Author: Susan Martinuk
A recent report claims that emergency departments are the latest health care crisis point… as if Canadians didn’t already know.
According to the Canadian Institute for Health Information (CIHI, a government-funded research centre that collects and analyzes health care data), emergency department patients face record overcrowding and long wait times, while a growing number are leaving without receiving care.
Meanwhile, emergency department workers must deal with staff shortages, limited bed capacity and patients presenting with cases that are increasingly complex and time-consuming. The latter is fuelled, in part, by a shortage of family doctors and a reluctance to go to the emergency department until it is absolutely necessary.
There’s nothing new here. The most intriguing aspect of the study was CIHI’s accompanying podcast that labelled emergency department wait times the “canary in the coal mine.”
Really? The canary in a coal mine is supposed to be a metaphor for an early warning sign of danger.
Emergency departments and the entirety of Canadian health care are well past such sensitive indicators of risk; the reality is that this is just one more dead canary in the toxic mineshaft of Canada’s medical system.
Losing emergency department doctors is a dead canary.
A recent survey in the Canadian Medical Association Journal revealed that burnout and stress are rife among those who work in emergency medicine. Ten per cent of emergency department doctors have left via retirement, turning to another area of practice or walking away from clinical medicine (i.e., stopped treating patients).
Of the remaining doctors who completed the survey, one-half have reduced their hours, 46 per cent scored high on emotional exhaustion and 55 per cent cited depersonalization — a detachment from patients and a known response to burnout.
One surveyed doctor put the final nail in the emergency department coffin by writing that the “future of emergency medicine is hopeless, with no possibility of recovery.” Hopelessness — just one more dead canary.
None of this is encouraging news for patients who arrive at the emergency department in the midst of their own personal health crisis.
Months-long (and even years-long) wait times for surgeries and specialists, limited resources for imaging, staffing shortages, doctor shortages, insufficient numbers of acute care beds, patients dying on waitlists, an aging population, minimal access to long-term care facilities and antiquated infrastructure are all dead canaries in the mineshaft of Canadian health care.
As these problems compound, they contribute to the systemic bottlenecks that create the barriers and inequities which leave patients frustrated and angry — unheard, uncared for and disrespected.
But the damage goes beyond delayed treatment and inadequate care. Every failure also undermines patients’ trust in the system.
For decades, Canadians broadly put their trust in their medical system. It underscored the relationship between doctor and patient, and the patient’s understanding of health care. Ready access for all was a powerful symbol of Canadian society.
But health care has changed, and every patient experience shapes our view of health care and impacts our level of trust in health care.
Canadians are finding that putting their trust in a fragmented, overwhelmed and under-resourced system means nothing when it comes to the reality of their day-to-day experiences in our medical system.
As a consequence, the social contract of trust that long bound Canadians to their universal health care system is breaking down. Canadians may still believe in universal health care, but that does not mean they trust the system to deliver it.
Trust is not an abstract concept in health care — it is built or weakened with every patient interaction. Environics Research recently examined the “trust gap” that exists in Canadian health care. It found that trust is shaped by experience — how quickly patients get care, whether they feel supported and how easily they are able to navigate the system.
Every time the system fails, or patients face delays and barriers to access care, there is an erosion of trust.
According to Environics, when systemic barriers become routine, patients become disaffected and choose not to seek care, to delay care, to self-manage their care or to make decisions based on accessibility or affordability rather than medical necessity. These decisions can result in poorer health outcomes, more complications and a greater reliance on acute care, placing even more pressure on an already overwhelmed system.
Conversely, patient trust is enhanced when care is accessible, systemic navigation is easy and patients feel connected to their care and believe that the system is working with them, not against them. When trust in health care is high, people are engaged in their care and health outcomes improve.
The way forward is complex, but other countries have shown that a renewed emphasis on patient rights can refocus health care systems, actively engage patients in their own care, improve treatment outcomes and enhance adherence to treatment protocols.
These basic rights (e.g., informed consent, shared decision-making, autonomy, non-discriminatory care and others) make a difference in the day-to-day interactions with patients. They cannot eliminate physician shortages or waiting lists, but they can help restore patients’ confidence that their concerns matter and their decisions are respected.
Acknowledging and promoting these rights is one step towards restoring trust in a broken health care system.
Susan Martinuk is a Senior Fellow at the Frontier Centre for Public Policy. A Vancouver-based researcher and communications specialist, she has written more than 1,500 published columns, articles and reports on health care, bioethics and public policy. She is the author of Patients at Risk: Exposing Canada’s Healthcare Crisis and the forthcoming Patient Rights: Restoring Trust in Canada’s Healthcare System.