Doug Angus

Bottoms Up to the Three-Legged Stool

“My brother had a problem with one of his thumbs. A filing cabinet fell on him when he was trying to move it. He actually had surgery done on it a couple years ago and the surgeon really botched it up. He’s been trying to get it corrected. He’s now moving into three years with this problem. And he’s still in the process of trying to get an interpretation of the MRI done on his thumb… and he can’t get it! He’s an expert in tax policy both in Canada and the U.S., he understands the tax system and knows how to access it, but if he had the same access to the healthcare system and his own records, it would’ve gone a lot differently.”

Doug’s frustration is that in other countries, people’s health records are at their fingertips. “In Denmark they have access to all their health information, including all their diagnostic information, everything! Imagine if I only had access to some information on my bank accounts! I’d be off after a while to a bank that’ll give me access. I can go online and book an appointment with the mechanic for my car, to see my banker, to get my windshield replaced. If I can do so much stuff online on all these other fronts, what’s going on here? Parts of Spain, Denmark, the U.K., are getting hooked up to get access to this information. How come we don’t?

“I really don’t think that changes are going to come until it’s driven from the bottom up. This is where the policy makers, managers – even healthcare providers, as good and sensitive as they are – don’t have the incentive to make it happen until the clients or families, us as citizens, have the tools to say ‘I’m going to decide where I’m going in this system and you’re going to help me.’

“I’ve been telling students this for the past few years: We have a triumvirate that runs the health care system. The Federal government, the Provincial government, then the Medical Professionals. And there’s our three-legged stool. But nowhere in the process, other than at face value, do Patients or Families get mentioned. They’re the fourth leg. I’ve seen patients mentioned in various mission statements around the healthcare sector. But until patients have the equivalent of an ATM card that has all of their patient information on it…”

Like other CAPCH luminaries, Doug has finally concluded that health care is so sacred we need to get it away from party politicians.

“Arm’s length away from them. Since so much public money goes into healthcare there needs to be accountability to Parliament, but not to the party in power. Election years, and years between elections, are too short. If a party in power puts some reform in place, it may take 4 or 5 years to see any effect. Too long. You see a whiplash thing – in Alberta the premier just abolished the regional health authorities put in place by the previous government. They were fairly new, but they were working! But - he comes from a rural constituency, and the rural people think ‘Edmonton and Calgary always tell us what to do’ – so instead of saying to his constituents ‘We’ll work on your concerns,’ this guy abolished the regional health authorities and established this just massive, unwieldy bureaucracy at the provincial level. And it’s just a mess, he’s just seriously impaired healthcare in that province.

“Similarly in Ontario, Ontario is now allowing Family Health Teams, physicians who bring in dieticians, nurse providers, counselors, what have you. This is something that I really do applaud the McGuinty government having pushed for, not as a ‘pilot project’, but making it part of the existing system. One of my colleagues in the Faculty of Medicine came to talk to my class: they had this idea in mind years ago! When the reimbursement mechanism enabled them to put it in place, they seized it. And yet we have this rhetoric at the provincial level: ‘Kick McGuinty out, we’ll do it better!’ Healthcare just becomes the pawn of the political process.

“It’s not a question of either/or, left/right, public/private: all have really good ideas, if they could only get away from the needless counter-productive shouting match that’s going on, and say ‘What is it we need to do for the future benefit of the citizens, for the next 25 years? What can we each contribute, and combine them with what you can do?’ Part of the problem is we don’t have any leadership emphasizing what we need to do. Politicians are so overwhelmed with this need to gain power… We used to be one of the top OECD nations (Organization for Economic Co-operation & Development) in health care. We’re now in the bottom third.

“But that’s where the academics, the policy makers, could be playing a better role  – with you, the citizens. The role a government used to play has disappeared. Government needs to withdraw Health Ministries from the party in power. Make them accountable to the provincial parliament so all the parties hold them responsible for spending public dollars, but give the Health Ministries the opportunity to embark on reforms that may take some years to put in place.

“I come back to major events like the collapse of the Berlin Wall, the collapse of the Soviet Union, and I think, ‘Gee, these things can happen!’ And guess where the initiative for all these kinds of things is coming from? From the bottom up.”


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