Caring should be ‘bedrock’ of health system - Dr. Peter Zalan

Curing and caring: how can I best illustrate the difference? I think with examples. Let me start with “curing.”

I received the following memo recently:

“Health Sciences North is commencing a Trans Aortic Valve Initiative (TAVI). This program will address the needs of patients that are considered too high risk for aortic valve replacement. We invite all physicians to make referrals to our centralized co-ordinator.”

The traditional treatment for critical narrowing of the aortic valve is open-heart surgery. TAVI means inserting a catheter containing the new valve through the skin in the groin, guiding it up an artery and into the heart.

The initial cost of the procedure is $38,000 in the U.S. The new technology cures a condition that causes heart failure, fainting spells, angina, and ultimately death. TAVI is an example of curing.

How about “caring?”

As simple an act as washing a patient’s hair in hospital is an example of caring. So is ensuring that the same patient gets the necessary help to eat her meal. Caring may include help with shopping, transportation and meal preparation for fragile elderly in the community.

Ontario’s new budget states that future increases in health care spending will be limited to 2.5 per cent. This will be a big drop from many years of six per cent increases. What will be the outcome if the province is already facing funding difficulties?

Look at Sudbury. Our emergency department has long wait times and suffers from chronic overcrowding. There are waiting lists for home care and home physiotherapy.

Many patients are without a family physician. There are long wait times for many elective surgeries. Over 70 ALC patients occupy beds at Health Sciences North that are meant for acute care.

The government’s hope is that its planned investments in an integrated, high-quality primary care system will decrease hospital admissions, and together with cost saving efficiencies, will yield the necessary savings.

This is unfortunately wishful thinking. A recent Canadian medical study concluded:

“Even if a national, integrated primary care system were established, it would not necessarily end cost escalation. It is imperative that issues such as increased technological and pharmaceutical interventions and increased service provision, also be tackled.”

The public’s use of medical services in Ontario has been increasing at a rate of 3.5 per cent per year. In addition, new technologies like TAVI are introduced on a regular basis.

If we were to admit that Ontario is unable to afford every need, then how should we proceed?

For me, caring is the bedrock, the initial step in building a high-quality health care system.

It means decent economic and home support for our poor and fragile elderly, decent home and institutional care for the chronically ill, the disabled, the cognitively impaired, and the mentally ill.

It means timely access to primary care, and to rehabilitation; and at the end of life it means access to palliative care in a supportive setting.

This approach, if adopted, would be the exact opposite of what we currently do in Canada. We fund high tech medicine and then everything else with whatever is left over.

There never seems to be enough left over to get the caring right; never enough to ensure that our elderly will live in dignity or that our emergency departments can function efficiently.

Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.

Posted by Vivian Scinto