"Treating patients callously is neither good social policy nor good economic policy," Jeffrey Turnbull says.
Yet, callousness is increasingly becoming a hallmark of treatment in our overburdened health care system.
Dr. Turnbull, chief of staff at the Ottawa Hospital, gives this example: An 80-year-old woman requires major surgery for an aneurysm (life-threatening swelling of a blood vessel); her two daughters fly in from Vancouver to be with her; the patient undergoes taxing preparation and is medicated for surgery; the surgical team is ready; but, at the last moment, the procedure is cancelled because there is no bed available after the surgery. "Sobbing, she told me she just couldn't go through that process again," he says.The physical, psychological and economic strain of illness and treatment, with our without surgery, is bad enough. We don't need to make torment an integral part of the journey of care.
The surgery-cancelled-at-the-last-minute scenario is repeated, with slight variations, about 450 times a year at the Ottawa Hospital. Consider that there are 900 hospitals nationwide - most of which rarely have an occupancy rate of less than 100 per cent - and you soon realize that tens of thousands of Canadians routinely suffer this sort of humiliation, and the delays cost hospitals (and taxpayers) untold millions.
Apart from cancelled surgery, a ripple effect of hospitals that are full - or, more precisely, overfull - is overcrowded emergency rooms, where patients languish on gurneys in hallways for days.
We aren't necessarily short of hospital beds. Rather, these backlogs occur because so many patients with chronic illnesses are in hospitals awaiting placement in a long-term care facility or because they have inadequate homecare.
At the Ottawa Hospital, there are about 160 of these so-called bed-blockers, but nationwide the number is in the thousands. In New Brunswick alone, there are 700 patients living in hospital beds awaiting placement in cheaper, more appropriate care. That is fully one-third of all hospital beds being misused.
Why do we tolerate such systemic inefficiency? Why do we tolerate such casual callousness?
"It not only costs us all in dollars and cents, it runs counter to our values as Canadians," says Dr. Turnbull, who is also president of the Canadian Medical Association.
His recent speech to the Empire Club of Canada in Toronto generated headlines because of a call for the federal government to invest in a health care action plan that would rival the Economic Action Plan, a massive infrastructure program.
With an election on the horizon, Dr. Turnbull's timing is good, but his deeper message may have been lost.
He did not make the mistake of calling for an infusion of cash into the health system alone. To his credit, Dr. Turnbull, co-founder of the Ottawa Inner City Health program, stresses that investing in education, poverty reduction and social housing are essential elements for population health. About one-fifth of all health spending is attributable to socioeconomic disparities, so we all pay for inequity.
The most important part of Dr. Turnbull's speech was not a call for a health care action plan, but a call for a reappraisal of our values and priorities.
As he noted, we spend an obscene amount of time and energy in Canada bickering over funding.
This year we will collectively spend about $192-billion on health care. Is that enough money? Too much? About 70 per cent of spending is paid out of the public purse. Do we have the private-public split right? Is the current federal-provincial split, about 25-75 per cent, fair?
All important questions but, as Dr. Turnbull says, we've missed an important step: "Before we talk about how we're going to pay for our health care system, we need to first decide what kind of health care system we want."
Medicare has a foundation of sound principles: Universality, accessibility, comprehensiveness, portability and public administration.
"Our health care system today makes a mockery of those principles, both in letter and in spirit," Dr. Turnbull says. "We're living under the delusion of what medicare ought to be rather than seeing it for what it really is."
Those are strong words, especially coming from Canada's top doctor. But they are words we need to hear, to ponder and to act on.
How universal is medicare if five million Canadians do not have ready access to a primary-care practitioner? How accessible is medicare if a scheduled surgery can be cancelled at a moment's notice? How comprehensive is medicare if you have to pay out-of-pocket for life-sustaining medication once you are discharged from hospital? How can portability be said to exist when Ontario hospitals systematically refuse to treat Quebec patients without upfront cash payments? How can the medicare system be said to be public-administered when it utterly lacks concerted, co-ordinated leadership?
Medicare, a public-funded insurance program, allows us to pool risk and make health care affordable to all, individually and collectively. But beyond that base economic function, Canadians have come to see medicare as a reflection of their core belief system: Notably, that a good health care system can help us live longer, more productive lives, and that quality care should be available to all, whether they are rich or poor, or whether they live in Whitehorse or Willowdale.
We talk a good game but those principles are no longer routinely reflected in the delivery of health care services at the coal face. Care should be accessible, affordable, compassionate and patient-centred, not inaccessible, inefficient, callous and politically driven.
To say the system is unsustainable is a cop-out. It is as sustainable as we will it to be. But to make it so, Canadians need to take back ownership of medicare, to demand a transformation that reflects their needs and their values.