Five simple ways to improve Canadian health care
The Conversation with U of T's Justin Hall and McMaster's Reza Mirza
Up to 30 per cent of health care is unnecessary.
That’s according to a study by the Canadian Institute for Health Information. Alarmist in its extrapolation, perhaps, but certainly indicative of a true problem.
Granted: unnecessary care is wasted time and expenditure in a system that buckles under the cost of designer drugs and an aging population. More subtle – but more important – is the actual harm caused by unnecessary health care.
We are resident physicians-in-training and we’ve joined Choosing Wisely, Canada’s grassroots movement to re-evaluate health care.
Chances are that if you visit a Canadian hospital, you will at some point receive care from a resident physician. Resident physicians like us earn the title of doctor after eight years of medical and post-secondary training, but our training continues in practice as we become experts in our chosen fields of specialty.
We provide round-the-clock coverage, staying in-house for our 26-hour call shifts.
Quality of care is the No. 1 priority
Resident Doctors of Canada, representing more than 9,000 resident physicians from coast to coast, has joined the campaign with the recent release of our list Five Things Residents and Patients Should Question.
We developed the list by reviewing existing research and generating a short list of candidate recommendations. More than 750 residents across Canada voted on the list, resulting in our final five recommendations.
The recommendations focus on measures we can take as residents to make the quality of patient care the first priority.
Our first recommendation is undeniably simple: we should only order tests that may affect our patient’s care plan.
Consider pneumonia, among the most common infections to land someone in the hospital. Despite appropriate treatment, X-rays will demonstrate pneumonia for six weeks, even after the infection has resolved. Thyroid levels, similarly, will remain unchanged for up to six weeks after medication adjustments.
And so frequent testing offers no advantage – unless you suffer from too many red blood cells (polycythemia vera) – and may tempt clinicians to tinker unnecessarily.
Needles: Not a fan favourite
Needles for blood work aren’t a highlight of anyone’s health-care experience, with the possible exception of masochists. Worse yet, the evidence is accumulating that we are basically blood-letting our patients with daily blood work while they’re hospitalized.
This is our second recommendation: avoid daily blood work in stable patients. As a patient, you should ask your physicians why we do each test and what we’re looking for, especially if you’re subjected to daily blood work.
Still on the topic of needles, why poke you with one unnecessarily? If you’re able to drink and you’re not nauseated, many of our medications are as effective by mouth as they are via your veins.
Allowing you to get up and move without being tethered to an IV (intravenous) pole decreases your risk of infection and clots, and shortens your hospital stay.
And so our third recommendation is to choose an oral medication whenever appropriate and tolerated, rather than an IV.
Avoiding invasive procedures
When investigating the cause and prognosis of illness, we have a dizzying array of options. (We find our toolbox fascinating, but we digress.) Our fourth recommendation is to use the least invasive option that is appropriate.
If a patient is in heart failure, we could order an X-ray or blood test, but we should be primarily relying on physical examination. The latter represents a cheaper, safer alternative to radiation or introducing a foreign instrument into a patient’s bloodstream.
Liberate the healthy
Finally, we strive to get patients back home without undue delay. If you’re sick and need immediate intervention, you should certainly stay in hospital. But the hospital has its risks too, from being bed-bound to antibiotic-resistant “superbugs.” That’s why our fifth recommendation is to arrange for non-urgent tests to be done outside the hospital if patients are well enough to go home.
By publishing this list, Canadian resident physicians are demonstrating our commitment to improving quality and patient safety. The next time you encounter a resident physician on the job, have a conversation with us about why more might not always be better.