The good, the bad and the ugly of palliative care subject of talk

POINTED TALK. Dr. Brian Goldman was in Gravenhurst May 6 to talk to the North Simcoe Muskoka Palliative Care Network during its annual general meeting. He said palliative care and senior patients may receive lesser care than their younger, healthier counterparts, but there are simple ways to fix the problems. Photo by Neil Etienne

If we don’t fix the issues, the problems with end-of-life care, palliative care will only compound down the road — Dr. Brian Goldman

GRAVENHURST - Palliative care and the effectiveness of the health-care system in general can be vastly improved, said the famed Dr. Brian Goldman.
The award-winning medical journalist, Toronto-area physician and CBC radio host of White Coat, Black Art was in Gravenhurst May 6 as the special guest speaker for the North Simcoe Muskoka Palliative Care Network during their annual general meeting at the Muskoka Boat & Heritage Centre.
Speaking to a crowd of palliative care nurses, doctors and health-care professionals, the doctor held back no punches on this thoughts about the Canadian health-care system and how those in palliative care or seniors seem to get a shorter end of the stick.
“Patients are being left behind, many of them right when they need help most,” he said. “We have a culture that denies people become frail, as if to say our mission is to keep people not frail until some nanosecond when it all runs downhill and they keel over, rather than allowing people the grace to enjoy their lives despite frailty.”
Through his speech, called The Good, The Bad and The Ugly of Palliative Care, Goldman pointed out the struggles of the health-care system, particularly for those in palliative care, is a symptom of the times.
“We just passed through an unprecedented period of health-care boom; we were spending more and more dollars and every time we had a problem we just spent more money,” he explained. “You know those times are coming to an end. In fact, we’re about to go back into a global recession and we, of course, have a big budget deficit in Ontario and a debt. We’re going to have to pay the piper and how we do that is being played out in front of us.”
“There’s a real battle for the hearts and minds of Ontario right now,” Goldman continued, adding the Ontario Medical Association and the provincial government are currently in debate over how the system will change. “We’re going to have to tackle some very serious issues and some people won’t be happy with how we do that.”
He said also tied to the times is the coming of age of the baby boomers and the high percentile of senior and palliative care patients. Combined with the fact physicians and general practitioners have become more scarce since medical student admissions to university were cut back in the mid-1990s, Goldman said, add to that the issue of money and how doctors are paid and “it tends to set up a practice to see patients as fast as possible.”
He explained this means some medical professionals will “cherry pick” and set up practices with a balance of low-need patients and high-needs, even if sometimes the balance is off kilter and favours the low-needs, generally younger patient that can be pushed through the office quickly.
“It’s the new normal,” he said. “It used to be people in hospitals convalesced, now people in the hospital are there because they are sick, often acutely,” Goldman said. “The point is it’s a health care in crisis.”
He said nurses are burning out at high rates, especially younger ones, registered nurses are taking on more responsibilities and physicians are specializing more and more. The factors all combine to leave the palliative care or senior patient at a lower priority. Using an example of two heart attack patients sitting in an emergency room, one being 50, the other 85, he said the doctor who has to make an immediate decision will almost always take the younger patient first.
“Maybe it’s subtle, but there is agism,” he added.
His solutions involve removing a new standard in the system, that health-care professionals allow only one complaint per visit. He said if those patients with multiple medical issues were dealt with all in one sitting, it would save time down the road and create a generally healthier patient.
“It’s worth the investment (of time) today,” he said, adding one way clinics are addressing the need is to create group medical sessions where patients with similar conditions, such as heart disease or diabetes, can be checked in a group setting. This way, he said, when a doctor gives advice to one patient, all the patients there benefit.
Goldman also said he strongly supports team medical clinics, physician assistants, enhanced paramedicine paramedics and the proliferation of nurse practitioner stations as a way to ease pressure on the system.
“To me it’s not a question of why, but why not,” Goldman said.
Statistics show 90 per cent of all Canadians will need palliative care in their lives, but 70 per cent of those will never get it as the system stands, said Goldman.
“If we don’t fix the issues, the problems with end-of-life care, palliative care will only compound down the road.”

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