Physician-assisted death and euthanasia is not a new topic of discussion, but is creeping to a tipping point in Canada with recent legislative decisions (see Bill 52 in Quebec, and other bills tabled). Anyone who has had experience with end-of-life care, whether personally or otherwise, would understand the complexity of the issues involved. If you haven’t already, have a read through this article published on HealthyDebate which nicely summarizes some of the key issues in the debate.
What struck me most from the article are the following points:
Came across an interesting piece in the paper recently, which nicely summarized many of the key challenges our healthcare system is facing. While the ultimate point of the article is to question the wisdom of increasing privatisation in our current system, I think the even more profound realisation is that:
Canada and the United States share a much more similar healthcare system than most would like to believe.
Telemedicine, in its various forms, is coming. It is good to see our regulatory bodies being proactive and tackling this new emerging field, instead of waiting on the sidelines for too long.
However, coming to a consensus on exact policies and regulatory rules might prove to be extremely difficult; we’ve already explored one potential form of telemedicine in a previous post and it’s inherent problems.
We have to start somewhere, but let’s hope there will be mechanisms built into any policy to allow for continued modification in reaction to what will certainly be an ever changing field.
Originally posted on Colleen Young:
By The College of Physicians and Surgeons of Ontario (@cpso_ca)
The College of Physicians and Surgeons of Ontario (CPSO) recently released a new draft version of its Telemedicine policy for external consultation and is looking to the #hcsmca community to provide feedback on it. The draft policy sets out the CPSO’s expectations of physicians who practise telemedicine. Given the evolution of technology and the increased use of telemedicine in diverse practice settings, the draft policy contains a number of new or revised expectations to ensure it is clear, up-to-date and comprehensive.
The CPSO is committed to ensuring that the draft policy reflects current practice issues, embodies the values and duties of medical professionalism, and is consistent with the CPSO’s mandate to protect the public. But in order to do this, we need to gather opinions and insights from a wide variety of interested parties. That’s where #hcsmca comes in…
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Interesting discussion – there are absolutely lessons that can be learned from other industries like aviation…but are we taking it too far at times? Transferring “solutions” too literally and directly into healthcare?
Originally posted on hcldr:
Blog post by Colin Hung
Learning and adopting best practices from others is often sage advice. After all, why invent from scratch when you can stand on the shoulders of those who have done it before? No matter what industry you work in you will hear repeated calls to “look beyond the border” to other industries for inspiration and innovation. Healthcare is no exception.
Just by the sheer number of articles and blog posts, it appears that the aviation industry is the most popular choice for healthcare inspiration. Everything from the way pilots are trained to the way that the FAA investigates incidents seems to have an equivalent in healthcare. Indeed many healthcare “innovations” appear to have been adopted from aviation including: checklists, standardized incident reporting and simulation training.
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Guest post by Ashely K.
Despite their geographical proximity, their similar cultural milieux, and their comparable per capita economic standings, Canada and the United States are vastly different places when it comes to health care. Is Canada too cost-conscious, putting the inevitable but seemingly insurmountable needs of the many over the immediate needs of the few? Has the United States become too client-centered, putting the needs of the privileged or particularly litigious few over the needs of the many? Which is better for patients?
Let’s contrast some examples. I just returned from a month-long elective at a large Trauma centre in the United States. My usual training centre is in Canada. These are real cases I have encountered, with the demographic details altered for patient confidentiality. First, a Canadian example:
Guest post by Nathan H.
In a time where banking can be done securely from all over the world by phone application, why are we stuck relying on pieces of crumpled paper from a patient’s wallet for their medication list?
In the dire time when a person requires resuscitative efforts it would be critical to know if that person is beta-blocked, or a had prescription for TCA’s or INH in an overdose situation. A provincial-wide electronic medical record could hopefully clarify that situation.
Guest post by Michael O’Brien.
Recently, Toronto doctor Danielle Martin achieved YouTube fame by appearing in front of a US senate hearing where she was asked to defend Canada’s single payer healthcare system to a largely partisan audience. The video shows a composed Dr. Martin outlining the benefits of Canada’s healthcare structure and contrasting it with the American one, while noting the strong public support in Canada for access to care that shouldn’t depend on one’s ability to pay. With close to 1 million views and further attention garnered from the media, it’s hard to deny the sense of pride and maybe even superiority Dr. Martin evokes when referring to our system, especially with the debate over Obamacare raging to the south of us.
But where does this sense of pride come from and is it even justified?
It is difficult to imagine modern hospital care without the nursing profession. In fact, the very first hospital in Canada was created by Augustine nuns (who, practically speaking, were nurses) in 1639: the Hôtel-Dieu in Québec City, which still functions to this day.
Much like how William Osler is celebrated in medical antiquity for physicians, Florence Nightingale is widely accepted as the founder of modern nursing. Her contributions in the Crimean War earned her the famed nickname “Lady with the Lamp”:
“She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.” -Cited in Cook, E. T. The Life of Florence Nightingale. (1913) Vol 1, p 237.
Guest post by Brandon R.
Let’s just imagine, for a second, a hypothetical patient scenario we’re faced with almost every day in the emergency department. An elderly gentleman is brought into the emergency department by his family with an exacerbation of a chronic medical condition. He’s not critically ill, but clearly isn’t thriving at home. Unfortunately he usually goes to the hospital across town, so none of his old records are accessible to you, the emergency physician. He’s also having trouble remembering how to take his medications at home, and his family is clearly nearing the end of what they can do to support him. You have no efficient method of communicating with his family doctor or home care worker. You don’t think he’s sick enough to absolutely need admission to hospital, but given the lack of ability to coordinate his care at home you have no choice but to call in a consultant to admit him to hospital.
Sound familiar? It should to anyone in emergency medicine, because scenarios like this happen every day.
In my emergency medicine residency program, we recently finished a 2 week block focusing on the administration and economics of our health care system, and it got me to thinking that this hypothetical patient scenario could illustrate many of the inefficiencies and problems our health care system is currently facing. Other countries have adopted strategies to help mitigate the problems of an aging population and rising costs, however Canada is lagging behind.
At the beginning of the month, an arbitration decision finally came out after a locked negotiation battle between Ontario’s nurses’ union and the Ontario Hospital Association: despite initial threat of a decrease in wages, nurses will be guaranteed a 1.4% annual wage increase over the next 2 years.
And rightly so – no one can argue against appropriate compensation for one of the most essential elements of acute hospital care. In fact, some would say this isn’t nearly enough.
However, I fear we might see potential unintended consequences. Have we considered the overall cost equation?