Thursday, July 26, 2012

Canada stories

I have just returned from a very pleasant camping and touring trip to New Brunswick and Nova Scotia, two beautiful provinces with lovely and interesting people.  As much as I try to put health care and process improvement behind me during vacations, they somehow manage to impinge, often for unexpected reasons.  Here are three anecdotes and observations that arose.  I offer them for what they are worth.  Again, please understand that the context was always one of warm and caring people, but people who face systemic and societal issues--just like south of the border.

Low tide in Alma, on the Bay of Fundy
The first story is a humorous one that comes from a seafood restaurant in Alma, NB, on the Bay of Fundy.  They were serving a linguini and sea food dish (with scallops, shrimp, and haddock), and I asked the waitress if I could please add a lobster tail to the dish.

"No," she answered, "all of our ordering is by computer, and there is no button to push to add lobster."

"What if you were to talk to the chef and ask him to add it?" I inquired.

"It is easy for me to talk to the chef.  We talk all the time," she said, "but he can't do it either because there is no button he could use."

Hmm, not a very customer-centric or Lean process!  While I was tempted to try a Five Easy Pieces approach to the problem, it seemed simpler to just order something else.

Scallop fleet in Digby, NS
The second story comes from a community hospital in Nova Scotia.  A member of our party had taken a dive into the surf and had been thrashed into the sand by a crashing wave.  He bumped his head badly and jarred his neck, and he needed emergency care.  Beyond the possible concussion, there was a clear danger of spinal cord injury or broken neck bones.

The Canadian health care system is quite good, and we knew we could expect good treatment.  What we did not understand is that a person from another country has to personally register and prove his or her ability to pay before going through the ED triage nurse.  So, this injured patient was sent to walk to another part of the hospital and spend a good amount of time filling out paperwork--including a promise to be bound by the legal system of the province in the event of a malpractice claim--before being evaluated.  Once this was over and the patient could be seen, the doctor immediately fitted the person with a neck brace, just in case there was serious spinal injury.

In the US, for all of its health care system problems, no such patient would have been sent to another part of the hospital and required to fill out such forms before being immediately seen in the ED.  Also, a family member would have been permitted to fill out the required forms.

Also, the patient needed a CT scan, which was not offered in the local hospital.  The staff at the local hospital called ahead to the regional hospital and said someone would be waiting for us.  We drove to that hospital, about 20 minutes away.  Not only was no one waiting, but the person at the front desk wanted the patient to go through all the paperwork again.  After persuading that person that the forms were already filled out, the patient was sent to radiology, where the door was locked and no one was visible.  Rousing a custodian, the patient finally found the way to the CAT scanning area and found a technician.

Again, the actual medical care at each step of this process was excellent, and the clinical staff were attentive, friendly, and professional.  And we were through the whole diagnosis in under four hours.  I found myself, though, comparing the process with that in the US, where EMTALA rules the day when a patient shows up in an ED, requiring immediate care without regard to legal status or ability to pay.

Hodo Cookies at the St. John (NB) City Market
The third story relates to obesity.  I have come to understand that this a worldwide problem in developed countries, and the US is a prime example.  I did not expect, though, to see it in the Maritimes.  More frightening than in the adults, the rate of teenage and young adult obesity was clearly visible.  This made me think that Canada, which has done so well in controlling its health care costs, is in for an inevitable uptick over the coming decades.


mamo said...

Paul, I love starting each day with your posts. Glad you had a good trip to my home province of Nova Scotia. As for your friend who crashed into the waves, I appreciate your points and would also suggest that if you were worried about a spinal cord injury the person should have entered the health care system through EMS (Emergency Medical System. Paramedics would have arrived on the scene and provided a high standard of care. Traveling by car on bumpy country roads in Nova Scotia and arriving to a satellite health centre as a walking wounded presents unnecessary risks. No excuse for what happened but we all have a responsible to minimize risk in the pursuit of greater safety!

Howard said...

Your experience was unfortunate and a manifestation of that hospital, not the Canadian “system” (I mean the registration part before triage). That would never happen at my hospital and I believe sincerely not at most Canadian hospitals.

We do have a lot of smaller hospitals without CT’s.

Our national medical protection association does ask that we request Americans sign a release promising to sue us in Canada if they sue us. This was because of a few unfortunate decisions by US courts to hear lawsuits over care rendered in Canada. However, these forms are mainly for elective care or care where the MD or hospital could be construed as having solicited care in the US, not generally for emergency patients and at most ED’s they don’t ask, or if you refuse to sign, we treat you anyways.

Paul Levy said...

Many thanks, Howard. And, on the last point, my friend signed the form, but they never collected it!

June Collmer said...

Thank you for another both interesting both interesting and lovely post.

mary said...

I am commenting on childhood obesity. Here's my take. If one fat parent has 3 kids, teaches them bad nutrition, they grow up fat. And each one has 3 kids, who learn the same nutritional standards, there are now 10 fat people. is the key. If you are going to spend $2.00 on chips, instead, spend $2.00 on bananas or low fat yogurt. I know it's a utopian suggestion but.......