It’s easy to be pessimistic about Canada’s publicly funded health-care system. Public testimony and metrics can shock. A more fulsome reality is that there are successes leading to healthier and longer lives – even in my chaotic specialty. Being a late-night urban emergency department (ED) doctor, I work the underbelly of health care. Beyond the nihilistic headlines, much good can go unnoticed.
- Ontario’s Ford government recently announced the RSV vaccine will be funded for all Ontario infants and pregnant women. RSV can cause respiratory failure among the youngest children and drive them and older adults to the ED.
- University Health Network (UHN) in Toronto has converted a parking lot into a 51-unit supportive housing building to house homeless people who most use the ED. This research-intensive hospital did something humane and concrete, elevating housing as a determinant of health and easing pressure on the ED.
- Over two years, St. Joseph’s Health Centre (SJHC) in Toronto, through taxpayer-funding and donors, built an entirely new ambulatory health zone to treat a high volume of patients and a geriatric-oriented unit. It rebuilt its resuscitation rooms, triage and pediatric zone. It rolled out 24/7 CT scan access and procured state-of-the art bronchoscopy intubation equipment for the most difficult airway cases. These improvements make this busy community hospital function more effective.
- Toronto General Hospital (TGH), with donor and taxpayer funding, opened a 10,000 square-foot Rapid Assessment Centre. Ambulatory patients are cared for in a bright, well-equipped space with 25 individual places to see patients. When I started at TGH, these patients were seen in one small room and queued in the corridor.
- Faced with admission delays, SJHC undertook an intensive effort to get admitted patients to the wards. The internal medicine service opened a rapid follow-up clinic next to the ED for patients well enough to go home. The results were dramatic, with a significant drop in Emergency Medical Service (EMS) offload times and space to care for patients.
- UHN saw a high number of patients coming solely for shelter from the cold. It opened a warming centre. It also encountered many intoxicated patients who needed a safe place to be monitored, so it opened a Stabilization Centre for patients after seeing an ER doctor.
- With $34 million from the Ford Government, UHN is building a new surgical tower. The Ford government also has announced $1 billion in funding for SJHC to build a new tower for more emergency, surgical and critical care.
- For urgent reasons, I can obtain an outpatient MRI in 2-5 days, and for an emergent reason even during my shift. For ambulatory patients I can obtain rapid neurosurgery, spine, neurology, gastroenterology, cardiology and hypertension follow-ups.
In my work, I am surrounded by a team of social workers, occupational therapists, geriatric nurse specialists and peer support workers. My injured patients requiring surgery for fractures can be discharged in less than 24 hours. An army of specialist doctors consult on my patients 24 hours a day. I have never asked an anesthesiologist’s support for a difficult airway and received anything short of instant definitive support. My doctor peers make astute and timely diagnoses daily. In the ED we daily perform simple, invasive and heroic procedures with pain-relief and curative outcomes.
Among Canada’s 41.7 million people, there are 16 million ED visits annually. In my experience, the majority are uneventfully smooth but require vigilance to ensure the job is well done. It’s not perfect. Only 23-27 per cent of Ontarians are admitted to hospital within the eight-hour benchmark. Nonetheless, we cannot dismiss how many children and parents, adults and seniors bestow a sincere thank-you to ED staff. In totality, these are indicators that it’s not all bad.
The passage of Ontario Bills 7, 60 and 124 have been met with significant controversy. Policy approaches to addictions, primary care and private radiology, gastroenterology and surgical care in Ontario are contentious. We must carry on a robust dialogue on how best to deliver health care.
I’ve worked around the world in areas with conflict, forced displacement and abject privation. The world outside Canada struggles amidst upheaval. While none of us is complacent, we must not glaze over that millions annually have a good experience in our publicly funded health-care system. It is bruised but not broken beyond repair.
We need to talk more about the good. It exists.
Hello Dr. Raghu,
I have been having very bad pains in the back for over a month. I needs to know what is causing this so I am glad that I will be able to get emergent MRI in the emergency dept. The progression of technology has no limit!
Dr. Raghu Venugopal writes a needed, laudatory, nuanced article about good things happening in the “underbelly” of emergency health care and beyond the “nihilistic headlines we encounter every day”,
He writes of good news, good results and good changes to the emergency health care system in Canada and he notes that he has also “worked around the world in areas with conflict, forced displacement and abject privation”.
However, all his very positive examples of exceptional care, innovations and initiatives are Toronto Ontario based. I would only suggest that he consider writing about the rest of Canada including all provinces and territories where good things are happening in very challenging emergency health care environments from prehospital care to rural emergency care to critical care transport to resuscitative care and more. From coast to coast to coast, there is exceptional emergency care happening every day in Canada.
John has an important point, to which I fully agree. Thanks for the valuable insight. I wrote about examples that I could 100% attest, from first-person experience. But the bigger point I appreciate, we have to have a balanced national perspective of what ails our system, and where we succeed. Much thanks for this, Raghu