So it seems Ontario ER waits are improving....

[P. McGee]

duplicate post

Edited September 18, 2010 by P. McGee

[P. McGee]

Name these hospitals.

Sick Kids in Toronto is the main example I was thinking of when I posted that, but I've had similar experiences at local hospitals in the GTA which I won't name (child having seizures was admitted with little delay). I don't doubt that there may be some very dysfunctional hospitals in Ontario though.

[wyly]

I think it's too long. I don't want to wait that long to be seen for something, that's all.

no one likes waiting but that's our life, we wait at traffic lights, we wait at the bank, we wait at the grocer checkout, we wait to get into theatres concerts, airports and buses that's just the way it is...going into a hospital ER with a non life threatening problems and you're going to wait while those in worse shape go first, waiting at ER's is probably the worst because you're not feeling well or your fretting about someone you've brought in, at times like those nothing happens quickly enough...

[Wild Bill]

I thought it appropriate to mention the history of just how we got into this situation in the first place!

---ANECDOTE ALERT!---

As a wee tad in the 50's and 60's I remember how there always seemed to be lots of doctors. Family GPs were always taking new patients. Most amazing compared to today, the doctor would come to your house if you were very sick and moving was a hardship!

Just to be sure that this was not a false memory, I phoned an always accurate source - my mother! She confirmed my recollections and added to them.

Things began to change in the 80's, after we had had some time with the medicare/OHIP thing. Doctors were put on a fixed fee schedule. House calls meant less money, due to the basic rate plus little or no allowance for travel time and expense. They rapidly became a thing of the past.

I believe it was during Bob Rae's NDP government in Ontario that the idea of capping doctors' fees came about, as an attempt to control ever rising health care costs. At the same time, positions in schools for medical students were reduced and the number of new OHIP billing numbers being issued was cut back. This meant fewer new doctors coming out of school and fewer new doctors billing OHIP. With fee caps, once a doctor "maxed out" he wouldn't get paid for any more patient time, so of course he wouldn't take any new patients. Subsequent provincial governments have not opened the numbers back up. They just keep quiet, hoping no one notices.

So we start with no more house calls. Of course, usually babies get sick and accidents happen outside of normal office hours. Where else can people go? ER's are their only choice! Only lately have we begun to see a few clinics and even fewer are 24 hour. Then we make it worse by having too few doctors. So even if your baby started a high fever or hacking cough at lunch time you don't have a family doctor of your own anyway!

We have fewer doctors graduating and getting billing numbers. Since "private pay" is illegal in Canada no billing number means no income for a doctor.

We also have a strong resistance to allowing immigrant doctors to get certified and practice here, even though it seems obvious we need them!

It's almost as if the goal was to CREATE this situation! It couldn't have happened better if it was planned! In reality of course, it's just the inevitable outcome of another good idea implemented by dumbass government types! The system's very structure was never properly thought out to be self-sustaining because it was easier for politicos to take the photo op credits now, trusting that by the time the problems had grown to a scary level they would be long gone and it would be someone else's problem to deal with!

Perhaps someone else could help with some stats but aren't we the WORST country at building a self-sustaining medicare system? The Europeans seem to all do a much better job. So it's not the basic idea of universal medicare that is at fault. It must be the way Canada has done it that's the problem.

http://www.cbc.ca/canada/toronto/story/2006/06/22/to-doctor20060622.html

"Despite efforts to increase the pool of family doctors, the college received up to 70,000 calls from people seeking a family doctor in 2005."

Edited September 18, 2010 by Wild Bill

[Michael Hardner]

Michael, if you think McGuinty has failed healthcare, what's your thoughts on what Harris did to healthcare.

Harris was the worst example of how not to restructure (or really, to just blindly cut) public services.

But Harris and McGuinty are two sides of the same coin: we get politicians like this because we have large government service operations that don't have the right kind of public oversight built into their operations. So we end up with politicians with exactly two tools: cut services or add services. They don't know how to organize things and make them better.

And how could they, really ? Running a giant organization like the province requires more than a background in law (McGuinty) or golf/teaching (Harris) to get right. Read Bob Rae's book "From Protest to Power" to get a sense of how baffling it is to try to move a giant machine like the Province of Ontario.

