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Commentary: The health care crisis in British Columbia in two examples

A commentary from a retired medical professor.

Ensuring the safety of every citizen is a core function of all levels of government. Yet, while several hundred citizens die each year due to a catastrophic shortage of family doctors, the inertia of our government, the very cause of this crisis, continues unabated.

He behaves like the Roman Emperor Nero, passively watching as the entire system is destroyed. In any private or corporate setting, our Minister of Health would consign his failed chimerical policies to the dustbin of history. Unfortunately, the vicissitudes of political life prevent these easy solutions.

According to published medical research data, approximately 1,500 to 2,000 British Columbians die each year because they do not have a family doctor. Thousands of people will suffer from worsening symptoms due to lack of medical supervision/monitoring of their disease.

Anxiety will be endemic. All of these sequelae are more common in our most vulnerable group, namely the elderly. All are preventable. Their occurrence represents a complete failure of health policies.

As a medical school professor, I know that individual case histories can be far more informative and illuminating than didactic presentations. So I will now describe two case histories, with my comments. They sadly show the disastrous consequences of how far our health care system has sunk.

A mother recently had to take her critically ill 17-year-old daughter to a hospital emergency room and two doctors told her they couldn’t help her daughter because they knew nothing about Crohn’s disease (which she had for years).

They prescribed him an opioid to relieve his pain and told him to call the children’s hospital. His only local family doctor is about to retire. Her daughter will then have no medical aid where she lives.

Her mother thinks she may have to move from her forever home to somewhere that has a proper hospital nearby, inevitably somewhere more expensive that she will find it hard to afford.

Crohn’s disease is a serious condition that typically causes lifelong severe symptoms that have a marked negative impact on quality of life. Without proper care, life expectancy will be reduced.

Although there is no cure, there are many medications that can relieve symptoms and reduce disease activity. Individual patients react differently to these.

The drugs can be administered alone or in combination. Some have significant side effects. Depending on an online doctor would be both unnecessary and potentially dangerous.

This patient requires ongoing comprehensive care by a family physician and a specialist. The fact that they have to move to find a suitable doctor is an appalling reflection on our healthcare system. It is both a parody and a tragedy.

This case history shows more evidence of the failure of our healthcare system. Prescribing an opioid, with the risk of addiction that comes with it, as first-line treatment borders on negligence. But ER doctors are overworked and are forced to fix the immediate problem as soon as possible and discharge the patient on the spot.

To suggest that the patient phone the Children’s Hospital rather than make such a referral is a gross violation of medical standards.

A 60-year-old woman had a history of cancer and was supposed to have regular screenings but couldn’t as there was no GP to arrange it for several years. Recently, she began feeling ill, but walk-in clinics (whose staff did not understand her complex history) were unable to diagnose her.

Eventually, she went to the emergency room after she started coughing up blood. They diagnosed him with advanced lung cancer, which had already spread to his brain and liver. She died within a month. To add insult to injury, no family doctor was available to coordinate her terminal care at home.

The death of this patient could well have been avoided or delayed by regular follow-up. Getting cancer early is precisely why none of these patients should be deprived of it.

I’ve heard oncologists talk about how they are now seeing more new patients with advanced cancer than ever before. Advanced often means incurable. I remember when I worked in Africa and met many patients with horribly advanced cancer.

Their country could not afford more than one doctor for every 15,000 people. We are a rich country. We can easily pay one family doctor for 1,000 patients. We are far from this goal.

Our government’s abysmal planning is causing countless deaths. If that’s not negligent homicide, I don’t know what is.

This patient experienced another setback in the delivery of our health services. Walk-in clinics are simple band-aids, where the countdown is often a driving force for the doctor to take shortcuts. The complete medical file is rarely available in these clinics. However, the history of a previous cancer and now not “feeling well” should have immediately alerted any reasonable physician capable of practicing in a reasonable facility.

Surprisingly, the provincial government made no provision in this year’s budget for the additional funds needed to address the doctor shortage. A recent government offer of a one-time contribution to general clinic operating costs, while a step in the right direction, will have minimal impact on the availability of family physicians.

As with many social issues, the most powerful stimulus for change occurs with widespread public exposure and pressure. Until recently, protests against the situation of the family doctor were only possible by private individuals, which guaranteed its ineffectiveness.

However, Vancouver Island is fortunate to have a recently formed and very active association, BC Health Care Matters (bchealthcarematters.com), whose mandate is to vigorously protest the shortage of family physicians.

The more the public supports this group, the greater the chances of success, so that the internationally shameful fifth of our five million people without a family doctor will begin to decline.

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