Politics and Economics
A Doctor Answers Four Questions on one of Canada's Central Election Issuesby
Ballicatter: What must the next Canadian government do for health care?
Dr. Heffernan: Hospitals need to be better funded, restructured, and better staffed. Waiting lists are the hot topic in current debates – and Paul Martin probably envisions increasing funding for technology (CAT scans, etc.). But there is a definite shortage of physicians.
The federal government should have far more control over health care. There are drastic salary differences among physicians in B.C., Québec, Newfoundland and Labrador and all over Canada. Pay discrepancies lead to regional differences in quality and demand for physicians. If we are to have the ‘universal’ health care called for, it must be centrally controlled.
I might add a further philosophical change in approach that is undoubtedly necessary. Investment in preventative approaches to medicine, to combat, e.g. obesity and smoking, would transform health care.
Ballicatter: What would it change to move toward home care?
Dr. Heffernan: Too many consider the hospital the principal place for care. Patients dictate to physicians: the former want to see the specialist because they think care will be better there. Often it is not. Such demands have given rise to the phenomenon known as the ‘referologist’: a physician whose primary function is to refer patients to specialists. The focus should be the family doctor, not the specialist.
At the moment, many patients are placed in the hospital’s ‘acute care’ – not ‘intensive care’ – beds. Many are there because they have no other (e.g. community) recourse – but they might need nothing more than supervision. It costs about $800 per night to keep someone in a single acute care bed. Many wait a month for a cheaper (not cheap) institutional bed. The patient is ill, but not acutely, often not waiting for an imminent death. He or she is sick enough to need care, but family and relatives, if there be such, could do the job well at home. For the most part, it is cheaper, and most importantly, it places the patient in the home. Taking the patient out of the home can have serious psychological effects, e.g. depression. Most people prefer to die or be cared for at home.
Ballicatter: Ideally, what should a doctor be?
Dr. Heffernan: Due to the shortage of doctors, time for patients is reduced. The biopsychosocial model for patient care is abandoned for the pared-down biological model. A family doctor who sees forty patients in a day will listen to the patient for five minutes about one problem. We, as physicians, would ideally have more time to talk with patients. And so we need far more doctors.
Doctors are expected to be doctors all the time. But the specialties that attract young doctors are those where the 9-5 life is available. We want to know what our children’s faces look like, to relax. A small-town family doctor can’t have a few drinks: with no other doctor around, she has to be ready at any time. Ideally, we’d like to be able to cease for a while to be the doctor.
Ballicatter: What is a doctor forced to be in the current scenario?
Dr. Heffernan: We are forced to be tired. Specialists are always being paged, and consequently, patients are prioritised. People wait a month for an operation simply because we can’t do it all at once. Most would like to know patients and explain what is happening, but cannot since there’s no time to do it. Medicine becomes business-like in approach. It is supposed to be an art and a science, but the art side quickly gets lost in the shuffle.