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Patient Demand For Health Care Is Eric Hoskins' Biggest Problem

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ERIC HOSKINS
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Ontario Health Minister Eric Hoskins has many big problems on his hands. He's locked in a protracted dispute with Ontario's doctors. He's got angry nurses to deal with. His own health-care bureaucrats have given him dismal approval ratings. He's got to support a premier who's ridiculously unpopular. And probably a whole host more.

However, the biggest problem of all is one that he refuses to talk about: that is the fact that demand for health care continues to grow, with no end in sight.

He's tried to avoid talking about this issue by attacking those who provide those services instead. It's an old political tactic -- attack the person, not the issue. It even works at times. But after a while, people catch on and realize that the issues that are dear to them are not improving.

Let's look at a couple of recent attacks that Hoskins made and see some potential outcomes.

He made headlines a while back suggesting some specialists were "overbilling" the OHIP system. He pointed to a radiologist who reads 300 diagnostic scans a day as an example. Even Globe and Mail health reporter Andre Picard tweeted out wondering if this was good care.

It's an old political tactic -- attack the person, not the issue.

There's only one problem with this. Hoskins very well knows that radiologists DON'T ORDER SCANS. If you have a cough, and fever, and you go to see you family doctor, your family doctor will listen to your lungs and determine if a chest X-ray is needed. Similarly, if you have severe stomach pain and are in hospital, it is the attending physician who orders the CT Scan, NOT the radiologist. So it's not like they are clearly referring patients to themselves and promoting their own business.

Further, let's say that whoever this radiologist is decides "I don't need the grief of being picked on, I'll only read 150 scans a day." Hoskins then has no one to attack, the radiologist works less and there's no story about him "overbilling" the health-care system. Perfect solution, right? Just what Hoskins wants.

The problem is that the 300 scans are going to come in anyway (because people keep getting sick, and need the tests). So now, on the second day, the radiologist will have not only the 150 he didn't read from the day before, but another 300 to deal with. On the third day he'll have 300 that he hasn't read yet, and yet another 300 coming in, and so on. The only possible result will be significant delays in patients getting test results, and thus delays in patients getting care.

Similarly, Hoskins has been known to attack ophthalmologists for doing too many cataract surgeries. Now in this case, it is true that they decide whether someone should have surgery or not. But does Hoskins really think that the ophthalmologists are doing surgeries before they are needed? If so, why hasn't he referred them to the College of Physicians and Surgeons for discipline? Why hasn't he referred them to the fraud department of the OHIP if he feels they are billing inappropriately?

The fact that Hoskins has NOT used those processes is very telling.

The simple answer is that he knows that, for the most part, these doctors are billing appropriately, and are dealing with patient demand as best as they can. Even with that, there are parts of Ontario where the wait list for cataract surgery is two years.

I'm not saying there aren't doctors who do inappropriate things, there sadly are, but there ARE processes to deal with them, and the fact that Hoskins has NOT used those processes is very telling.

Unfortunately, the problem of patient demand is not limited to just the need for diagnostic testing and cataract surgery. I'm on the Ontario Doctors Discussion Forum, a private Facebook page where physicians talk about medical politics, but also about some truly tragic stories (with patient identifiers removed of course) coming out of Ontario's health-care system. Recent examples include:

  • A 14-year-old boy who has attempted suicide, and is deemed psychiatrically to be a high risk to himself. Attending physician was unable to find a psychiatric facility for him (despite 2.5 hours on the phone over a 24 hour period) and is considering transferring him to Winnipeg or even Calgary.
  • A 20-year-old patient with an unstable back fracture (one that could sever the spinal cord) forced to wait for 20 hours in emergency until a hospital could be found to take her (unknown how long it took to actually get the surgery to stabilize her spine).
  • Discussion about what to do when a psychiatrist has left a hospital, and there is no replacement, with a multitude of critically ill patients left without the specialized care they need.
  • Countless stories of hospitals "pushing" patients out the door to try and alleviate a bed crisis.
  • Numerous attempts to find a colleague to consult on a patient who needs urgent specialized care, because the usual referral network is too bogged down to help and so on.

I confess I'm puzzled why the leadership of the Ontario Medical Association (OMA) hasn't advertised these types of situations. They've chosen instead to tell people to look both ways before they cross the street. While I appreciate that's good advice, the OMA would be better off actively advocating for improvements in the health-care system, since that is what their membership so clearly is being frustrated by.

However, as these kind of stories become more and more common, the growing awareness that something is seriously, and fundamentally wrong with the health-care system is sure to envelop Minister Hoskins this year. Maybe then he'll stop playing politics, and actually work in true partnership with all health-care workers, to deliver the improvements our health-care system so badly needs.

If not, the voters will surely let him know in 2018.

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