About a week ago, Ontario Health Minister Dr. Eric Hoskins delivered some new proposals for managing health care in the province. The new discussion paper, Patients First, has the same name as the public relations campaign developed by the Ontario Medical Association to inform Ontario patients about the cuts to the health care system and physician services in particular. You can find the report here.
The discussion paper identified a number of gaps in care and proposed various means to deal with these but the report, like so many other similar reports, does not really address how a central government learned about or plans to improve integration of services at a local level.
The paper has been widely criticized for being short on detail by other writers but I want to address the fact that this paper was developed without sufficient consultation with doctors and patients.
As an Ontario Medical Association Board Member, I know for a fact that the content was not discussed with the OMA. The current animosity between the government and the OMA interferes with the usual pattern of consultation but how can the government actually justify not speaking with doctors through this organization? More than any other doctors’ group, the OMA, as the organization that negotiates doctors’ fees, understands exactly how medicine is practiced in a physician’s office and at the bedside. The OMA understands how care is delivered by a physician, how care is delivered by a physician with a team and how hard a doctor works to integrate that care with the community resources available to a patient. It is front line physicians who truly understand the gaps in the Ontario health care system because we are living with them with our patients. In fact, even a conversation with the OMA President himself might have helped since Dr. Toth’s main job is that of a family doctor in a Southwestern Ontario town. Gaps in the system are not theoretical for him and his patients.
The second important group not yet consulted are patients. I am not thinking about patient advocacy groups or the “public” mentioned several times in the discussion paper, but the actual person sitting in a medical waiting room wondering how this new, improved system will work. She’s heard about LHINs (Local Health Integration Networks) but isn’t clear what they do or what it will mean for her and her family if they’re expanded. She’s glad the Community Care Access Centres (CCACs) may be disbanded because they’re only providing one assisted bath per week for her mother and no housekeeping. She is surprised that the paper doesn’t mention funding at all or where it will come from. Will hospitals be better funded because of these new proposed measures so that her father-in-law can have his knee operation? The mother of one of my patients actually went to firstname.lastname@example.org – the website established to take comments or questions about the paper – to ask these questions after reading about cuts to funding on a poster in my office. She told me that she also asked whether these new initiatives will mean that her son with schizophrenia will have follow-up beyond his eighteenth birthday.
One first Nations girl I follow saw a copy of the report in my office and asked, “So who puts patients first really?” That is the question. Can the government’s view of Patients First be integrated with doctors’ views that each patient with them every day deserves a plan that puts them and their family member first? Can you do that without consulting the OMA? I believe that the government likely did talk with doctors but the reason you discuss plans like this thoroughly with the people who don’t always agree with you is that they see issues you never considered.
You also have to address each single patient’s concerns about their mother, father-in-law and son. How will home care change? When will my father-in-law get his operation? What doctor will look after my son? Addressing concerns in general, theoretical terms is not going to inspire confidence that this time the government has the answer.
I asked my patient how she would know if the government plan is working. “I’ll be able to go home,” she answered. That would be accountability for this girl who can only get care thousands of kilometers away from home. Is this too much to ask?
This new government discussion paper has lofty goals, but they seem to be built primarily on administrative changes. The paper is still too theoretical for me. I don’t want a plan that considers how to organize me away from the family doctor I like so that the Medical Officer of Health can work more closely with the Local Health Integration Network. I want a plan that will help me find an adult psychiatrist for one patient and that will let another get good medical care in her own community. I want a plan that will help in the particular as well as the collective. That puts each patient first – each real patient and the team looking after them.
Are my patients’ visions of Patients First too much to ask?