Dr. Brian Day @DrBrianDay Twitter

  • Past President Canadian Medical Association
  • Past President Arthroscopy Association of North America
  • Honourary Associate Professor University of British Columbia
  • 2014 Doctors of BC Don Rix Leadership Award

Address to the Annual Meeting (QMA)

Apr 19, 2008

Quebec Medical Association

"Building Momentum toward a Patient-Focused Health System"

Dr. Brian Day
Canadian Medical Association

Good afternoon.

It is my pleasure to be here today and thank you all for the opportunity to speak to you.

Before I begin, let me apologize for the fact that I cannot address you in my favourite language, which is French. My schooling was in post-war Liverpool, where I was given no choice but to learn Latin, German and English.

In order to make amends for my deficiency, I have made certain that all of my 6 children are French speaking and one of my sons Jonathan, who was with us last night at the QMA fun night, lives here in Quebec.

My friend, our colleague and your next CMA President, Dr. Robert Ouellet, has tried to teach me a few French phrases, but he told me to stop trying because, I was a bad student, had a terrible accent and I was spoiling a beautiful language.

As I have traveled across Canada to speak with our colleagues these past eight months, I have noticed a growing momentum for change that owes much of its origin to initiatives here in Quebec. I tell Canadians that we are indebted to Quebec, where the people and the doctors, stand strong in the assertion that the status quo in health care is not acceptable.

As Ronald Reagan once said, "status quo" is Latin for the mess we are in, and it seems that Quebeckers understand Reagan's version of Latin.

Quebec is considered the social policy laboratory of Canada and history certainly lends some credence to that. It is no coincidence that the Supreme Court of Canada challenge against the suffering of patients on wait lists was a Quebec initiative.

It is appropriate that the recent Castonguay Task Force has confirmed the need for change here in Quebec. This important report will have a significant impact on the future of Canadian health policy reform.

A Pollara poll of just a few months ago revealed that 68% of Canadians believe that the Canadian health system needs major reforms, or a complete rebuild. The percentage in favour of a complete rebuild was by far the highest here in Quebec.

With 68% support amongst the electorate, why aren't all parties jumping on this as a main platform? Any political guru will tell you that with 68% support, you need not worry about any opposition, because post-election with such a majority, there won't be any opposition. Polls consistently show that come election time, health care is the number one issue in the minds of voters.

Today I would like to discuss some examples of how the growing momentum for change is overcoming the barrier to reform in our health care system.

I will talk about how this presents a unique opportunity for the CMA and the doctors of Quebec to step up our advocacy efforts as never before, and maintain the momentum for change and improvement. Nothing less than number 1. Nothing less than the best. That should be the goal for our health system.

Everyone in this room recognizes that health care costs are a significant and a serious challenge for governments.

Remarkably, we do have some who even deny that costs. The facts are plain. There has been a 400% rise in health costs between 1984 and 2005, with just a 25% rise in population (2005 dollars). That is unsustainable inflation.

Demographic pressures of an aging population of baby boomer patients and doctors, and new expensive drugs and medical technologies, add tremendously to costs. New and effective drugs are now available that cost up to $700,000 a year to fund. So far, they are mostly for rare diseases. What will we do when effective drugs of that price become available for common diseases?

For just one example in my specialty, knee replacement, the numbers being done are projected to rise by 670 % within 18 years.

Canadians will have to choose which services are to be covered by our publicly financed health care insurance.

As the World Health Organisation has stated, "If services are to be provided for all, not all services can be provided".

Of course, as the Castonguay task force pointed out, making those choices - even discussing them - is anchored in ideology and weighed down by dogma.

Instead of a system that works for patients, we have patients that are forced to work the system as they languish on waiting lists.

At the CMA's Taming of the Queue conference this week, we sat in silence as an emergency doctor told the story of 5 patients dying in his hospital's waiting room in one day.

We heard last week of the general surgeon who had to cancel surgery on 6 breast cancer patients in one month. Those in charge should be relieved that there aren't riots in the streets. Canadians are too nice.

On costs, let us be clear on the reality that our failure to provide timely access comes with a major cost, both medically and financially.

In January, the CMA released new research showing that, in addition to the human health cost and suffering, patients waiting for care in just four priority areas targeted in the 2004 First Ministers Health Accord, cost the Canadian economy 14.8 billion dollars in 2007.

The cost here in Quebec alone was over $2.8-billion in that year.

