Prevention = Simplicity

Health: A state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity.

- World Health Organization

I figured out the connection between my recent anti-smoking tirade and simplicity in healthcare: Prevention = Simplicity.

So much of what we consider modern medicine is acute-care, high-tech, expensive rescue treatment for conditions related to behaviour. Think of sun exposure and skin cancer, obesity, driving while intoxicated, and of course, all the illness caused by tobacco addiction.

I wonder if some health economist has done the math on the relative cost of interventions to prevent disease and interventions to rescue us from the effects of disease? I suppose it would be (relatively) simple to tally up the cost of chemotherapy drugs or ICU stays, but I wonder how human suffering fits into that equation?

The ultimate simplicity is to avoid all those illnesses with primary prevention. But, healthy living is so boring. How can you compete with all those commercials for fast food? (Mmmmm, bacon.) Look how much fun those guys are having at the bar. ("Drink responsibly")

We need a marketing campaign for healthy living.

Maclean's interview with Sholom Glouberman: More on PFCC, EMR and patient experience

Here's a great interview with Sholom Glouberman, founder of the Patients' Association of Canada, is yet another illustration of how poor system design interferes with patient care.

Points of note:

He is an intelligent, confident man with extensive experience in
healthcare, yet he describes his experience as "passive".

Physicians weren't aware of key clinical information, even though it was apparently written in his chart.

Staff signatures were often illegible. His take on the possible
reason for that is interesting. I always thought it was just poor habit,
but he has reason to suggest it may be deliberate.

I particularly note one of his final points. When he is asked whether patients are being asked to participate on healthcare planning and operational committees, he says:

It’s beginning to happen. There are patients on boards of hospitals and health care organizations now. But the patients have to be trained up so that they’re not taken over by the system, and they have to have support. That’s why we need a patients’ organization that stands behind them and is a place where they can come to for resources and for help.

A mother's voice speaks loudly and clearly for EMR and PFCC

"Anonymous" left a powerful comment on a recent post "Leaders: Clear the path and your team will do their best work". As she tells the story of taking her daughter for treatment of a chronic condition, you can feel her frustration at a system that can't move a simple piece of information from one provider to another within 36 hours.

Implementing an EMR might move providers closer to patient and family-centred care, but it would certainly help patients/families overcome resistance to PFCC. A PFCC-aligned EMR would be accessible to the patient. (How could it not be?! We own our medical history!) With the same access to information as any caregiver, patients/families can choose the role they play in their own care. If you want the old "You're the doctor" approach, you can have it. If you want all your test results - explained in plain language (see this Wired magazine article for a suggestion on how this can be done) - you can have them. (Without needing to lug around a "medical binder".)

Anonymous, you speak clearly and passionately on your daughter's behalf. Your points are respectful. You don't lay blame. I can rant endlessly about the benefits of EMR, in person and on this blog, but I won't have nearly the impact that you can have. Oddly, even though power in healthcare usually rests with providers, in this case, it's the opposite. You, Anonymous, have the power to advocate for EMR. You can make the point that patient care will improve. You can tell your family's story about how your daughter's care is impeded by the lack of EMR.

Talk to the decision-makers who can make EMR happen in Saskatchewan. Tell your story to your MLA. Write to the Minister of Health and the Premier. Ask to have 5 minutes at the start of your regional health authority's board meeting to explain what an impact the lack of an EMR is having on your daughter's care. The comment you wrote is already a powerful letter-to-the-editor for your local paper. Speak to your daughter's patient support group about how EMR could make all of their lives easier.

EMR = PFCC. Spread the word, Anonymous.

Not a smoker? Too bad – smoking is still killing you!

I am FURIOUS!

I have just come back from the hospital where I attended a man with serious complications of a chronic disease. He was the 3^rd person I saw today with similar complications from the same disease.

I am furious because none of these people needed to suffer. This disease is completely preventable.

The disease is tobacco addiction.

Perhaps you’re wondering what smoking-related disease urologists treat? You know that cigarettes cause heart disease and lung cancer, but those areas are far removed from urology territory. Give up? It’s bladder cancer – one of the top 10 types of cancer, and primarily caused by tobacco abuse.

The most serious bladder cancers are treated with major surgery: bladder removal and creation of a urinary stoma. It’s a long operation with significant complications. Many of those complications are related to other problems faced by smokers: heart and lung disease, poor wound healing, etc.

During the last month, I’ve had long conversations with 2 patients who were agonizing over their decision to undergo surgery for their bladder cancers. Both were long-time smokers and had severe lung disease. They knew that surgery would be risky, but were also facing certain death if the cancer spread. One man’s wife was in tears as we spoke on the phone.

The maddening thing is that the twin diseases they face never had to happen. They would be spared the physical and emotional suffering if they never smoked.

But, smoking affects non-smokers too. I don’t mean disease caused by second-hand smoke. I’m talking about the money and effort wasted treating largely preventable diseases. Cancer, heart and lung disease, and stroke burn up huge amounts of healthcare resources. That’s money from everyone’s taxes. It means longer wait lists as provider time is taken up managing chronic, tobacco-related disease.

None of this is news to you. We’re inundated with anti-smoking information from the time we’re in grade school. Yet, about 20% Canadians continue to smoke. This despite warning labels, funding for smoking cessation medications, and restrictions on smoking in public places.

These efforts aren’t enough. We’re all suffering the effects of smoking. Smokers suffer personally and dreadfully. Non-smokers pay the price through wasted healthcare resources.

I’m upset enough (and politically naïve enough) to demand a direct solution. And, I won’t direct this to “the system” or “the government”. I say this to the 4 people responsible for preventing smoking-related illness in Canada and Saskatchewan: Prime Minister Stephen Harper, federal Minister of Health Leona Aglukkaq, Premier Brad Wall and provincial Minister of Health Don McMorris.

Stop thinking about tobacco abuse as a personal choice to use a legal product. Tobacco is legal only if your government allows it to be. If you doubt that tobacco use is an addiction, visit my hospital in January when patients smoke outside, shivering in cotton gowns in -30C weather.

Warnings on cigarette packs and public smoking restrictions are not enough.

Choke this problem at its source: Make tobacco illegal in Canada. Wait a year before implementing the law. During that year, lavish free smoking cessation products and support on smokers.

There’s a long list of problems with this plan. We look to you – our leaders – to solve those problems.

Tobacco companies will fight you, literally for their survival. So what? They poison our neighbors. They profit on the back of your healthcare budget.

Save lives. Lead the world.

Put me out of a job. Please.

(April 19, 2011 - I received a response from Don McMorris, Sask Minister of Health.  He outlined Sask's initiatives to reduce smoking - no pharmacy sales, no smoking in cars with children,etc.  Thanks, Minister.)