Discussion: What Do You Think Is The Biggest Problem Facing The Canadian Medical System Today?

[AAAmeds]

See title for question! Happy discussing!

IMO, (very) long wait times and (lack of) access to health care in rural and isolated are two big problems that we have!

[MountainAmoeba]

I would guess poor management and prevention of chronic diseases.

[AAAmeds]

I would guess poor management and prevention of chronic diseases.

Can you elaborate a little? any specific examples you have in mind?

[rmorelan]

let me add some new ones for thought (I am putting this out as a point of discussion more than anything - this is arguable and I am not stating it as something I completely agree with). Mostly because we don't talk about this sort of thing. 

 

the system is unsustainable in terms of funding with every increasing costs due to both an aging population and also simply the cost of health care per person will continue to increase as advancing technology will always result in better treatment options that also will cost more. All the upcoming advanced treatments are exciting and yes also more expensive. Costs will continue to increase faster than the underlying tax base. We simply cannot increase funding to help care at this point - if fact our health care budget compromises other areas of our society that also improve health (noticed your tuition payments lately for instance and the loans you have - what is the impact on our society's health of that?). 

 

the long wait times, lack of rural access - lack of access in general, the raging issues with doctors etc all ultimately stem from this underlying cause. 

 

Hospital management can and must improve - resources must be optimized. However even optimal management of resources cannot overcome the forces at play. If 20 people have to sit down at the same time and there are 10 chairs management cannot solve the problem (leadership will but that is a different story). Care simply costs and will continue to cost more and more than what we can afford. Since the problem is unsolvable and yet everyone is so attached to be being solvable politically and for our overall Canadian identity the end result is endless attempts at distraction, redirection, increased cries for oversight and shifting resources to improve that aspect of the overall failure that people happen to notice (emerg acceess, wait times for a particular thing be it cancer, hip replacement, eye surgery, family doctor access........), and blame on parts of the system that are expensive (like doctors, medication, hospital administration, or chronically ill patients). None of this solves the problem. 

 

If management cannot solve this problem - then leadership must be used instead. One definition of leadership is convincing people do to things that are likely unpleasant - not because you told them to do it, but because they want to. 

[MountainAmoeba]

Yeah, for sure.

 

Specifically preventable diseases, that unduly burden the health care system.

 

COPD

Diabetes

HTN

CAD

Renal Disease

 

Etc.

 

We need to do more to prevent them, and then when they manifest we need to enable people to have meaningful control of their disease, and become better at preventing hospitalizations.

[rmorelan]

I will say as well for the sake of those interviewing - what ever you have a  problem in the system make sure you also have a solution You don't want to get caught on the follow up

[ralk]

Coordination of care.

 

Nothing in our medical system is standardized. Even within individual institutions and departments, physician rules and responsibilities are poorly defined. When they are, they're often ignored. Communications between providers can range from virtually nothing to being so expansive they're functionally useless. Even when communication is good, no doctor trusts what another says without direct verification. Referral systems are a joke, with issues both from those making the referrals and those receiving them. Records are variable and frequently inaccessible. The abundance of trainees doesn't help either, especially since medical training suffers from the same lack of standardization as medical practice.

 

So much miscommunication. So much duplication of work. Patients who have no idea what's going on with their care and subject to frequent delays in receiving service. And if something goes wrong, it's usually someone else's fault, because when everyone's responsible for a patient's well-being, no one is.

 

We need to start functioning like more of a team for our patients and less like individuals who just happen to have similar goals.

[Sauna]

I’m gonna throw out an unpopular opinion here (for the sake of stimulating discussion) that would be risky to bring up in an interview situation, but nonetheless one that I hold strongly:

 

- Aging is the #1 risk factor for every major disease

- Aging is the #1 co-morbidity of every major disease

- Aging meets every definition of a disease, yet is not considered a disease.

 

Aging is simply the gradual deterioration of physiological function and accumulation of metabolic damage over time. The inevitability of growing old and senile has become so deeply engrained within our minds, that we consider this pathological process “normal”.

