Sunday 13 September 2015

The letter I almost (but didn't) send to the Minister of Health.





Dear Minister,

                    I don’t usually write letters to newspapers, politicians or lawyers, mainly because I like the Canadian system and have worked hard to see it work.  I was born in Ireland, studied medicine there, and when I graduated I had to decide what I wanted to do with my life.   I did not choose Canada serendipitously, indeed I had family in the US and classmates from the ‘Colonies’ and was offered employment opportunities that would have enabled me to pay off my considerable student debts as well as make a comfortable living for myself, my wife and baby daughter.  I thought carefully about all of these things and finally decided that I wanted to be a Canadian.  Not an American, not an important Physician in some British Colony and not even a partner in a practice in London, England, where I was an assistant family doctor when I applied to come to Canada.  (Just after I arrived I had a communication from that practice offering me a partnership, as one of the partners in the practice developed angina pectoris.).    Minister, as I was applying for a position in Regina, Saskatchewan, I received a communication from the British Medical Association, warning me of the Socialist system being instituted by Tommy Douglas.   They pointed out it was not supported by the BMA.    That did not deter me and I came to Regina nevertheless, and met many fine people, medical and non-medical, political and non-political and spent thirty five years in medical practice in the province, the last ten years as Professor and Chair of the Department of Family Medicine.   Through all those years, Minister, I believed we had an exemplary health care system that, while far from perfect was striving to offer the best possible use of the available resources.  As the Chair and Professor of the Department of Family Medicine at the University of Saskatchewan I had knowledge of medical care across the country, so I believe my comments to be applicable on a National basis and not to be confined to Saskatchewan, or Ontario, where I have been in practice for the past fifteen years or so, initially as a Faculty Member at UWO and more recently as a physician doing some locum work a day or so a week. 

            The story I am about to tell you Minister, is of a recent incident that shook my confidence in certain aspects of the Canadian Health Care system, of which I have been a proponent, participant and patient for the past fifty years.  It is a story I feel compelled to write, because I am in a position to critically evaluate what is going on and feel these comments should be shared.  It is a story not to criticize the health care providers, but to criticize what has happened to a health care system that was once an example of excellence but has steadily deteriorated over recent years. 

            After an accident in Hilton Head, S. Carolina, in which my seventy-seven year old wife tripped over a concrete parking marker and hit the ground with an impact that I was afraid she had suffered a serious and potentially disastrous head injury, I headed back to Canada the following morning, after observing her throughout the night and deciding her condition was stable and it was safe to travel.  We arrived home, in London Ontario, two and a half days later, after an ordeal, that I’m sure you can imagine.  Indeed, in retrospect, I question the wisdom of my decision, to drive that distance, on minimal sleep.  To cut a long story short, first thing in the morning, after arriving home, we took a trip to the emergency room, at University Hospital, and that’s where this story really starts.

            On the morning of Wednesday, twentieth of February, 2012, I brought my bruised and battered wife to the Emergency room at University Hospital, in London.    Minister, we sat there for five hours.  I am a physician and I was satisfied that my wife was in no immediate danger. I couldn’t help speculating on what might have happened if a patient was bleeding from a subdural hematoma or worse.  Because her hand and arm were grotesquely swollen and bruised, they were the immediate focus of attention.    So, after five hours, limbs were x rayed and the splint that I had already applied was considered to be adequate treatment for the moment.  Her head was either not noticed or considered to be unimportant, despite extensive bruising and tenderness over the zygomatic bones of the face and a black eye.   I brought her home from the emergency room at University Hospital where she had been sitting for five hours without having been assessed for a head injury by a physician, when she was so uncomfortable that she insisted on signing herself out.   Being a physician I was satisfied that she was not bleeding into her brain.  However, this was not known by the staff and it concerns me that someone whose cognition may have been impaired was allowed to leave emergency without any real attempts to explain the possible risks involved..  Equally unbelievable, Minister, was the fact that despite the fact that  Family Medicine programs  try to make our students aware of women’s health issues and of the fact that they must screen for family abuse, nobody asked my wife if she had been beaten up by her husband or otherwise abused..  By the way, there were notices around the emergency room advising this would be screened for, except that it never happened.  I found this almost unbelievable and and think that this aspect of emergency room care needs careful review.

            Next morning, since my wife (understandably!) refused to go back to emergency at University Hospital, and her head had not yet been looked at, we went to St. Joe’s where the experience was much more acceptable.  The CT scan showed some bone damage, fortunately not severe.   Minister,  I have spent much of my life working (and sometimes living) in hospitals and I understand the difficulties that health care workers have to contend with .   (Indeed, I hardly dare to as both my offspring work in, what has regrettably become  “The Health Care Industry”.    Suffice it to say, that something is amiss in the state of Health Care, that in my opinion is more related to its administration, than to the delivery of health care personnel.. 

       Those inadequacies must be addressed by the administration, as well as by those who deliver the care.   The Health Care System in Canada is deteriorating.  I do not believe you would have settled for that level of care for a member of your own family and neither would most Canadians.



                              Sincerely,

                                                 

 Stanley G.Smith,  MA, MB, B.Ch, BAO, CCFP, FCFP.

                   Professor Emeritus, Dept of Family Medicine, University of Western Ontario.

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