Thread by @drdeepasoni

Some thoughts on the #HealthCareCrisis in Ontario (and across Canada).

23 years as an EM physician and I have never seen things as bad as they have been for the last several months...with no sign of letting up

The bandaid solutions being thrown around: Government tells colleges they have two weeks to figure out how to increase the supply of doctors and nurses...are just that...bandaids - on a hemorrhaging wound.

Let's talk real solutions can we?

When you look at personality characteristic amongst healthcare workers..doctors, nurses, all the other members of the healthcare team... characteristics such as empathy, compassion, resilience are part of the fibre of our being...it's literally what leads us to find these careers

So when you have a situation like we find ourselves in now...where burnout has caused mass departures from the profession..it's time to ask why?

Why have people who have empathy, compassion & resilience, not been able to shore up those resources within themselves to keep going?

It's easy to blame the #pandemic - no doubt, it has taken a toll. Wave after wave going on almost 3 years now, we have not been able to catch a break. Before vaccines, we went to work terrified that we were going to get sick and/or bring it home to our loved ones

Once vaccination started, we breathed a sigh of relief.

Only to find that people had become sicker from not having routine screening tests and care. Patients were coming to ERs with more advanced disease and needed more intensive levels of care

And if the system had the capacity to take on this extra burden, all would have been ok

But it didn't. It hasn't had that capacity for at least 2 decades.

Hallway medicine has been around for years. 🇨🇦 has one of the lowest beds/population of all OECD nations

What does that mean? It means that when a patient is sick enough to need admission to hospital, and the system lacks the beds to support those admissions, that patient ends up on a stretcher in a hallway. Admitted. To hospital. In a hallway.

media have been reporting these stories for years. They come with catchy titles like "flu surge", "winter surge"...the word surge implying: this is an anomaly and after some time, things will go back to "normal"...except that time has not come, nor will it, without real change

Now what happens when hospitals are so full that admitted patients take up the beds in the emergency department and the hallways?

ER patients waiting to be seen experience long wait times - if there aren't beds to see patients on, those patients have to wait...a long time

Across the country, ER waits have reached unheard of lengths.

Hours: sitting with a child who has a fever and won't drink fluids, a family member with abdominal pain, an elderly parent with confusion...you can imagine the worry and frustration they feel waiting

The trouble is, many people have not experienced the emergency department until they first need it.

... when they step in and realize the lines and the waiting, for some patients and families, the stress and frustration bubbles over as anger towards the front line staff

These front line staff are doing the best they can in a system with too few beds, too few of resources.

As they try to do their jobs, they encounter anger, hostility and sometimes, violence because of the waits.

Would you want to go into a job where you are treated this way?

On top of this, #Bill124 has locked nurses wages. Inflation continues to rise and their wages are locked at 1%.

Is it any wonder that many are opting not to work in these high stress environments?

Despite how easy it sounds to just bring in nurses from overseas, it's not that simple...a senior nurse has a lived intuition...they can see a child at triage and in 60 seconds make an assessment that this child needs immediate care. That intuition takes years to develop

So losing the numbers of nurses we have lost has had deep impacts on hospitals across the country.

If we want a system that has the Human Resources to care for patients, then that system needs to care for its workers first.

Repeal bill 124. Pay nurses fairly for the work they do. Make it appealing to do this sacred work. When people don't feel valued by a system, you get the results we see in front of us today. ERs that can't stay open, hospitals having to send patients elsewhere for care

Adding beds into the system only works if there are enough staff to take care of the patient in that bed.

Otherwise, it's just a piece of metal with four wheels and a foam mattress.

Make the working environment safe.

patients need to understand that frontline staff... doctors, nurses, technicians, provide care... we don't decide funding or resource allocation.

those concerns need to be brought forward to their MPP

every hospital needs a sign like this

Now for the big problems: this has been brewing for at least two decades. Our healthcare system was founded on the principle of universal access...at a time when people needed far less care, lived shorter lives, managed many of their illnesses at home with family support

In Canada we have a unique problem: money for healthcare is doled out by the federal government to the provinces. The provinces then decide how to spend this money.

Can you imagine how our Postal Service would run if we had 10 provincial postal units (plus territories)?

We need federal and provincial governments to work together to build a unified system that can sustain our population for the next 50 years.

this will require courage, innovation, working with the people on the front lines, and thinking past 4 year election cycles

Examples of this type of innovation: abolish provincial licensing. Create one national license for all doctors and all nurses in 🇨🇦.

this would allow flow of human resources to areas of need- nurses and docs could fill in as locums in other provinces to allow time off/vacation

Build up the home care system. Make this a job that people want to do.

if we want elderly, cancer patients, palliative patients cared for in their homes, families need to have home care supports.

Otherwise, the burden will continue to fall on hospitals

Our population is ageing. By 2046, the population over age 85 will have tripled to 2.5 million. This demographic requires a lot more care. Get in front of this now.

build up the long-term care system, dementia care programs, respite care for family caregivers to unclog hospitals

Teach people to have the hard discussions with their loved ones.

everyone should have advance directives and powers of attorney in place.

Realistic discussions need to take place about what can/cannot be done in advanced disease states - before the patient ends up in the ER

Teach people how to care for common illnesses at home. This was wisdom that was held by the grandmothers of families many years ago. But as populations live more isolated lives, this precious knowledge has been been lost - basic how to care for:

*Fever
*Common colds
(Cough/runny nose/fever usually does not need antibiotics)
*sprains
*back pain
*gastroenteritis - stomach flu

knowing how to care for yourself and your family with these common conditions can save you a lot of waiting time in ERs

Prevention:
eat nutrient dense food

get up and exercise

get 7 to 8 hours of sleep daily

reduce your consumption of alcohol/tobacco/marijuana

manage stress levels by yoga/meditation/breathing

As we go into the fall, in anticipation of yet another wave of #COVID19... now more than ever, we need more than sound bites and catchy slogans.

We need governments that genuinely want to serve the people that elected them to find sustainable solutions to this crisis

HCW: frontline doctors, nurses & all other members of this team... we find our joy and purpose in taking care of patients.

we need governments to rebuild the system from the ground up. Not Band-Aid solutions. Real change.

So we can care for patients as they deserve. 🙏🏽