Sunday, March 13, 2016

One Asshole's (Informed) Opinion: Still waiting after all these years

Can you call something a crisis if it's been going on for 20 years?

If you came of age in the 1990s like me, I imagine you'd feel somewhat old seeing this advertised on TV:

That's right, it's been 20 years since that fateful time. Man does time fly, or so you might think. Then I stumbled upon this story in my local paper:

Dementia patients creating logjam at Victoria Hospital

You don't even need to read it. I'll summarize: the hospital is blowing its budget keeping sick, elderly patients in the wrong place for extended periods, because there aren't enough long-term care beds. It's leading to ER overcrowding, stressed-out caregivers, and so on. There are stories like this every day of the week, in every town in Canada.

The first time I heard stories like this? About 20 years ago, when I began med school and had to start paying attention. I have no doubt the problems started earlier than that, but that's really neither here nor there. How does a ubiquitous problem, with a cause that's universally agreed upon, continue to go unaddressed for over two decades?

I posed that very question to a senior bureaucrat from the Ministry of Health a few years back. If you know the problem is a lack of long-term care beds, why not subsidize some long-term care beds and see if the situation improves? Instead of hosting $100,000 meetings of health care workers to brainstorm cost-saving ideas (with no sense of irony), maybe try fixing the actual problem?

The response: "We did that. The waitlist went down for about six months, then went back up." Oh, I see! It's like what I said in my last post about wait times. In health care, adding capacity is like building new lanes on a highway. Eventually, the usage catches up and you're right back to where you started!


The highway lanes analogy holds true for some parts of a health care system but not all. If you open more hospital wards, more patients will be admitted, or there will be less pressure to discharge. If you buy more MRI machines, more MRIs will be ordered when they wouldn't have been before. If you fund more social workers or therapists, more counseling and therapy will take place. Likewise for physiotherapy, medications, cardiology tests, and so on.

But long-term care falls into the same category as hospices and birthing suites. The society's needs are what they are and that's that. If the number of childbearing women in a town was growing rapidly, would you hold off on building and staffing birthing suites? Would you instead expect women to deliver at home with X hours of midwife care? As someone who's been witness to how pissed off a woman can get during delivery, trust me, you would not. Yet we seem to have no problem foisting the same expectations on families of frail or demented seniors (or dying cancer patients, for that matter).

Do the bureaucrats and politicians seriously believe that people want to go into a nursing home? In fifteen years of practice I saw only a handful of seniors that preferred to live in care than independently, and in each case the patient had no family or social network to speak of.

Whatever the reasons offered, it's willful ignorance, pure and simple.

It might be the case that letting people languish in hospital or at home waiting for long-term care or hospice saves money, though I doubt it. Even if it does save money, it does so at the cost of vast amounts of misery and suffering for the sick and their caregivers, and it's been that way for 20 years or longer. That's a disgrace, pure and simple.

Oh, and for those of you who didn't come of age in the 1990s? Spoiler alert--OJ got off.

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