Adel Doss has seen the inside of a hospital too many times to count.
The 54-year-old Toronto resident, who has Type 1 diabetes and multiple sclerosis, fell in his home last fall, leaving him with two broken arms and so frail he had to be hospitalized.
Mr. Doss spent a month recuperating at Toronto’s Sunnybrook Health Sciences Centre. Because he also had a bacterial infection, he was given a private room. It costs more than $1,000 a day, on average, for a bed in an acute-care hospital in Canada.
But that was just his most recent hospital stay. In the past few years, Mr. Doss has broken a hip, suffered a stroke and battled countless infections. Although support workers help him at home a few hours each week, it’s not enough. He keeps deteriorating.
“We’ve been here too many times,” says his sister, Minerva Doss, who lives with her brother and takes time from work to be at his hospital bedside. “He comes in here all the time.”
That’s the problem. In Canada, the health-care system is designed for urgent medical situations, like heart attacks and accident trauma.
But patients like Mr. Doss who have chronic problems get caught up in a vicious cycle of deteriorating at home until they require hospitalization, then get discharged only to repeat the process every few weeks or months. It’s expensive, inefficient and, in many ways, detrimental to our health.
Now, a growing contingent of innovative physicians and health experts believe they have the answer: Get rid of hospitals.
“The trouble is health care has changed and our patients have changed and we haven’t,” says Dr. Jeffrey Turnbull, chief of staff at the Ottawa Hospital and former president of the Canadian Medical Association who is winning accolades for his attempts to reform the system.
“Do I think it’s dramatic to say ‘Do I think this will be the end of the hospital?’ No.”
Instead of having imposing, difficult-to-navigate monoliths that handle people after they have already fallen into a medical crisis, a new breed of MD like Dr. Turnbull is calling for a network of community health-care centres would host regular medical clinics as well as provide access to physiotherapists, social workers, dietitians, housing-support staff and other health professionals. Health teams would make house calls where necessary.
There would still be a need for acute-care buildings that treat children who fall off of a jungle gym or middle-aged men who have a heart attack while shovelling snow, and to perform surgeries. But in an ideal future, those buildings would be smaller, more focused operations within the context of a larger system that integrates community-based care.
Dr. Rick Glazier, a family physician and scientist at the Institute for Clinical Evaluative Sciences in Toronto, also argue that simply funnelling more money into home and community care without dismantling the current hospital system is misguided: It just adds costs to the current inefficiencies. Home care typically operates in isolation from hospitals, meaning doctors can’t track patients’ progress, and the ability to adjust medications, order tests and communicate between health-care providers is lost. What is needed, says Dr. Glazier, is a truly integrated system.
“Just spending more on home care as it’s currently constituted might not accomplish all that much, but linking it with primary care, all the services... could be a really big step forward.”
Thinking outside the box
When Ottawa police officers spot a severely intoxicated homeless person, they often call on paramedics to take the individual to the hospital. Once there, however, the person has to wait for hours to be seen because there are so many others in front of him or her. The paramedics and ambulance aren’t allowed to leave until the patient is officially in the hospital’s care.
Usually, the individual sobers up in a few hours and simply walks away.
“It’s very inefficient care, ineffective care and very expensive,” Dr. Turnbull says.