Health Minister go visit an ER: Take Mr Eby with you!
Last night I spent 11 infuriating hours in the Royal Jubilee Hospital ER waiting to be seen. I am a retired teaching hospital specialist who has worked in Africa and India. I can attest that my experience in the ER was as substandard as I have seen in developing countries. It reflects the totality of failure of our BC government to provide the essentials of primary care (PC).
A major part of the problem is that a large chunk of the dozens of waiting-room patients have no place being in a hospital ER. All but one of the patients in the waiting area walked in unaided. No visible blood or guts. They looked no different than a crowd in a shopping mall (or average family practice clinic). The more seriously ill patients were admitted through a different entrance. Just the visibly ‘healthy’ remained. About three dozen of us. (As an aside, my medical issue needed assessment for an ultrasound). Right beside was an elderly lady who thought that the soft, malleable cap in her hearing aid was stuck in her ear after she removed the device. No symptoms. No blood. 11 hours waiting to see a busy ER doctor who would spend 20 seconds removing it. Virtually anyone with common sense could do that, including the parking lot attendant! On my other side, a young man had just broken his nose in a football game. After 10 hours waiting, I told him that there is no way that an ENT surgeon would see him at 2am and besides, most broken noses are optimally repaired after 3-4 days. We even confirmed this by looking it up on his computer. Behind me, I overheard a young woman describing her sinus infection which she had had many times prior. She waited 12 hours to simply get an antibiotic prescription.
I am absolutely confident that a physician assistant (PA) or nurse practitioner (NP), set up in an examination room in ER, could easily have seen/assessed/treated 1-2 dozen of such patients in 2-3 hours, administering perfectly adequate care allowing patients (like myself), that need to be seen by an MD without unacceptable delays. The same applies to the number of waiting patients in family practice clinics. It should be stressed that over-saturated ERs are not due to inadequate hospital facilities. Rather they represent an abject failure of provision of PC. In this regard, Canada resides near the bottom of over 20 OECD countries in wait times to see a doctor.
BC is unique in that we are the only province without an active PA program. Well over 1200 PAs are employed across Canada, where some of these programs have been operative for well over a decade. Instead our BC government prides itself on having several Urgent Primary Care Centers (UPCC), supposedly to handle exactly the sort of patients described above. The huge ER wait times attest to the complete failure, here in Victoria, of these expensive centers that have never been able to fulfill their mandates. We also lag behind several provinces in our number of NPs.
Nevertheless, our Minister of Health repeatedly boasts of the large increase in numbers of new family practitioners since the new model of reimbursement was initiated. But the current huge ER wait-times and, indeed, closures, provide confirmation that the impact of these increases is far less than predicted. The reasons for this are obvious. It may appear reasonable to talk of total numbers of newly recruited doctors but many those only work part time in FP. We have no idea what the full-time equivalents (FTE) are so we are unable to assess their actual contribution. When I directly asked Mr Dix for this FTE number he stated that it “was not available”! Furthermore, FPs don’t work at night nor weekends. So with UPCCs being completely ineffective, we still continue to have horrendously overworked, substandard ERs across the entire province which will continue unabated until think out of the box and change the model of PC.
Mr Eby, we voters have just told you how much we disapprove of your modus operandi, a major component of which is health care. We have spoken. Now it is your turn to act differently.
Dr Adrian Fine MD, FRCP (retired physician)
Spring 2024 CAPA presentation at BC Legislature - (Camille Currie, Adrian Fine, Sharman Minus)