It's the latest instalment of our Hacking the System: Making health care work for you series.
Listen to the whole interview here.
Mike Finnerty: We've been looking this week at what people are having to do to make the health care system work for them. And I'd like to start with elder care, caring for an aging and infirm loved one, either at home or in a facility. The public retirement facilities are stretched so thin that even in a public facility people hire companions to be with their loved ones. Is that the way it should be?
Gaétan Barrette: No. I believe that you should not have to hire people. Well it is something you can do, obviously — this is not something we will tell people not to do. But technically speaking we should not have to do that. One of the issues at stake here, is that home care in those situations has to be more developed. This is something we will try to do over the next year.
MF: How do you put more resources into home care with tighter budgets?
GB: Actually, this situation that you were talking about was about someone who is at the end of his or her life. Care should be rendered more available to those patients. The fee schedule for general practitioners in this area is not an incentive — it’s the reverse.
I know many doctors and nurses and CLSCs who are quite willing to develop that kind of home care and this is something we’re working on, because I really believe that this is a situation that has to be lived in-family, at home whenever possible and you don’t need to be transferred to hospital to go through this difficult time at life.
Many, many people do ask for that, and we are working on a solution where there will be incentives for doctors and teams to work together and increase the availability of such care.
MF: Will that be more resources, or reorganized resources?
GB: It’s reorganizing resources. As I said before, doctors’ fee schedules is such that there is no incentive. [...]
We can reorganize resources without having money and provide those kinds of services at home, and I think that is what people want nowadays.
MF: We looked at colonoscopies [in our Hacking the System series], one of the big screening tests for one of the worst cancers, colorectal cancer.
Here in Montreal they really want to move toward the take-home FIT test, but we were told they don't feel they can really launch it here because the wait lists are so long, if people do get a positive test, they'll be waiting, anxious, for too long.
We met a woman who was told she'd have to wait 18 to 24 months for a test even though a doctor recommended one after her mother had a tumour found. What's the solution for colonoscopy wait times?
GB: There are two issues, it’s two-fold when we get into the subject of colonoscopies. First of all, people need to realize this should be an examination, a procedure reserved and directed to those who have a positive FIT test. The FIT test is a test that detects minute amount of blood in the stool and we know that the test is extremely powerful. If you have a negative FIT test, it’s fair to say and secure to say you don’t have cancer.
When the FIT test is positive, institutions in this province and especially in the Montreal area, they are instructed to pass those patients first. But the wait time is quite long.
MF: If you get a positive FIT test, you get to say to your doctor, “I get to get bumped up the queue.”
GB: That’s the way it works. When a gastroenterologist or general surgeon — those are the two who do that procedure — it’s already done that way. When your family physician, if you have one, receives a positive FIT test result, he requests an endoscopy to the hospital for instance, and the hospital is instructed to prioritize the patients who will get the procedure, and number one is a patient with a family history of cancer and a positive FIT test.
MF: Still four in 10 Montrealers don’t have a family doctor. What should people do?
GB:There’s a wicket where you can put your name on the waiting list, and this doesn’t work perfectly. [...] But the answer lies probably somewhere else. We are in discussions with the FMOQ [the federation of general practitioners] on this issue and in the next weeks or months we will have something to announce that I hope will have a greater effect as opposed to what we’ve had today.
I still believe we have enough doctors in this province… We have enough doctors in this province, both specialists and general practitioners, and we have to reorganize things so that we have more of a guarantee, or simply directly guaranteed access to family physicians and the answer is there.
MF: You have developed a formidable reputation as someone who will get the job done, so I want to ask you a question about your real priorities. Are you mostly just focused on the budget or are there service improvements you’re bound and determined to deliver?
GB: Both. I strongly believe if we are to have a sustainable health care system, publicly funded, we have to balance the budget. But at the same time I’m really, really equally determined to resolve the access issue and the fluidity that we have to have in this system so the patient, from his home to more specialized care, will have access, it’s going to be easy for him. And I can guarantee one thing: I will really, really do whatever I can to achieve that in this mandate.