Monday, July 30, 2007

Canadian Medicare: through the eyes of Peter Gzowski

Canadian Medicare: through the eyes of Peter Gzowski

Health Care 1: Diagnosis

I am sitting on a hard chair in the X-ray wing of a very good—I am to learn—hospital. I have two gowns on: one that opens from the back, one from the front. The combination protects my modesty, I suppose, but I still feel vulnerable. They can get at me either way and stick things in me where I don’t want them to. The gowns don’t match; one is pale blue, the other green. I can’t figure out how to tie them. My scrawny legs jut out from under their hems. My knees show. My feet are encased in floppy cotton slippers, which tie at the ankle, like mukluks, except I can’t figure out how to do them up, either. My dignity is back in the changing cubicle, along with my trousers. The receptionist, young enough to date one of my sons, calls me Peter, as if I have no last name. A technician passes by without looking at me. She is in a peach pantsuit made, like my gown ensemble, of cotton. She looks sharp. Why can’t I have something like that?

I’m tense and, to tell you the truth, a bit scared. I’m sure at least one of my charts will reflect what doctors call “white coat syndrome”—blood pressure that rises because someone’s taking your blood pressure. Except as a visitor, hospitals—health-care facilities of any kind—are foreign turf for me. Not that I’ve looked after myself all these years. More, in fact, that I haven’t. And now I’m getting the works. “Chest X-ray,” the doctor said last week when, at last, I’d actually gone for a visit. “Blood tests, CAT scan, ultrasound, something-oscopy, barium ene—”

“Barium?” I said. “Don’t they—?”

“We’ll make the arrangements,” he said. “Don’t worry.”

Yeah, don’t worry. He isn’t sitting in borrowed jammies, in a world where strangers who call you by your first name stick things into places on your body even you haven’t seen.

Emmett Hall died recently, in a nursing home in Saskatoon. He was ninety-seven. The Globe and Mail called him the “father of medicare,” and so, on the radio, did I. At least one Globe reader and at least one Morningside listener wrote in to say, “Hold on, now, Mr. Justice Hall was a great man, all right, but the father of medicare was Tommy Douglas.” Well, sure, if you want. Tommy Douglas was premier of Saskatchewan when the first provincial health-insurance legislation came in, in 1962, and it wasn’t until 1964 that Mr. Justice Hall’s report was published. But that report gave us the plan for universal, national health care, and that plan, amended and expanded over the years, has been one of the defining characteristics—perhaps the defining characteristic—of the Canada we have built. Medicare helps to make us who we are. And now, as I sit bare-legged in an unfamiliar waiting room, edgily anticipating the end of my privacy, the man who mapped it out for us is gone.

The technician in peach returns. “Peter…?” she says, glancing at her clipboard. I have the impression she would try my last name, but the extra consonants dissuade her. An occupational hazard where she works, I guess. I realize, too, that my revery on Mr. Justice Hall has lasted perhaps five minutes at the most; I have scarcely been waiting at all. “Come with me,” the technician says, and leads me down the hall.

It’s not nearly as bad as I’d feared. I have been, as a doctor I know puts it, “hanging crêpe”—imagining the worst. When I actually get in to the darkness of the ultrasound room, my fears turn out to be unfounded. People are nice to me. They work quickly. They explain what they’re doing. They warm the gel before spreading it on my tummy. They make me feel…not at home, but as if I’m being looked after, cared for. Even the barium ene…well, let’s not talk about the barium, okay? The point is I’m in good hands.*

There’s a lot of pressure on those hands these days. Everywhere, governments are wondering how much of this we can afford. But the politicians haven’t been sitting in their jammies, either, thinking of Mr. Justice Emmett Hall.

I worried about a lot of things when I was in the hospital—maybe some of them too much. But one of them wasn’t money. I like it that way, don’t you?

* As you’ll see in the piece that follows, those hands and their instruments, as it turned out, almost certainly saved my life.

Taken from Peter Gzowski’s book: Friends, Moments, Countryside. Selected columns from Canadian Living, 1993 -98. Here is a review and a place to order. Great summer reading!

Methadone maintenance. Reforming practices in Ontario

The Government of Ontario has responded to task force report recommendations recommending reform to methadone maintenance practices in the province.

The full report can be found at:

Here are the links to two Toronto Star articles:

Here is the governments response:

July 26, 2007: McGuinty Government Increasing Access to Methadone Treatment: Investing $2 Million To Improve Treatment For People With Opioid Addictions

TORONTO- The McGuinty government is increasing access to methadone maintenance treatment for people with opioid addictions by investing an additional $2 million in treatment initiatives across Ontario, Health and Long-Term Care Minister George Smitherman announced today.

“Our government is committed to providing better treatment for people who are addicted to heroin and other opioids,” said Smitherman. “This new funding will allow for continuous improvement of professional services and increase awareness in communities about the value of methadone maintenance treatment.”

The $2 million announced today will be allocated to improve methadone maintenance treatment (MMT) in Ontario as follows:

$1 million to recruit more doctors to prescribe methadone and other treatments, expand training and professional supports at the Centre for Addiction and Mental Health and develop best practice guidelines for nurses, counsellors and pharmacists

$200,000 to the College of Physicians and Surgeons of Canada to enhance enforcement of best practice guidelines and quality assurance initiatives related to methadone services

$500,000 to increase public awareness regarding the benefits of MMT and issues related to opioid dependence.

$300,000 to develop a resource guide to assist in the proper introduction of MMT into local communities including the funding of local “Citizen Engagement Committees”

This brings the province’s annual total funding for MMT initiatives to $4.3 million.

After having consulted with experts in the field, the government intends to finalize changes to the OHIP fee codes that govern payment for testing performed in physician's offices related to methadone maintenance programs. This move will provide greater accountability and help to eliminate unnecessary testing and is expected to save approximately $3 million per year.

In April 2006, the government created the Methadone Maintenance Treatment Practices Task Force to provide advice on access to methadone, best practices and training, payment models, quality assurance and assessment, and community engagement. As part of today’s announcement the government also released the Report of the Methadone Maintenance Treatment Practices Task Force which outlines 26 recommendations directed at all key stakeholders involved in methadone maintenance treatment in the province.

“We want to thank the task force members for their hard work, analysis and dedication in participating in the Task Force and for lending their collective expertise to this important matter,” said Smitherman. “The government is working with stakeholders to implement several of the recommendations.”

“We are pleased the government is taking action on the recommendations of the Task Force report by increasing access to methadone treatment for people with opioid addictions,” said Anton Hart, Chair of the Methadone Maintenance Treatment Practices Task Force.

It is estimated that the social, economic and health care costs of untreated opioid addictions exceeds $1 billion including lost productivity and premature mortality along with costs associated with law enforcement and the use of the criminal justice system.