 

And yet, the process of aging is one that is susceptible to medical intervention, as well as lifestyle interventions. It’s becoming more clear now that control and manipulation of this process is not some unattainable fantasy, as evidenced by the rise of Calico (receiving a $240 million investment from Google) and HLI (receiving a $220 million investment April 2016).

 

Given this, I strongly believe that a paradigm shift that prioritizes going after the process of aging itself, rather than individual diseases, is one very promising preventative solution for our colossal health care costs and overburdened system, while also significantly increasing quality of life.

 

I suppose this isn’t necessarily Canada-specific, but I would say it is the biggest problem our system faces BECAUSE not enough people even recognize it as a problem yet. This approach has only emerged recently, and from looking at History, it’s probably going to take a while to catch on. A combined effort from not only physicians, but also researchers, public health officials, and virtually every other health care profession is required to make this possible.

[AAAmeds]

let me add some new ones for thought (I am putting this out as a point of discussion more than anything - this is arguable and I am not stating it as something I completely agree with). Mostly because we don't talk about this sort of thing. 

 

the system is unsustainable in terms of funding with every increasing costs due to both an aging population and also simply the cost of health care per person will continue to increase as advancing technology will always result in better treatment options that also will cost more. All the upcoming advanced treatments are exciting and yes also more expensive. Costs will continue to increase faster than the underlying tax base. We simply cannot increase funding to help care at this point - if fact our health care budget compromises other areas of our society that also improve health (noticed your tuition payments lately for instance and the loans you have - what is the impact on our society's health of that?). 

 

the long wait times, lack of rural access - lack of access in general, the raging issues with doctors etc all ultimately stem from this underlying cause. 

 

Hospital management can and must improve - resources must be optimized. However even optimal management of resources cannot overcome the forces at play. If 20 people have to sit down at the same time and there are 10 chairs management cannot solve the problem (leadership will but that is a different story). Care simply costs and will continue to cost more and more than what we can afford. Since the problem is unsolvable and yet everyone is so attached to be being solvable politically and for our overall Canadian identity the end result is endless attempts at distraction, redirection, increased cries for oversight and shifting resources to improve that aspect of the overall failure that people happen to notice (emerg acceess, wait times for a particular thing be it cancer, hip replacement, eye surgery, family doctor access........), and blame on parts of the system that are expensive (like doctors, medication, hospital administration, or chronically ill patients). None of this solves the problem. 

 

If management cannot solve this problem - then leadership must be used instead. One definition of leadership is convincing people do to things that are likely unpleasant - not because you told them to do it, but because they want to. 

Thanks for the detailed post. I agree with the points you made, but I am a bit confused on how leadership can resolve this seemingly unresolvable problem. Can you elaborate a little bit?

[rmorelan]

Thanks for the detailed post. I agree with the points you made, but I am a bit confused on how leadership can resolve this seemingly unresolvable problem. Can you elaborate a little bit?

 

well if you believe that leadership can convince people to want to do things that are unpleasant or against their interests for the greater team/good etc, etc. then it can help in a lot of ways. If you have an unsolvable problem then you need to convert the situation into something that can be solved. 

 

For starters to extend my example leadership would make it so 20 people didn't want to set down all at once. Some might not sit down at all, others only for a short time. Leadership is what escapes the boundaries of the problem ha. 

 

Some people think we could solve the issues with funding with a 2 tier system - getting everyone to agree to that and make a new system that works would be a huge leadership problem but still a problem that could only be solved with it. 

 

but that is just one approach. We could also redefine what we do provide in terms of care. As a point of discussion the actual wording of the Canada Health Act says all necessary health service must be insured. We provide a lot more than what is medically necessary. Some people think that is actually a big part of the problem but talking about that is a difficult conversation. As an example - end of life care - what exactly is necessary and what isn't? What is we actually sat down and told everyone what that meant, and required by law that people actually have on file somewhere what they want. 

 

We could find ways to increase the funding for health care - that would ultimately mean more taxation in some form. Again not popular ha.

 

I guess a point I am trying to make with this is that there is a big difference between management and leadership. To be honest I think that leadership from doctors is somewhat lacking. That isn't all that surprising mind you - doctors are very busy, have urgent needs with their patients, and the entire system is based on us treating one person at time with all our best efforts. Leadership is about looking at big picture stuff and we simply don't do that regularly - we lack the training, and we lack any from of reward for doing so (leadership doesn't pay very well, ha). Yet we have to do better. 

