Tuesday, May 08, 2012

Liberal Ontario's Health Care: Putting Administrators First

Have you ever seen a doctor's office in one of Toronto's massive hospitals? It's rather interesting to see how much they've shrunk since I first used to visit my Dad's office in the old College Wing (now MaRS) at Toronto General Hospital (TGH). I described it in my book Lifeliner, for it was seared on my brain's memory circuits: the waiting room, the spacious area where the secretary sat (I was 8 and tiny after all), the adjoining room where my Dad saw his patients, and the dark, poky place where a black examination table had somehow been shoehorned in. Well, today, doctor's offices remind me of that poky examination room.

The Ontario government spends that little on caring for the sick. Huh? Let me explain.

At Toronto Western Hospital, I squeeze into a tiny room at the far end of three tiny rooms that open into a long, thin secretary's office. The main hallway is wider. The tiny room has just enough space for three chairs, a desk smooshed against the wall, and a narrow bookcase. If one family member accompanies the patient, one manuevres to get into place. I have no idea where a second member of my family would sit. Maybe we'd meet in the hallway? The window is always open as the room is a tad overheated. The middle room is barely big enough to fit two people and the piles of paper everywhere for the lack of sufficient furniture because, well, there's nowhere to place the furniture. The last room is a bit amusing. It's where the Chief of the department holds court. Yes, the Chief, the big doctor cheese. You open the door, which has just enough space to open, take a step and sit in one of two chairs smacked up against each other close to the round table in the middle of the room. The doc sucks in his breath and squeeeezes between table and desk to sit at the table so as to face the patient. The desk is smack up against the wall. He merely twists a bit to pick up the phone on the desk, table and desk are that close. Journals and books and patient charts for the day are piled up on the floor, on the table, on the desk. It rivals the hordes of files in their numerous cases that used to decorate my Dad's secretaries' office. But their office in the at-that-time-new Eaton Wing at TGH was bigger than the entirety of these three offices and secretarial space. My Dad's then-new office had been designed so that patients could be comfortable, could bring family, and could hold all his journals, papers, books, charts for the day, you know, the things doctors need to refer to when treating patients.

That was when hospitals were in the business of attracting the best doctors to treat all the patients who needed care. Now TGH builds doctors offices like cubicles in Fort Knox, as if there are rampaging hordes of patients trying to assassinate doctors or spies trying to steal ideas or maybe just to make it more difficult for patients and doctors to get to know each other.

Concomitant with shrinking offices, I have seen an interesting trend of younger doctors no longer working solely at one hospital. One day they're at the hospital, another at a clinic, another at telehealth, maybe another nowhere. They no longer work solely at the hospital because the hospital doesn't want them there, I bet.

So why am I talking office sizes? Because sizes reflect where our health care system focuses.

Yes, I know, you'd think it'd be obvious: patient care should be the focus.

Well, it's not. Doctors' offices have shrunk because administrations have gobbled up their space and, worse, have gobbled up what used to be wards or places where doctors met groups of patients. Apparently TGH has one-third the number of beds today than back in the 1970s. (No, not one-third fewer but one-third of.) Yet the population has increased tremendously and medicine has become more complicated. Patients who used to die and be shipped out quickly, now stay in hospital to be treated, their lives saved. Other patients who used to have no options but sit sick at home now are admitted to hospital for chronic treatments. But we have fewer beds?!!

The reason why there are no beds available for patients, why we have waiting lists, is because there are no nurses and no doctors to treat them.

The reason why there are fewer beds and longer waiting lists are because health care dollars are more and more going to administrators.

And the government has facilitated that, continues to allow it.

For some reason, governments and the grumbling public seem to think that health care costs are all the doctors' fault, as if they go out into the street ringing bells, calling in patients to come and see them. Or as if doctors are overcharging and living in comfy riches. Well, maybe those natural-born Canadians who came from well-off families do. But many are immigrants, coming here with nothing. Many have huge student loans that take years to pay off. And all of them must pay out of their OHIP fees the costs of everything you see: office space, secretaries, equipment, nurses, etc. etc. The hospitals don't pay for those.

But we don't complain about how much administrators and nurse managers are paid. We don't call for cuts to their extremely generous compensation packages. We don't inspect their commodious offices and demand austerity from them. It's almost as if an administrator who doesn't treat or look after one sick person is more valued than any doctor. No, not almost. Going by their actions, the government does value an administrator more than even the most famous, the most caring of doctors.

And so in an age when one must wait 2 years to see a psychiatrist who specializes in brain injury, in an age where only one doctor in the entire biggest city in Canada conducts small bowel examinations from inside the bowel with a capsule with no risk of radiation, where waiting lists for "retired" specialists are 6 months, where too many still have no GP, where eye care is seen as optional (going blind is no biggie, you know), where physiotherapy is only for the well off (so what if pain and injuries cost you a working life and government tax revenue), and where the Ontario Drug Benefit Program pays for fewer and fewer drugs, the Liberal government of Dalton McGuinty, led by Deb Matthews, thinks cutting doctors and services even more is a good thing.

Was Deb Matthews aware of irony when said "choosing seniors over specialists." Seniors get care frm spclsts esp rare gerontologists.

Hearts get the most attention. Seniors are important to the government but gerontologists are rarer than hen's teeth. And woe betide you if you have gastroenterology issues that require a colonscopy, which many seniors do. You'll have to wait because hospitals overcharge and hold short hours, and the government doesn't want private non-profit clinics to conduct them as they charge the government less.

No, wait, that can't be right.

You'd think the Liberals in their cost cutting would prefer private clinics because they cost the government less (and also provide comprehensive care) than the big publicly owned hospitals. They have shorter wait times too, as far as I can tell. But then private doctor-owned clinics are in the business of caring for sick people. Meanwhile, because the Liberals thought it best to give hospitals one big chunk of change -- aka block funding -- with seemingly no accountability to ensure it all goes to patient care, administrators do what they do best: feather their nests. Our tax dollars now go to bureaucratic rules and bureaucratic offices. They go less and less to caring for sick people.

So why are the Liberals cutting fees and services and procedures -- why are they forcing more Ontarians to remain sick, to die while waiting -- when they could improve patient care and help the bottom line in one swoop by changing block funding of hospitals back to paying only for each patient cared for? I don't have an answer. Do you?

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