The estimates in this study are extremely conservative and don't, for example, include the growing, and significant costs of waiting to see the GP or specialist.

They do not include the costs, short and long term, of the deterioration that occurs while waiting.

Imagine the costs if all of these were included, in all areas of clinical care.

Patients deteriorate while they wait. They sometimes develop chronic and severe irreversible damage, addiction to painkillers, and depression. It need not happen. It has to stop.

Last month a report, published in Chronic Diseases in Canada, estimated the economic cost of mental health in Canada to be a staggering $51 billion. That's a lot of money. Re-invested into the health care system, that would be a huge benefit.

Canadians are spending vast amounts of money in order to limit access and keep people waiting. We are paying to prevent patients getting better. The prevention of patients getting better is not what doctors mean when we talk about preventative medicine.

A study released last month by the European-based Health Consumer Powerhouse, comparing Canada's health system to 29 European countries, ranked us 23rd overall - alongside countries such as Slovenia, Rumania, and Lithuania. We came in last - 30 out of 30 - in terms of value for money.

Many countries have universal care, no wait lists, and cost the same or less to run as ours does. Wait lists can and must be eliminated in Canada. The momentum to do just that is growing and it is growing around a movement to empower patients and to shift the focus to patient care.

The CMA believes we need what some have called a "Copernican revolution" in health care.

Just as Copernicus, and later Galileo, proved that the Earth wasn't the centre of the universe, so must we develop a model where the system revolves around the patient, not the other way around. Patients have been the "Pluto" of the solar system - hardly even considered a planet. We need to place the patient at the centre of our health-care system.

This change needs action and leadership.

We must eliminate block funding or global budgets of institutions, in favour of patient-focused funding. This idea is supported by the Castonguay Task Force. And by Senator Kirby. And by the CMA. In the words of your president, Dr. Trudeau, "Clinicians and managers must see patients as a source of revenues, and not as a source of expenditures."

Building incentives to treat patients will return patients to their rightful place at the centre of the health care system, and stimulate healthy competition.

The Organisation for Economic Co-operation and Development has stated unequivocally that patient focused funding will increase productivity and reduce wait lists, even in primarily government operated systems - and even in rural hospitals.

The opportunity and the momentum for change is growing. Apart from Quebec, other recent health policy activities indicate growing support for change and for the idea of patient-focused funding.

In BC, we have seen success with new emergency funding models based on performance. There are initiatives to add the principle of accountability and sustainability to our health laws. The recent BC provincial budget has added further resources to this effort. Patients will reap the rewards through improved care and access.

New Brunswick has released a new health plan, with a major focus on improving access, supporting innovation and will examine a shift to patient-focused care and funding. Alberta and Nova Scotia are taking steps in reform.

We must not let the Canada Health Act stifle innovation. It must not be a barrier to improvement and progress. It is a federal Act that is based on principles developed over 45 years ago, and must be updated for the 21st Century. The Canada Health Act must not be used as a mechanism to maintain the status quo.

Governments have a legal, moral, and economic duty to deliver timely care. The aging baby boomers are informed, active, and impatient. They will not want to wait, nor should they.

Successful partnerships with the private sector have helped shorten wait lists in many key areas, but more work and more cooperation is needed.

My colleagues and I opened the Cambie Surgery Centre in 1996, in the middle of a long, 10 year, tenure of the NDP government.

We opened in response to pressures of massive wait lists. 450 of my patients were on a list -, and rationed time in the O.R. My personal OR time dropped from 22 to 5 hours a week - 10 hours less than recommended for maintenance of competence by the Canadian Orthopaedic Association.

We have helped eliminate wait lists for injured workers, and other groups. We have helped retain and repatriate health workers in BC, and we are a valuable part of the Canadian health system.

We are always patient focused.

I believe the same can be said of our CMA President-Elect, Dr. Ouellet, and other physicians here in Quebec.

It is time to assign the private-public rhetoric on health care to its true and deserving place in Canadian health policy. It is a relic of tedious and tiresome propaganda and falsehood that is undeserving of debate.

The fact is that the private sector props up our health system now. Philanthropic efforts fund many, many, capital projects in health care in Canada. Not to mention the private contributions made by the 80,000 charities that are, for the most part, not even accounted for when we calculate health costs in Canada.

Canadians know that a vibrant economy and a successful business culture are absolutely necessary if we are to fund health care and other social services.

