Ensuring safety for each and every citizen is an essential function of all levels of government. A couple of deaths on crosswalks or at a road junction can initiate immediate corrective measures: Reaction becomes the order of the day.
Yet when many hundreds of citizens die each year because of a catastrophic shortfall in family practitioners (FP), our provincial government’s inertia, the very cause of this crisis, continues unabated. It behaves like the Roman emperor Nero; passively watching while the whole system is destroyed.
In any private or corporate setting, Adrian Dix, our minister of health, would be fired for such incompetence. He would join his quixotic failed policies in the dustbin of history. Unfortunately, the vicissitudes of political life preclude such easy solutions.
According to published medical research data, approximately 1,500 to 2,000 British Columbians will die each year because of having no FP. Interestingly, this is a very similar figure to the number of provincial overdose deaths. Countless thousands will suffer worsening symptoms due to lack of medical supervision/follow-up of their disease. Anxiety will be endemic.
All of these sequelae are more prevalent in our most vulnerable group, the elderly. All the above are preventable. Their occurrence represent a complete failure of health policies.
From my decades as a medical-school teacher, I know that individual case histories can be far more instructive and illuminating than didactic presentations, so I’ll now describe two case histories, with my comments, that have recently come to my attention. They, sadly, show the dire consequences of the depths to which our healthcare system has descended.
A mother recently had to take her severely ill 17-year-old daughter (JB) to the emergency room at a district hospital and was told by two doctors they could not help her daughter because they didn't know anything about Crohn's disease (which she had suffered from for years). They prescribed an opioid for her pain and told her to call Children's Hospital.
Her only local FP is about to retire. Her daughter will then have no medical help where she lives. Her mother feels she may have to relocate from her lifelong home to somewhere that has a suitable hospital nearby, inevitably a more expensive location which she will have difficulty affording.
Crohn’s disease is a serious condition that usually causes lifelong severe symptoms that have a marked negative impact on quality of life. Without appropriate care, life expectancy will be reduced. Although there is no cure, there are many medications that can help symptoms and reduce disease severity. Individual patients respond differently to these.
The drugs may be given singly or in combination. Some have significant side effects. Phoning up an on-line physician would be both useless and potentially harmful. JB needs comprehensive continuing care by both a FP and a specialist. The fact that they have to move in order to get any appropriate doctor is an appalling reflection on our health system.
This case history shows other evidence of our failed healthcare system. Prescribing an opioid—with its attendant risk of addiction—as first-line therapy approaches negligence. But the overall strain on the healthcare system often results in mistakes like this because the (sometimes substandard because no-one else is available) physicians are overworked and are forced to solve the immediate problem ASAP and discharge the patient pronto!
To suggest that the patient phone Children’s Hospital is a gross abrogation of medical standards. It is incumbent upon a person’s physician to make such referrals.
Mrs AB, aged 60, had a history of cancer and was supposed to get regular screenings, but it never happened because there was no GP to arrange it for over three years. Recently, she started feeling ill, but walk-in clinics (that didn't understand her complex history) were unable to diagnose her. Finally, she went to the ER after she started coughing up blood. They diagnosed her with advanced lung cancer, which had already spread to her brain and liver. She died within a month. To add insult to injury, no FP was available to coordinate her terminal care at home.
This patient’s death might well have been prevented or postponed by regular follow-up. Picking up early cancer is precisely why no such patients should be deprived of it. I have heard oncologists relate how they are now seeing more new patients with advanced cancer than ever before. Advanced means often untreatable.
I am reminded of when I worked in Africa and encountered many patients with horribly advanced cancer. Their country could afford no more than one doctor per 15,000 people. We are a wealthy country. We can easily afford one family practitioner per 1,000 patients. We are nowhere near that target. Abysmal planning by our provincial government is causing countless such deaths.
If this is not negligent homicide, I don’t know what is.
This patient experienced yet another pitfall in the provision of our healthcare services. Walk-in clinics are mere Band-Aids, where the ticking clock is often a driving force for the physician to cut corners. The complete medical record is seldom available in these clinics. However, the history of previous cancer and now not ‘feeling well’ should have raised an immediate alarm to any reasonable doctor able to practise in a reasonable facility.
The current NDP government, astonishingly, has made no provision in this year’s budget for any extra funds needed to combat the FP shortage. The minister of health continues to promote urgent primary care centres in spite of their obvious abject failure in practice. Our premier, John Horgan, fobs us off by blaming the federal government, crucially ignoring the fact that the delivery of healthcare is a provincial responsibility.
A very recent government offer of a one-off contribution to the overhead costs of running a FP clinic, although a move in the right direction, will have minimal impact on FP availability.
A large number of our current FPs have been openly critical of the current situation but with no apparent result. As with many social issues, the most potent stimulus for change occurs with widespread public exposure and pressure. Up until recently, protests about the FP situation was only possible by individuals, thereby guaranteeing ineffectiveness.
However, Vancouver Island is fortunate in having a recently formed and very active association, B.C. Health Care Matters, whose mandate is to rigorously protest the dearth of FPs (www.bchealthcarematters.com). The greater the public support for this group, the higher chance of success so that the current internationally disgraceful one-fifth of our five million population without a FP will start to decline.