[yungmd37]

I’m gonna throw out an unpopular opinion here (for the sake of stimulating discussion) that would be risky to bring up in an interview situation, but nonetheless one that I hold strongly:

 

- Aging is the #1 risk factor for every major disease

- Aging is the #1 co-morbidity of every major disease

- Aging meets every definition of a disease, yet is not considered a disease.

 

Aging is simply the gradual deterioration of physiological function and accumulation of metabolic damage over time. The inevitability of growing old and senile has become so deeply engrained within our minds, that we consider this pathological process “normal”.

 

And yet, the process of aging is one that is susceptible to medical intervention, as well as lifestyle interventions. It’s becoming more clear now that control and manipulation of this process is not some unattainable fantasy, as evidenced by the rise of Calico (receiving a $240 million investment from Google) and HLI (receiving a $220 million investment April 2016).

 

Given this, I strongly believe that a paradigm shift that prioritizes going after the process of aging itself, rather than individual diseases, is one very promising preventative solution for our colossal health care costs and overburdened system, while also significantly increasing quality of life.

 

I suppose this isn’t necessarily Canada-specific, but I would say it is the biggest problem our system faces BECAUSE not enough people even recognize it as a problem yet. This approach has only emerged recently, and from looking at History, it’s probably going to take a while to catch on. A combined effort from not only physicians, but also researchers, public health officials, and virtually every other health care profession is required to make this possible.

 

Just going to play the devil's advocate here - do you not think that combatting aging will contribute to decreased mortality rates, leading to overpopulation and thus (once again) an increased burden on the healthcare system?

 

Aging is definitely one of the biggest determinants of disease, but one must consider that this process is essential to ensure continued progress of our society and humanity as a whole. Sure the ability to slow, or even reverse, aging would be great for the immediate future (with decrease mortality leading to increased productivity in pretty much every country), but one has to consider the long term consequences - an increased population size with the inability to age will most probably lead to exponential increases in population size over generations, as none of the old generations will be removed from the population. This leads to increased burdens of non-aging related diseases (such as purely genetic diseases, environmental diseases, nutritional diseases, etc.) on the healthcare system due to an increased volume of patients it must deal with.

[rmorelan]

Just going to play the devil's advocate here - do you not think that combatting aging will contribute to decreased mortality rates, leading to overpopulation and thus (once again) an increased burden on the healthcare system?

 

Aging is definitely one of the biggest determinants of disease, but one must consider that this process is essential to ensure continued progress of our society and humanity as a whole. Sure the ability to slow, or even reverse, aging would be great for the immediate future (with decrease mortality leading to increased productivity in pretty much every country), but one has to consider the long term consequences - an increased population size with the inability to age will most probably lead to exponential increases in population size over generations, as none of the old generations will be removed from the population. This leads to increased burdens of non-aging related diseases (such as purely genetic diseases, environmental diseases, nutritional diseases, etc.) on the healthcare system due to an increased volume of patients it must deal with.

 

ha that is an interesting route One of the questions from that is what would the birth rate have to be if people were immortal. We would still die due to traumatic injuries, infection, suicide, war..... If we are truly immortal the rate of death would still be proportional to the population - but unless we also make ourselves fertile forever the birth rate would actually not be proportional as an increasingly small part of the population could give birth over times (increasing more people would be over 45-50 years old). There is a steady state point from both of those factors where the forces equalize. Where that point is depends on the rates.

 

Right now we have a falling population in almost all highly developed countries and rely on immigration - we don't talk about that enough I think. Those are the sort of countries that could support the technology to dramatically extend life as well.  The more developed we become the lower the birth rate is. One interesting question I guess is how low would the birth rate get? How close would it be to the death rate with "immortal improvements" in the future. Right now we are about 1.6 births per person (including our immigrant population which historically is quite a bit higher than the rest of the population - remove them and that rate will fall further). We need at least 2.1 in order to match our population. That actually is a big gap and it seems to be widening. Also of note around 50% of the world population lives in a country with sub replacement fertility rates. 

