Tuesday, November 12, 2013

Canadian Healthcare–Villains Amongst the Heroes

Who is to say who is the villain and who is the hero? Probably the dictionary. - Joss Whedon

Of the many gifts that my parents gave to me when I was young, two stand out.

From my mother, I received the gift of reading and the insatiable need for constant knowledge acquisition.

From my father, I received the gift of constantly asking questions, the need to understand the “why” of things and the need to never stop asking until I was satisfied with the answer.

Both gifts came together suddenly on Saturday past when my father was admitted to hospital in Eastern Canada in septic shock and renal failure.

It turns out that he was suffering from a retroperitoneal abscess, a massive, internal pus-filled infection that has a 75% mortality rate.

Thanks to the healthcare practitioners who quickly and correctly diagnosed this condition, my father is now recuperating, fortunate to be in the 25% and not the 75%.

I am very grateful to them for their quick thinking and the result.

But as my father taught me, after an event occurs it is important to understand why this happened so that it doesn’t happen again to my father or to anyone else.

Blame is not important but prevention is.

So a little due diligence produced this interesting trail of events.

Retroperitoneal abscesses are caused by a number of things including infections introduced via hospital procedures such as routine diagnostics or surgeries.  They are also caused by bleeding within the body, including bleeding from ulcers or micro ulcers.

A little extra digging revealed the fact that my father was on an anti-inflammatory medication for 17 years as a preventative measure against a bout of arthritis he had suffered years ago.

That’s like taking aspirin for 17 years on the off-chance that you might get a headache at some point.

I spoke to a couple of doctors about the use of this medication for this long as a preventative measure and they told me that it is simply not allowed.  One doctor, when I described the use of this medication for this long, replied with one phrase, that being (and forgive the language) “Holy Shit”.

One of the interesting by-products of this medication even in short-term use is the potential for the creation of micro ulcers and bleeding and the risk is especially heightened in the elderly.  For this reason, monitoring for bleeding is required although in my father’s case, no such monitoring was performed.

Hmmmmmm …. the plot thickens.

The documentation accompanying the medication indicates that it must be used in the minimum dosage possible and for as short a duration as possible.  I wonder what the risks are from taking it for 17 years.

Exploring the doctor’s background, one quickly learns that he:

- sought to put a 20 year old male on valium to slow him down because “he works too hard”

- once put a 22 year old male on Dolobid, Feldene and Orudis (all anti-inflammatory medications used for the treatment of osteoarthritis and / or rheumatoid arthritis) and aspirin simultaneously upon receiving complaint of a sore back and without any further testing to justify the use of the medications

- sent the same young male to the hospital a short time later with the diagnosis that he was having a heart attack (he turned out to be fine although the medical team that had been alerted weren’t too pleased with the doctor).  There are known complications from the previously named medications and heart and stroke risk although the connection was never made or explored.

- told a mid 40’s patient after placing him on cholesterol treatment medication that it would be easier to treat the patient if he weren’t an alcoholic.  The patient, a non-drinker, discovered that the initial baseline liver test that is required for this medication had not been performed and the subsequent liver test for monitoring abnormal medicinal impact indicated that the liver was seriously malfunctioning (a known side effect of the medication).  Without a baseline, the doctor was blaming it incorrectly on the lifestyle of the patient and the liver function returned to normal when use of the medication stopped.

- told a female patient that the pneumonia scars on her lungs as seen in a chest x-ray were in fact the signs of lung cancer and that treatment for such was imperative.

People are still emailing me their stories.  I think these are sufficient and are verifiable with doctor-written reports, hospital reports and prescriptions.

So, as a strategy guy who asks a lot of questions (thanks, Dad – it’s all your fault), I look at past performance as a predictor of current / future behavior.

And what I see appears to be much more than coincidence.

All that being said, we must not forget  ……………..

The Canadian healthcare system is filled with many heroes, people who go above and beyond to treat an incredibly diverse collection of diseases and injuries with ever-tightening constraints in the resources that they have access to.

Such are the heroes who saved my father’s Life this weekend and I am grateful to them.

In fact, I believe all Canadians should feel grateful to have such a healthcare system, one of the best in the world.

However, it is doesn’t help the heroes when there are doctors who are actually introducing patients into the system through carelessness or negligence that probably shouldn’t have been introduced in the first place.

Maybe a prescription of litigation such as is used in the US might cure the system of what ails it.  I’m don’t know as I’m not sure if the pandemic of litigation sweeping the US is actually solving anything or just making everything more complicated.

Meanwhile, the Canadian system won’t get better if we refuse to question the actions of a few bad apples merely because we don’t want to offend the heroes in the system, because we are told that we shouldn’t question anyone with more knowledge or authority or because we are told that we should feel so grateful for the entire system that to question anything is to be expressing a lack of gratitude for everything.

And it won’t get better in cases like my father’s when doctors will privately admit that this doctor made mistakes but will not admit so publicly for fear of losing their own jobs.

The bottom line …..

The best way we can help the healthcare system and ourselves is to follow the advice of my parents when they imparted these two key elements upon me many years ago:

1. Learn all that you can – in this case, about your health and any treatment options that a doctor insists you follow

2. Don’t be afraid to ask questions until you’re satisfied, even if it means offending someone.  A good doctor will welcome questions and dialog.  Open dialog brings knowledge and understanding, both of which strengthen the relationship and the results.  Only the weak-minded or those with something to hide will get angry or defensive when the opportunity for dialog arises.  Either are a warning that perhaps a second opinion should be sought.

I was raised to always be respectful of doctors and I am, recognizing the incredible knowledge that many have, the constraints that they work within and their raison d'être, their desire to heal others.

But I think one can have the deepest respect for someone and still not be afraid to ask questions of them.

What do you think?

My questioning continues …..

How about yours?

In service and servanthood,


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