Hidden effects of current health care crisis

Surgical waitlists, crowded emergency rooms and a critical shortage of family physicians are in the regional and national news almost every evening these days.

These are the calling cards of the current health care crisis -visible, unacceptable problems in need of immediate repair if we want to save the reputation of our celebrated healthcare system.

Many other negative effects of current inadequate health care funding also exist, but remain largely hidden from the media spotlight.

One hidden effect I am particularly concerned about is the lack of time, resources, privacy and attention given to providing necessary psychosocial assessment in all areas of health care.

When I was still a medical student, there was a lot of emphasis placed in our training on this aspect of health care – comprehensive medical assessment for any condition included consideration of the psychological and social aspects of the patient’s life.

Even 30 years ago it was understood that at least 90 percent of a diagnosis in most cases depends on a comprehensive history. Obtaining such a history requires time and an establishment of rapport in a comfortable, confidential environment.

At the time there was an entire discipline known as consultation liaison psychiatry, which had the mandate to provide psychiatric services on all medical wards and ascertain the importance of psychosocial aspects of a patient’s experience in relation to all medical problems whether primarily psychiatric or not.

My first academic clinical appointment was as a psychiatric consultant to a gastrointestinal program at a major teaching hospital. Here I attended clinical rounds for all patients with gastrointestinal problems.

During this time, I participated in team conferences and had the opportunity to bring relevant psychological and social issues to light. With most patients, these issues were important to proper diagnosis and treatment.

As a psychiatric consultant I was also available to advise on environmental and professional practices that might enhance quality of care in the hospital setting.

For example, if a physician wishes to ask patients about highly personal matters, it is important to do so in a place where the patient feels confident others will not overhear their conversation.

Compare this to our current situation, where patients are often left on stretchers in hallways, closets, cast rooms and showers because of a lack of sufficient space.

What chance is there to engage a patient in conversation about intimate life details when he or she is lying in a hallway with no privacy and the conversation can be heard by anyone passing by?

I believe it is nearly impossible to understand the psychosocial aspects of health care in overcrowded, understaffed medical and surgical wards.

Practicing good medicine involves more than running tests and procedures – it requires time and a doctor/patient relationship.

Unfortunately, these important elements to quality healthcare are hard to come by in our current system and the powers now controlling healthcare seem to have no idea about those other aspects of medicine.

Medical advisory committees that used to play an important role in advising administrators in areas they were not expected to understand, have become ineffective and are not taken seriously.

Governments footing the healthcare bill are only interested in the bottom line and have no idea what is missing. The cost of this shortsightedness is paid in human suffering and other consequences of poor health care – missed diagnoses, excessive tests and unnecessary procedures.


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