 

This can be really theoretical ha - point is I guess increasing the lifespan of our population won't matter in terms of population growth until we at least reach the death rate. We actually have quite a bit to go until we are there. Some people argue that we don't actually have a choice but to figure out how to extend our lifespan to bring those two things close together. The long range goal would be to increase the standard of living in most countries in the world - if we do that then increasingly countries while shift if the trends hold to having lower birth rates, and falling populations. 

 

as a side note this is what is so strange about all the anti-immigration arguments, and complaints about the cost. We can no longer get immigrants from other developed countries (which were our original sources). Those countries are also falling in population. Either we take in large volumes of people (who also happen to for the next generation also has an increased birth rate) or we shrink and the system fails as the tax base evaporates. So we pay the cost now or pay a much higher price later. Doesn't matter what side of the political spectrum you happen to be on - those are just the reality of our situation. 

[Sauna]

Just going to play the devil's advocate here - do you not think that combatting aging will contribute to decreased mortality rates, leading to overpopulation and thus (once again) an increased burden on the healthcare system?

 

Aging is definitely one of the biggest determinants of disease, but one must consider that this process is essential to ensure continued progress of our society and humanity as a whole. Sure the ability to slow, or even reverse, aging would be great for the immediate future (with decrease mortality leading to increased productivity in pretty much every country), but one has to consider the long term consequences - an increased population size with the inability to age will most probably lead to exponential increases in population size over generations, as none of the old generations will be removed from the population. This leads to increased burdens of non-aging related diseases (such as purely genetic diseases, environmental diseases, nutritional diseases, etc.) on the healthcare system due to an increased volume of patients it must deal with.

 

 

ha that is an interesting route One of the questions from that is what would the birth rate have to be if people were immortal. We would still die due to traumatic injuries, infection, suicide, war..... If we are truly immortal the rate of death would still be proportional to the population - but unless we also make ourselves fertile forever the birth rate would actually not be proportional as an increasingly small part of the population could give birth over times (increasing more people would be over 45-50 years old). There is a steady state point from both of those factors where the forces equalize. Where that point is depends on the rates.

 

Right now we have a falling population in almost all highly developed countries and rely on immigration - we don't talk about that enough I think. Those are the sort of countries that could support the technology to dramatically extend life as well.  The more developed we become the lower the birth rate is. One interesting question I guess is how low would the birth rate get? How close would it be to the death rate with "immortal improvements" in the future. Right now we are about 1.6 births per person (including our immigrant population which historically is quite a bit higher than the rest of the population - remove them and that rate will fall further). We need at least 2.1 in order to match our population. That actually is a big gap and it seems to be widening. Also of note around 50% of the world population lives in a country with sub replacement fertility rates. 

 

This can be really theoretical ha - point is I guess increasing the lifespan of our population won't matter in terms of population growth until we at least reach the death rate. We actually have quite a bit to go until we are there. Some people argue that we don't actually have a choice but to figure out how to extend our lifespan to bring those two things close together. The long range goal would be to increase the standard of living in most countries in the world - if we do that then increasingly countries while shift if the trends hold to having lower birth rates, and falling populations. 

 

as a side note this is what is so strange about all the anti-immigration arguments, and complaints about the cost. We can no longer get immigrants from other developed countries (which were our original sources). Those countries are also falling in population. Either we take in large volumes of people (who also happen to for the next generation also has an increased birth rate) or we shrink and the system fails as the tax base evaporates. So we pay the cost now or pay a much higher price later. Doesn't matter what side of the political spectrum you happen to be on - those are just the reality of our situation. 

Yeah we have a degree of manipulation over the birth rate. For example, having less kids is a sacrifice we as a society can very well make in exchange for ending aging and the major diseases (and therefore the suffering of millions).

 

There is also no longer such thing as an independent field. If you walk into a hospital, every machine in there is made by an engineer - to the point where medicine wouldn't be what it is today, with our diagnostic imaging and robotic surgery, without engineers. Likewise, aging is not exclusively a bio-medical problem - so by the time overpopulation becomes a problem I suspect there will be other advances made in other fields (most notably, efficient energy and space exploration) to counter it.