I have been following an interesting story in the newspaper. I don’t want to even get into the particulars but it really has me thinking.
Here in Canada we have a wonderful medical system with free health care for all. With my health issues you can’t even imagine how grateful I am for that, it truly is wonderful. Majority of which is paid for by the Government, well via our tax dollars. Really, what could be better?
As with any system though it does have it’s limits as there just never seems to be enough money alloted to meet every need or to meet the need on what is seen to be a timely basis. I want no one to take me wrong, I am very grateful and appreciative of our medical care system. In this post it is more like I am wondering or thinking to myself about the system when stretched to its limits. The system naturally works withing budgetary restraints. With these restraints in mind it then falls to the various health authorities, hospitals and doctors to allocate the time and resources in the most practical and efficient manner. I say fair enough.
Now I am not sure how to word this to get my real meaning across. With the budgetary restraints, with the shortage of doctors, nurses and health care professionals, some one some where has to be making very difficult decisions. It must be decided based on both the budget and man power available, who do we treat and who do we not treat? Now I am sure the most obvious answer would be to treat the most critical patients first and I say right on to that, that is as it should be.
But is it really that simple. I am of two minds with this issue and am simply posing a questions to any that may care to answer. I will then give several areas of medicine that come immediately to mind that are causing me the confusion in my own mind. Maybe you can help me resolve this issue I do know where I stand on it.
Question: Should our health care system, should doctors be required to treat everyone with the same quality care to either improve quality of life or to extend that life? Sounds simple, but is it?
There is a huge shortage of family doctors here in Manitoba. These family doctors have only so much time in any given day to devote to patients. How does that doctor ration his time? Should he turn away the really sick or the elderly because they may take up more than “their fair share” of his time? In the time it would have taken to tend to one person with serious multiple conditions he/she could have tended to 3 or 4 others with less serious demands on his/her time but that still do need his attention.
How do doctors balance their work loads in the most effective way? One way would be to eliminate patients with riskier life styles or habits that can have a negative impact on their lives. But one example I know of is that many doctors will refuse to treat smokers. I suppose the idea being that, I have many patients to pick and choose from and if you are not willing to do something more to improve your health such as quit smoking then I am not going to give you my time. I will devote the time to those willing to do their part to improve their health lives. I can see the point but how far can this line of thinking be taken, I wonder? What about someone that is over weight, constantly taking in to many calories? They are not doing everything they can to lead a healthy life style. Should they be culled from the patient list? The potential for this list just goes on and on, drug addicts, sex trade workers, gang members……. How do we as a society determine how we get the most out of our medical dollars? Let’s look at it from a slightly different angle, what about those that willingly and knowingly engage in extreme and dangerous sports? You willingly and knowingly engaged in a risky sport or what ever, where should you fit into the strained medical budget?
I am not sure how well I am wording this but our Canadian medical system has a limit on its resources annually. Every day someone out there be it the doctors, the health managers someone is making almost God like decisions as to who will and who won’t be treated or at least in the priority in which they will be treated. Do we have some sort of guidelines in place to help with this decision making process?
Let’s take a look at the terminally ill or those with multiple chronic conditions. Is there or should there be a point when the medical professionals just say enough is enough. We have already spent to much of our stretched budget on this person. There is no hope of a medical recovery so just “pull the plug”, let’s devote our resources to someone that we have a chance of curing. Bluntly, that would be the most cost efficient way of managing the budget but certainly not maybe the most humane way. I am not trying to imply this is indeed the case. I am just asking as someone out there is daily making this sort of decisions. In every case the situation will vary and circumstances will vary, but are there some sort of rough guidelines in place?
I would like to be able to say that I know everyone gets the same quality care from every doctor. But, I know that is not true. There is my example of doctors refusing to treat smokers. I have my own personal example or story. When I first moved here to Winnipeg, it was to be closer to my health specialists, all of whom are really excellent. But even with all my specialist is place I still needed a family doctor. Here in Manitoba there is an office you can call that has a list of all doctors accepting new patients. Great, I thought, that is until the first 4 refused to accept me as a patient because I was to complicated with my medical conditions, I would be to time consuming. I will never forget the exact words of the 4th doctor. “Taking you on as a patient would be a waste of my time”. Lucked in on the 5th try and found Dr. C. he has been excellent.
I ask all what are your thoughts on this.