Doctors offer prescription for health-care reform

This week, I was pleased to see the opinions of several health commentators who have recommendations on how to improve our health and the health system. There have been a few points of consensus, which include:

• New Brunswickers need to take more responsibility for their own health (and should be encouraged through a variety of means to do so).
• Our health system suffers from too many “silos” — many people are responsible for different elements of the health system, but they don’t talk to each other as much as they could.
• Our system is built on the 1960s standard of acute care delivered in hospitals and hasn’t kept up with both the illnesses and technologies of today.

Many of their recommendations are aligned with what doctors have been saying for years, but some commentary has compelled us to speak out. Doctors think we need more of a focus on the problems from the point of view of our patients.

Doctors see thousands of patients every day and we see their struggles as real people. They have problems with the system, but let’s start with the root of many issues: our collective state of health.

'The sickest province in the country'

Sixty per cent of New Brunswickers have at least one chronic disease; 13 per cent of those people are on six or more medications. We have the second highest rate of disability, the third highest rate of diabetes and the third highest rates of cancer in Canada. We are the second heaviest province, with two-thirds of us being overweight or obese. We smoke more than the average, we eat fewer vegetables and the list goes on.

Healthy living should be a big focus for everyone and it is for doctors. In the last year, we worked with dietitians on Make Menus Matter, a program that asked parents to send us pictures of their children’s school cafeteria menus in an effort to raise awareness of what our kids eat at school.

We sponsored Run New Brunswick’s children’s running program, which is on track to see 3,000 children complete a “fun run” and get a medal to recognize their activity. We promoted Prescriptions for Health, which has seen doctors hand out thousands of prescriptions to patients to get them moving.

In short, doctors are proponents of healthy choices because they keep us healthy for years to come. But we’ve also got to take care of patients who are sick today.

In advance of the election, we asked doctors what frustrations they hear from their patients most often. Eighty five per cent said they hear about a lack of timely access to family doctors, the number of seniors waiting in hospital beds for long-term care homes, and emergency room wait times.

We took their feedback and sought out to propose solutions.

More family doctors, teams of professionals needed

We believe every New Brunswicker should have a family doctor. 50,000 New Brunswickers don’t have one. Some others have suggested that only 20,000 people don’t have one and others have suggested that because we have “only” 50,000 people without a family doctor, we’re doing well.

We think it’s odd that we’re hearing arguments on “how many thousands of people without family doctors is acceptable?”

When we ask New Brunswickers on Facebook what they think about this, we get a sad competition on who’s waited the longest for a family doctor: “I’ve been waiting for three years.” “Well, I’ve been waiting for four.” “10!” One fellow on the news said he’d been waiting for 17 years!

There are many costs to the system associated with patients who don’t have a primary care provider. They get sick too and they visit walk-in clinics and emergency rooms to get care. Sometimes, they see us too late and an illness has already progressed beyond the point when moderate interventions can help.

To diagnose and manage chronic diseases like diabetes for all patients, augmenting our primary care system with teams of doctors, nurse practitioners and other health professionals working from a common medical record is important.

Our call for family doctors isn’t a call against any other health professional — it’s a call to re-orient our health system back toward patients who have 21st century illnesses that are best managed through primary care and patient education. We need more doctors, nurses and other providers working together in teams to care for patients more effectively.

Seniors living in hospitals

We’ve also suggested building several nursing homes. This is proving to be an unpopular suggestion. Most seniors want to stay in their own homes.

Some think we should increase home care provided to seniors to help them stay independent, offer better prevention of falls and it would allow for more community-based transportation programs. We agree with all of those things.

While more effort can and should be made to improve home care, we can’t avoid building nursing homes.- Dr. Lynn Hansen

But here’s why we called for more nursing home beds: patients need them. Twenty five per cent of hospital beds in the province are used by seniors who don’t want, or need, to be there.

Many seniors stuck in a hospital cannot simply go home again, even with additional help. They suffer from multiple conditions, including dementia and need round-the-clock care.

Nursing homes offer a safer environment and a much better quality of life than hospitals, including recreational activities and social engagement.

While more effort can and should be made to improve home care, we can’t avoid building nursing homes. They are a necessary element of the system and though they are expensive, our increasing elderly population and the prevalence of chronic conditions and dementia make them necessities.

If you meet an elderly man who has been living in a hospital for over a year who has few visitors and can’t go outside, I bet you’d agree that he could really benefit from a nursing home, not a hospital bed.

Shorter ER wait times

Finally, we hear from patients about long emergency room wait times.

Last year, New Brunswickers visited emergency rooms a total of 606,000 times. And 60 per cent of those visits were “non-urgent” or “less urgent." the kind of visits that could be best handled by better access to primary care, including after-hours, on the weekends and during the day.

Together with better primary care, we need to match service supply to patient demand in our ERs. Adding resources when ERs are busiest would reduce wait times.

This happens in places, such as Ontario, where 90 per cent of patients who go to the ER with a non-urgent condition walk out in less than four hours.

An investment in patients

It would cost roughly two per cent of the total health budget to implement these measures.

And the estimates on savings from these initiatives are substantial: as one example, reducing the number of seniors living in hospitals would save somewhere from $37 million to $51 million in the hospital system, according to a government report.

Our health-care system is ailing and while we need an eye to policy changes that would help us in the future, we need to do so with a focus on patient problems of the here and now.

Let’s listen to patients on health care.