Essay: A sick health system

Essay: A sick healthcare system

UPDATE ; DAY

A new book by the good doctor Alain Vadeboncoeur, an emergency physician for twenty-seven years, is always an event. Because the good doctor is resistant to jargon and is used to calling a spade a spade. And that he takes pleasure in caring for, while going against the current.

After hitting rock bottom during the pandemic, he says, now is the time to do our soul-searching, take the pulse of the patient – ​​our healthcare system – and provide them with the care they need. 

That is to say, to consider new solutions for the future, for the benefit of caregivers and patients. Because he believes that his most important responsibility, after that of caring, “is not to praise or criticize the health system – although it lends itself largely to praise or criticism – but to bear witness to it, to make its issues understood, to explain its strengths and weaknesses, to examine its workings, to teach its mysteries and above all to work to improve it”.

However, our health system, “mistreated by just about everyone”, is not to be thrown out with the bath water. Not everything is negative, he says, but there is room for improvement, and the emergency physician will tell us how to go about it, according to him, with concrete cases in support.

Be close to the pitch

It will be easy to understand that the distance is immense between the office of the Minister of Health, which manages the biggest budget of the State, and the bottom of the pyramid, hospitals and their nursing staff, doctors' offices, pharmacies, centers of long-term accommodation, etc. Between the top and the base, managers who must ensure that information flows in both directions. And above all that they are close to the field where the fight against disease and for well-being is played out.

There is no shortage of ideas, some realistic, others the most eccentric. Should we settle for a reform or not change anything in the network? he asks? Add something private or reinforce its public character? Where should we invest? How to coordinate the services offered? So many questions to which he tries to find answers. The good doctor is also a sage, like the Chevalier Olivier, in La Chanson de Roland. The greatest caution is called for, he replies. But this caution should not be an obstacle to innovation. 

Vadeboncoeur proposes to act, but at the local level above all, with the participation of all those concerned, including patients. And to cite as an example “this access point for people without a family doctor – a good idea insofar as simple one-off care rather than long-term care is sometimes all that is required”. And this local initiative, undertaken in Rimouski, Minister Dubé is working to transpose it throughout Quebec.

The false patients

The good doctor Vadeboncoeur begins to dream of the day when patient files will be computerized according to the same system and will no longer have to be sent by fax, which we wanted to implement with the reform of the former Minister Barrette, who, according to Vadeboncoeur, did not have the technical and administrative means of its ambitions. We have quite a backlog to make up for, he notes.

He also dreams of the day when medicine will first treat the sick, abandoning the “well” who by the thousands rush to the doctor to be reassured about their state of health. 

“A significant part of the medical work is devolved to those healthy people who may not be asking for so much.” Unfortunately, we spend a lot to treat the little discomforts, the little worries of these healthy people. The cost of this unnecessary care is estimated at five billion dollars a year. 

This can represent between 10% and 20% of unnecessary visits to the doctor. It's a lot. Eliminating them would certainly make it possible to better take care of the chronically ill, the elderly with loss of autonomy and those who spend too much time in the emergency room.

In short, when we chose to work in improve the health of others, we can only be steeped in humanity, he claims, and we would like to believe it. Alain Vadeboncoeur as Minister of Health? Why not.