES, absolutely hates, the power and privilege MDs have, and has a sole mission to dismiss it, AT ALL COST. Each day begins with a chant - justice for all, destroy the doctors "privilege".

Within central, "social justice", has replaced rationality. This is solely about power. Central will win. The backroom deals have been made.
Mfo I agree completely with your assessment. Ideology has trumped common sense.

I'd like to post your warning on his blog verbatim but don't know Realist's thoughts on cross-posting.
A warning for Shawn , an old Japanese saying " After victory , tighten your helmet chord".

Letting down one's guard after victory , the slight bit of complacency makes one vulnerable to a sudden counter attack.

One can expect the ministry to be eager to invite him , ASAP, to a supposedly 'get to know you' meeting with " Barzini", they will send someone that Shawn absolutely trusts, guaranteeing his safety and that of the OMA and the membership.

A la Don Corleone " whoever approaches you to set up a meeting with the ministry , watch out, he's the traitor".
May 7, 2017 | Unregistered CommenterAndris
What Dr. Shawn Whatley has in his corner is a pit-bull named Dr. Nadia Alam.
May 7, 2017 | Unregistered Commenterg.fraser

One has no doubt that both DR. Whaley and Dr. Alam are noble people,struggling against the mess. I truly, wish them well.

Regretfully, one must advise them of the struggle. From the Prime Minister, through the Premier, through the various Ministries, the MDs are the "enemies" against social reform. The sociologists "believe" we are all equal, and thus, any issues are driven by systemic sociological bias. The biologists go, biology drives the issues, address, fairly inequity, but, in the end, some are biologically unable to deal with the current society. The new leaders need to quickly pick their camp. MDs treat disease as best they can, and will assure those resources become available, and try to even out inequities, or MDs own all the issues of society and are greedy. One wishes them well. Make a stand.
We need to have the Fureai kippu exchange, as in Japan. We don't always need a Dalton McGuinty "made in Ontario" solution to every problem, because the solutions are out there already.
May 7, 2017 | Unregistered CommenterSteve

Your warnings were passed on to Dr. Whatley and he offered a big thanks.

Another recent blog post. Let's get ready to rumble.
Over the years the OMA has regurgitated from within itself KoolAid marinated Presidents that have not inspired the loyalty of the membership.

Had they called the membership to arms, as I've mentioned before , the membership would not have risen from the trenches.

Dr. Whatley is cut from a different cloth , he exhibits the most important features of leadership possessing both courage and judgement.

Added to that he has a certain self effacing amiability about him that appeals to those in the trenches.

Added to that, conversing with him and reading his offerings , he is a thinker--- as Edison put it " 5% of the people think; 10% of the people think that they think; and the other 85% would rather die than think".

Dr. Whatley comes out of the ranks of the 5%.
May 9, 2017 | Unregistered CommenterAndris

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