When I gave a talk at the Empire Club in Toronto several months ago, the Registered Nurses' Association of Ontario held a conference to denounce the content of my speech - 2 hours before the speech, and before they knew what I was going to say! In so doing, they denounced private insurance.

They had no response to the observation that their website advertised multiple levels of private health insurance for themselves and their members! In fact, 70% of Canadians have private insurance that covers many medically necessary services.

The QMA's continuing efforts to cut through the political rhetoric will bear fruit. Our patients are counting on us to keep health care at the top of the political agenda, here in Quebec, and across the country.

We must speak out for our patients.

The CMA's current "More Doctors, More Care" campaign is designed to spur our politicians into taking action. We want a patient-focused system that is accountable, effective, efficient and sustainable.

Such a system can't exist without enough doctors. We are 26,000 doctors short of the average in developed countries, and we now lag behind at 24th in the world in the number of doctors per population. In 1970, we were 4th.

Fifteen hundred young Canadians are going to medical school in foreign countries. These are "A" students, Canadians, who have been forced to leave the country for their medical training.

In the short term, we need to encourage them to return (most don't), but in the long term, we need to expand capacity and create new medical schools.

Here in Quebec, this very issue is playing out right now as medical school enrolment has increased significantly, but the schools are full and need more funding for preceptors.

Many thousands of Canadians have supported the "More Doctors" campaign by sending postcards to the Prime Minister and urging immediate action. These postcards are available at moredoctors.ca, so please consider joining our effort.

We are pressing governments to increase our capacity to train health professionals, to support research, to collect and evaluate data on Canada's health workforce, and to increase dramatically the use of electronic medical records by physicians.

As we look to the future and a truly patient-focused health care system, the role of technology cannot and must not be ignored. However, in a recent survey of doctors' use of electronic medical records in 8 developed countries, Canada came in last.

Investing in physician office automation will improve the flow of information, and will lead to improved productivity, improved research data, and better care of patients.

We should be ashamed that we only spend a third of the OECD average on IT in our hospitals.

Canada's poor record in avoidable adverse effects and hospital deaths is, in part, due to the absence of available information in a timely manner. We must document, measure and analyze all data relating to hospital, physician, and patient services.

Patient care and safety often require us to share medical information. Without electronic records this is cumbersome, inefficient, and often impossible. We need IT to establish and track outcomes and perform measurements that will drive improvement.

A patient-focused system demands that data on hospital performance and quality be made available to them - as it is in many countries.

The CMA considers IT to be a cornerstone to building a truly patient-focused health care system for the 21st century.

I recently had the opportunity to launch the first-ever made in Canada personal health record that lets patients communicate securely with their physician.

This personal health record operates through the mydoctor.ca portal created by Practice Solutions, which is a CMA company. Larry Mohr, the President of Practice Solutions and one of the visionaries behind this initiative is with us here today.

The Personal Health Record represents a giant leap forward in the use of technology allowing physicians to register their patients to use online tools such as an asthma tracker, blood pressure tool and weight tracker. The massive burden of chronic disease in Canada, will be helped greatly by this initiative.

Designed by physicians, the portal also provides secure messaging through a private channel of communication between patient and doctor. This initiative is about medicine, and the CMA, evolving to meet the needs of 21st-century patients.

I believe that there is growing momentum to overhaul our health care system so that we can deliver efficient, effective, universally accessible health care that is second to none.

The people and doctors of Quebec will have the strong support of the CMA as they continue to lead and provide the momentum for change. Looking forward, I predict that we will succeed. Quebec is ideally positioned to lead Canada in achieving that success

Governments must act and recognize that inappropriate wait lists can be eliminated in Canada. Other countries have achieved this, and are reaping the benefits. Canada must address the shortage of doctors. We must become self-sufficient in terms of educating and training enough health professionals Similarly, patient-focused health care requires patient-focused tools, such as the personal patient health record.

For our health system to be ranked at the bottom when compared with 29 European countries in value for money, must be a wakeup call. Rising costs, together with economic data that shows we are actually paying to keep people on wait lists, should be a wakeup call. The massive shortage of doctors in Canada, in part caused by misguided government policy is yet another wakeup call. So let's wake up!Last fall, our Governor General said Canada is the greatest country in the world.

Our goal must be to build the best health care system in the world: one that is truly patient focused. We can do it. You can make it happen. Thank you.