Medicine is not my area of expertise, but I have often joked that I almost feel ready to take some of the med-school exams.
I have taken ownership of and responsibility for my health and in the process, I have learned so much. Having struggled with serious health problems since a rather ominous diagnosis in March of 2007, (spoiler alert— this story has a happy ending) I have evolved over the last almost 12 years from the typical “my-doctor-knows-best” patient approach to a person who knows everything there is to know about her condition, its symptoms and the everyday decisions that impact my health outcomes.
It is estimated that more than two million Canadians are affected by autoimmune diseases. Of the approximately 50 different types of autoimmune diseases that have been identified to date, in Canada, the most prevalent ones include lupus, rheumatoid arthritis, multiple sclerosis, Crohn’s disease and Sjögren’s syndrome. In each of these, the overactive immune system becomes confused and attacks healthy cells and tissues within the body instead of working to destroy the bad ones. For a patient with an autoimmune disease that has targeted one or more vital organs, the illness becomes life-threatening. In all cases, however, patients suffer from a wide range of symptoms in differing degrees of severity. The cause is not known and to date, there is no cure. Patients affected by one of these conditions must learn to live with it and despite it. The result? Lots of pills, lots of doctors, lots of confusion.
Where does the federal government come in?
I acknowledge that it is difficult for most Canadians to sort out what is specifically of provincial or federal jurisdiction in matters of health care.
Each province is responsible to legislate and operate its own health-care regime. As a result, each province’s system was instituted at different times, is administered and operates differently leading to significant differences from one province to the other as each deals with its particular demographic and geographic challenges.
The role of the federal government is to provide leadership and set the big-picture goals with a view to achieving best practices across the country. It is also responsible for legislating and providing health care to specific groups that fall within federal jurisdiction, including First Nations living on reserves, Inuit, RCMP, and Canadian Forces, federal penitentiary inmates, to name a few. As it is responsible for funding, the federal government provides long-term, sustainable funding models and manages federal-provincial relations through funding and conditions imposed upon that funding.
Because of the staggered and irregular method by which it was created, the Canadian health-care system could benefit from some review and improvement. For example, most experts agree that an increase in primary care is much needed across the country to lessen waiting times and expand access to remote and underserved communities. Canadians could also benefit from standardization of the health-care system based on best practices. Furthermore, the tremendous advancements in technology would allow for electronic record keeping being shared by health-care providers and could conceivably be accessed by patients themselves, thereby increasing the engagement of patients in their own care. It is proven that involvement of the patient in a plan of care has the very positive effect of increasing transparency, education as well as that patient’s participation and compliance leading to better outcomes. Better outcomes lead to efficiencies.
In a perfect world, we could even consider a patient-based health-care system where hospitals have their purpose, but primary and outpatient care is provided by community clinics that are connected through electronic access to records and where health-care professionals of all fields are on-site to provide multidisciplinary health services, from conventional western medical practices to other modalities that complement and improve management of a patient’s case.
Without wanting to over simplify an incredibly complex bi-jurisdictional situation, my simple solution is this: the federal government should take leadership in developing, funding and ensuring implementation of standardized integrated and integrative health-care systems across Canada, thereby ensuring delivery of health-care services to the populations for which it has jurisdiction, but also including patients currently underserved by the existing provincial systems. Such community clinics would need to be both integrated and integrative.
An integrated health-care system is one where efficiency is the main objective. Medical care providers from support staff, to nurses, physicians and specialists work together as a team, communicating frequently, with each member attending to their specific area of competency to deliver care in the most collaborative and efficient manner. Essentially, it is a “one-stop shop” for the patient. The benefit for the members of the health-care team is that they have clear roles and can deliver only what is necessary with the assurance that the patient will benefit from a comprehensive plan of care.
An integrative health-care system is one where the comprehensive plan of care is the main objective. Over the past several years, so much has been learned about the benefits of alternative medicine. I recall a time when patients were faced with the need to choose between a conventional medical plan of care or an alternative plan, such as naturopathic, osteopathic, traditional Indigenous and ancient Chinese medicine. We now know that alternative medicine modalities can be complementary to a plan of care. Most patients, if given the choice would want access to the full gamut of methods to treat their symptoms while attempting to identify and address the root cause of their ailments. Better still, much could be done by way of preventive medicine to manage existing conditions and even avoid illness altogether.
As the holder of the purse strings, the federal government could develop such a population-based, integrated and integrative model of health care, not a bad national health-care strategy as we head into the next election.
Senator Josée Forest-Niesing represents Ontario.
This article appeared in the February 4, 2019, edition of The Hill Times.