As a physician, I have been very troubled by the many concerns about health care and long-term care raised in your newspaper in recent months and, indeed, for a number of years.
There are many examples to choose from: concerns about the nutrition in long-term care (canned “Spaghetti-Os” rather than fresh food); multiple women upset about unsympathetic or unsupportive treatment in emergency departments when experiencing a miscarriage; patients unhappy about cleanliness in hospitals; inaccurate reporting of X-rays and diagnostic images; patients not getting or delays in getting particular types of treatment; and, of course, other serious matters such as those that led to the Cameron Inquiry on breast receptors testing in laboratories.
Physicians and health professionals see other things that are of concern but are most often reluctant to speak up due to draconian policies designed to intimidate or deter any “whistleblowers.” Such policies are wrong-headed and confuse secrecy about system performance with the need to protect individual confidentiality. We cannot achieve the highest quality of care when a “shoot the messenger” mentality exists, as it does right now. “Whistleblowers” need protection.
Health care is enormously complex and costly. It is not easy running a system that is so diverse, employs thousands and provides hundreds of thousands, even millions of individual contacts or services to the people of Newfound-
land and Labrador. Health-care providers (and administrators) work hard in a very hectic and often stressful environment and perfection is not achievable. It is possible in this context to unintentionally upset someone and mistakes can occur. But for the most, part health professionals are dedicated to doing what is best. This task is made more difficult when health authorities have seemingly unlimited access to legal services and when avoidance of liability plays such a prominent role in administration.
Privacy protections are meaningless when patients or their families need to go to the media in order to get the “system” to respond as it should.
Individuals are almost powerless against a large and unaccountable bureaucracy that has risk managers, lawyers, public relations and client-services personnel working for the “corporation.” Indeed, the “corporate mentality” and “corporate loyalty” is a major part of the problem. People and patients have been transformed into the much more impersonal “clients.” There are some sound reasons for such terminology since people may be patients, family members or, in a long-term care facility, simply “residents.” Health care is very personal and efforts to indoctrinate the world into using impersonal corporate language have pronounced negative effects and should cease.
A young woman in an emergency department distressed over the destruction of her hopes and dreams for her pregnancy is not concerned whether “policy” has been followed. When she desperately needs information, human support and comfort, a toll-free number to call is somehow not the same. I hope we are not going to hear that support and comfort are not the business of the “corporate” health-care system.
At the heart of the problem is the near total absence of effective accountability of the health-care system to the people (not clients) that it is intended to serve, the same people who are footing the bill. Health care is the single largest sector of the economy, over 11 per cent of GDP, and multiple times larger than all municipal budgets combined. Yet we all have an opportunity to elect our local councils.
Not so in health care, where accountability is a sham. I have just returned from the federal Liberal convention in Montreal where the Liberal Party of Newfoundland and Labrador succeeded in passing a resolution calling for changes to the Canada Health Act to make health care directly accountable to patients and their families. Other countries that are getting better value and better results from their public healthcare systems are doing a better job of being accountable.
How would direct accountability work? There are lots of possibilities. In Staffordshire, England, the national Patient’s Association had the resources to help lead the way in exposing hundreds of unnecessary deaths. Internal competition in England’s National Health Service is starting to lead to improved quality of care. In a long-term care facility, an independent elected committee of residents and family members could have a role and should be respected by the health-care authority. Such a committee would likely have been able to deal with any concerns about the nature and quality of food served to residents. Volunteer-elected, community-based Health Councils with the power to ask questions and compel answers from health authorities would be an important option to consider. How many patients were left in corridors and for how long? How many complaints and on what type of topics have been received? And of course, the complete reports of hospital accreditation should be posted online for the public and media to see.
Accountability is so important to achieve high quality cost effective care that responds to the needs of the public that it cannot be left to large corporations with an interest in self-protection to call the shots. Direct accountability of the healthcare system to patients, families and the public is essential to make health care better and the Liberal Party is leading the way.
Ken LeDez writes from
Portugal Cove-St. Philip’s.