Experiencing a medical emergency is an incredibly stressful experience for patients and their families. This stress should not be compounded by worries about getting an ambulance bill they can't afford. As physicians, we know the importance of the first few minutes of an emergency situation, and the crucial role of Emergency Medical Services (EMS) in saving lives. And yet ambulance fees remain a significant barrier to people receiving necessary care across Canada.
A federal election could be called any time in the next few months, judging by the media coverage and the ramping up of political activity. Many issues have been crowding into the media headlines in anticipation of the election -- but with a notable absence of any consideration of healthcare by our political parties. Apparently the subject is still on the minds of the electorate though, at least amongst my own circle of friends, colleagues and neighbours, many of whom note the leading edge of our baby-boomers have now turned 65.
In a public healthcare system, too often system failures end up as fodder for Question Period battles rather than impetus for learning. When investments have been made in new models of health service funding and delivery that don't work out, it can be difficult to proclaim failure as a means to move toward success.
The need for people also to make advance directives (often called living wills) and to discuss them with family is greater than ever as medical technology advances, but there is a serious legal problem. You may have an advance directive signed in perfect health clearly stating your wishes, but if and when you become incompetent, current law in some provinces permits your next of kin or power of attorney to ignore it. Surely new legislation must recognize and prevent this potential abuse that most people would find offensive and unacceptable.
The continuum of patient-centred care could include a consistency of health care professionals familiar with a patient's case and who are buttressed by the flow of relevant patient history and investigations. Patient centredness by the professional care-giver would target care, communication and common ground or a shared understanding between those receiving the care and those providing it.
The dismal record of for-profit hospitals illustrates the problem with running hospitals as businesses. The for-profits have higher death rates and employ fewer clinical personnel like nurses than their non-profit counterparts. But care at for-profits actually costs more, and they spend much more on the bureaucracy, a reflection of the high cost of implementing shrewd financial strategies. Canadian hospital administrators don't have to play financial games to assure their survival.
QUESTION: I had a major operation at an Ontario hospital. At an appointment before the operation, the doctor told me about what to expect from the surgery and the possible risks. Then he asked me to sign a consent form. I didn't really understand everything he said, but felt pressured into signing the form
Mental illness is one of the biggest predictors of inequitable access to care in this country. We know that having a mental illness means that you are far less likely to get the healthcare you need than someone without a mental illness and that mental illness is a bigger predictor of poor access to care than low income.
As January comes to an end, those who vowed to eat better in 2015 have probably already given up. Not very surprising, considering that most people grossly underestimate the amount of calories they consume, and underestimate their fat, salt and sugar consumption, even after consulting nutrition labels.
Although advertising of prescription medicines to the public is generally banned in Canada on public health grounds, shifts in administrative policy have allowed two types of ads since late 2000: "reminder" ads that mention a brand name, but make no health claims; and "help-seeking" ads that mention a condition, but do not state a brand or company name. We have identified six main weaknesses in how Health Canada regulates this advertising.
While policy should be evidence-informed rather than belief-based, the complexity of health-system change makes it difficult to draw a straight line from one evidence-based improvement to health-system change as a whole. Improving the quality and quantity of evidence-based decision-making is perhaps the greatest challenge in systematically devising policies for bending the cost curve.
The Liberal government of New Brunswick appears to be stepping back from the brink of mandatory prescription drug insurance. And so they should. The drug plan chosen by the Conservatives was designed on a false premise: that the private sector can better manage things than government can. In many sectors, that might be true. But not in health care.
Most Canadians probably don't realize that health care in Canada is quietly undergoing a major transformation in funding that could significantly impact patients. Three provinces -- Quebec, Ontario and British Columbia -- are implementing a new funding model for hospitals and other provinces are watching with interest.
At present, this time-consuming service is an uninsured one and its accompanying opportunity cost -- taking physicians away from attending to other patients on a fee-for-service basis -- is borne solely by the physician. Because the College considers the medical document to access medical marijuana equivalent to a prescription and, since prescriptions and activities related to prescriptions are insured services, physicians cannot charge patients; fair enough. But what about the for-profit corporations who are benefitting at the physicians' expense?
Last fall when I visited Canada, I met a Toronto doctor named Gary Bloch who has developed a poverty tool for medical practitioners. Bloch's idea was to zoom in on the social determinants of health -- food, housing, transportation -- all poverty markers linked to bad health and poor health outcomes.
Scientific evidence does not support the presumption of Bill 10 that there will be a reduction in bureaucracy with the centralization of decision-making. National and international experience has shown time and time again that the proposed reform will not have the desired effects and, in fact, will make healthcare delivery more complex.
In the wake of new health expenditure data from the Canadian Institute for Health Information (CIHI), the evidence continues to mount that Canadian public health expenditure growth is moderating. Moreover, adjusting for inflation and population growth, per capita provincial and territorial government health expenditures have actually declined since their peak in 2010.
If the law is changed, physicians must be given a choice as to whether or not they will practice assisted suicide. In all likelihood there will be a limited number of physicians who actually offer the service, and, just as doctors who prescribe methadone are specifically registered to do so through their governing bodies, likely similar regulations will be imposed on physicians who do elect to practice assisted suicide. For that reason, in the event physician-assisted-suicide becomes legal, there needs to be a corresponding immunity protecting doctors who have acted in good faith and that prevents family members from suing them.
Dr. Mel Borins wants to you to be healthy and he wants you equipped with more than just your family doctor's orders. A family physician and associate professor of medicine at the University of Toronto, Borins is a leading expert in health and wellness who has advocated evidence-based, alternative medicine for decades.
This past week, the Supreme Court of Canada has been hearing an appeal by the BC Civil Liberties Association that could grant terminally ill Canadians the right to assisted suicide. The Court faces a daunting task. Palliative care cannot eliminate every facet of end-of life suffering. Preserving dignity for patients at the end of life requires a steadfast commitment to non-abandonment, meticulous management of suffering and a tone of care marked by kindness. In response to this dignity conserving approach, the former head of the Hemlock Society conceded that "if most individuals with a terminal illness were treated this way, the incentive to end their lives would be greatly reduced."
In recent years, provincial governments and medical associations have introduced various measures to speed up the time it takes for patients to see their primary health care providers. But relatively prompt access is still not available to a majority of Canadians. When patients can't see their family physicians, they often head to the nearest hospital -- and that contributes to longer emergency department wait times. So the issue of access has wide ramifications for the health care system.