Ontario docs are leaving – patients have trouble finding good doctors

{November 29, 2012}   A Proposal for a Patient-focused Charter – Dr. Brian Day




A proposal for a patient-focused charter

Written by Dr. Brian Day on November 28, 2012 for CanadianHealthcareNetwork.ca


Day Time

by Dr. Brian Day


An ethical physician’s role is to attempt to ensure quality healthcare that is appropriate, effective, and provided in a timely fashion. When forced to choose between loyalty to regulations that conflict with that role and the well-being of patients, we have a duty to favour the latter.
Consider this: The government-owned North Korean airline—Koryo—is a monopoly that dictates the amount it spends and has the ability to extract whatever funds it wants from its clients. It owns and controls the facilities that deliver the service. It decides its locations; trains, employs, regulates and funds the workers; and governs how, when and where the population is served. It also determines the level and quality of services provided, while regulating and evaluating its own performance. Koryo is rated as the worst-performing airline in the world. Our government-run Canadian health system operates under the same set of rules.
In addition to the need to introduce competition from non-government funders and providers into our health system, our publicly owned agencies must be subject to penalties for poor performance, and rewards for good service. If hospital global budgets are replaced by patient-focused funding, token commitments to excellent patient care in mission statements will have to be matched by action in order to produce sustainable financial statements.
I would like to propose the following actions, based on rewards and penalties, that would ensure transformation to a patient-focused system:
  1. Patients awaiting elective consultation with a specialist should be seen within two to four weeks. Those assigned a longer period would receive funding from the health region to arrange their own consultation with anyone, anywhere, including out-of-province or out-of-country care.
  2. Patients with acute injuries or illness needing an emergency assessment in an acute-care hospital shall wait no more than four hours for urgent tests or treatment. A hospital that cannot deliver care in this timeline will transfer the patient to another institution, accompanied by funding (from the budget of the first hospital), in an amount that is double the estimated cost of that patient’s total care or, if no alternative is available, a similar amount would be returned to government.
  3. Patients with sub-acute illnesses designated by their doctor as urgent, rather than emergency, shall receive investigation and treatment within one week of referral.
  4. Patients with non-emergency illnesses or injuries, who are in pain and or disabled, will receive all investigations and treatments within one month of referral.
  5. Patients with non-urgent or chronic illnesses or injuries, who are restricted but not suffering significant pain or disability, will receive all investigations and treatments within three months of referral.
  6. Failure to achieve the timelines referred to in 3, 4 and 5 will result in referral to a second facility that will receive funding at double the estimated cost, again with the primary institution providing those funds.


The suggested penalties for non-compliance will actually save money (in the long term) through a reduction in morbidity and disability. Facilities would soon realize that resource allocation would have to be diverted to patient care. Hospitals would compete for work, with the best and most efficient being the most financially successful.
I am most distressed by the suffering that a disenfranchised group of patients receive in Canada. I refer to children, who are suffering from access issues on a scale that should shame those in charge of our health system. In my proposed categories above, all children would be placed in category 2, 3, or 4.
On the theme of children, my clinic’s constitutional challenge is being joined by another child (three of the five plaintiffs are now children), who has suffered as a result of our health system. Despite the best efforts of his mother, 16-year-old Walid Waitkus, who suffered from a progressive spine deformity, languished for 27 months on a so-called urgent wait list. Last summer Walid was running, cycling, and playing on the beach. He is now is now paralyzed for life. (See Walid in this YouTube video.)
The outcome suffered by Walid would not occur in any other developed country. Apart from the tragic human element, the long-term economic cost of the delay in Walid’s surgery is incalculable, but appears of little concern to governments that operate on budgets tied to four-year electoral cycles.
In my view our current system is more than inefficient. It is immoral. Hopefully our action in court will also prove it to be unlawful.
Dr. Brian Day is a Vancouver-based orthopedic surgeon who served as President of the Canadian Medical Association in 2007-08.


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