Province is experimenting with how to boil a frog
Penny- wise but pound- foolish strategies have led to an avoidable crisis in B. C.’ s emergency rooms
Late 19th- century European scientists reported that when water temperature is raised very, very slowly from room to boiling point, a frog that would typically leap out to save itself instead adjusts to the gradual change, showing no inclination to escape its impending doom.
Welcome to the B. C. government’s version of the frog- boiling experiment. The frogs are ER patients and medical staff. The heating water is the increasingly hostile ER conditions to which we are all meekly adjusting to our peril.
How did ERs get to this crisis point, you ask? ER docs and teams are naturally inclined to solve problems quickly, with whatever resources are available. We specialize in cost- efficient problem solving.
Heart attack — got it! Intracranial bleed — yep! Infections of the skin, dehydration, or a blood clot in the leg …. why use an in- patient bed? Why not treat them in the ER and they can then go home to their own beds with equally good health outcomes?
Innovative ER treatments saved the health care system a whack of money over the last two decades.
What were the unintended consequences of our good intentions?
• Ignoring the demographic signs, administrators and consultants took the credit and extrapolated that rate of savings into the future …. “Run hospitals at 99 per cent capacity … just like a factory.”
• Hospitals were taken offline, or torn down, dropping the number of hospital beds per population in B. C. to one of the lowest in Canada, and Canada’s to one of the lowest in the developed world.
• The few new hospitals built were done so with too few beds.
And so, over the last 20 years, the water temperature gradually crept up.
We have gone from holding, say, two patients for a few hours, to holding 30 patients, some of them for days, until an in- patient bed becomes free. With our ER filled with patients who should be cared for upstairs, ER docs must treat heart attacks in the hallway …. and overwhelming infections in the waiting room. Not good!
Forty thousand MORE patients arrive on our ER doorsteps each year than we are staffed to care for, with no more doctors to see them. Patients with potentially life- threatening emergencies routinely wait hours to see a doctor. ERs are a problem that it makes economic sense to solve. But instead we continue penny- wise, pound- foolish patterns …
When patients wait too long to a see a doctor:
• They are sicker by the time they’re treated — more cost.
• Frustrated patients leave without being seen, then return later, sicker still — more cost.
• ER chaos and inefficiency increase exponentially — producing delays, mistakes, and — more cost.
Research has proven the longer patients wait in the ER for a bed, the longer is their total time in hospital. We pay with our health, and poor care costs taxpayers more money. Occasionally, government is shamed into throwing in a cup or two of cold water to drop our ER water temperature.
In 2006 and 2010: a few more doctors — one cup. In 2009, a 30- page Overcrowding Report — second cup.
Earlier this year, it became clear ER services are not a priority. Government now rejects the computer model built to hire the safest, most- costefficient number of ER docs at each site, and is soft- peddling the government’s own Overcrowding Report’s recommendations.
And so our patients wait, and wait, while government sidesteps its responsibility, refusing to address that there are simply more people in the province, while spending taxpayer millions to import Bollywood movie stars for a campaign boost.
How does the B. C. government propose we fix the problem? It is suggesting we reopen the Physician Master Agreement and take money away from programs that provide patients in underserved areas with better access to family doctors and specialists. That much- needed funding was negotiated so that patients’ needs could be better met in their communities. It might eventually result in less need for emergency room services. The penny- wise, pound- foolish pattern continues.
To make a serious difference, we need enough funding to hire approximately 30 full- time ER doctors to meet current needs ($ 10 million or approximately 0.0006 per cent of the total health care budget). We also need government’s commitment to fix ER overcrowding: to make and then enforce compassionate in- patient admission practices. We know what we’re proposing can work. We’ve modelled our plan on U. K. and New Zealand’s successful solutions.
ER doctors are hopeful that our patients’ story will have a much happier ending than that of those poor little frogs in the 1880s experiment — but we need your help.
That’s why ER doctors are declaring an emergency.
We’ve launched an interactive website, www. bcemergencycare. com, where it takes 15 seconds to send your elected officials, friends and neighbours a message that ERs are important to you and your family; that you want action before we little frogs discover it’s too late.
Let’s all not be meek, but speak! Send government a message: “Fix ERs for all British Columbians, now!”
Then, let the healing begin.