Also, to point out: Harris really shouldn't enter into this discussion. We're past him now. What we need to do is talk about OUR current system, not Harris and not the US system. Talking about anything but our system deflects the focus from improving what we have.

We have to come up with a better way.

We have spent years talking about only two-tier versus no two-tier. Meanwhile, the status quo doesn't improve. If it doesn't improve, then it declines. If it declines past a certain point, then two-tier will be the only other option on the table, since we haven't been talking about anything else.

[Michael Hardner]

Cost doesn't decrease overall over time anywhere, whether we're talking private or public. You can decrease costs for a while or in some areas, but overtime, you can't escape inflation, especially while you're trying to increase the level of service.

That's incorrect.

Agriculture costs, communication costs, manufacturing costs all go down over time. Inflation is not a real cost increase because your wages go up as well.

[Michael Hardner]

(child having seizures was admitted with little delay).

LITTLE delay ? That's an immediate threat, and I would hope that they would be taken immediately ?

I went to ER with a severe injury 20 years ago and got immediate treatment, which is as it should be.

[Michael Hardner]

no one likes waiting but that's our life, we wait at traffic lights, we wait at the bank, we wait at the grocer checkout, we wait to get into theatres concerts, airports and buses that's just the way it is...going into a hospital ER with a non life threatening problems and you're going to wait while those in worse shape go first, waiting at ER's is probably the worst because you're not feeling well or your fretting about someone you've brought in, at times like those nothing happens quickly enough...

I know there's going to be waiting, and I know there will be a longer wait than for anything else I have to wait for in real time but I think 4 hours is too long.

[Michael Hardner]

I believe it was during Bob Rae's NDP government in Ontario that the idea of capping doctors' fees came about, as an attempt to control ever rising health care costs. At the same time, positions in schools for medical students were reduced and the number of new OHIP billing numbers being issued was cut back. This meant fewer new doctors coming out of school and fewer new doctors billing OHIP. With fee caps, once a doctor "maxed out" he wouldn't get paid for any more patient time, so of course he wouldn't take any new patients. Subsequent provincial governments have not opened the numbers back up. They just keep quiet, hoping no one notices.

David Peterson, I think.

The number of doctors coming out of school is, I believe, determined by the number of spaces and worked out between the province and the OMA.

So we start with no more house calls. Of course, usually babies get sick and accidents happen outside of normal office hours. Where else can people go? ER's are their only choice! Only lately have we begun to see a few clinics and even fewer are 24 hour. Then we make it worse by having too few doctors. So even if your baby started a high fever or hacking cough at lunch time you don't have a family doctor of your own anyway!

House calls are a waste of resources, so I don't think it's bad to cut them back. We have telehealth now as well as clinics.

We have fewer doctors graduating and getting billing numbers. Since "private pay" is illegal in Canada no billing number means no income for a doctor.

We also have a strong resistance to allowing immigrant doctors to get certified and practice here, even though it seems obvious we need them!

It's almost as if the goal was to CREATE this situation! It couldn't have happened better if it was planned! In reality of course, it's just the inevitable outcome of another good idea implemented by dumbass government types! The system's very structure was never properly thought out to be self-sustaining because it was easier for politicos to take the photo op credits now, trusting that by the time the problems had grown to a scary level they would be long gone and it would be someone else's problem to deal with!

Almost, but no - the system falls apart before our eyes and nobody really says anything about it.

The day that the Ontario government announced there would be no eHealth inquiry, it wasn't on the (radio) news at all. As for eHealth itself, the government isn't really saying much about that at all.

Part of eHealth is to collect data which will help with reporting, and - hopefully - provide us with better metrics on how the system is. But if nobody cares, then why should the government launch a system that, in effect, will lead to a check on its own performance ?

Perhaps someone else could help with some stats but aren't we the WORST country at building a self-sustaining medicare system? The Europeans seem to all do a much better job. So it's not the basic idea of universal medicare that is at fault. It must be the way Canada has done it that's the problem.

http://www.cbc.ca/canada/toronto/story/2006/06/22/to-doctor20060622.html

"Despite efforts to increase the pool of family doctors, the college received up to 70,000 calls from people seeking a family doctor in 2005."

Doctor shortages, increased costs, longer wait times persist despite these problems happening for years, and even decades. Until we demand a system that provides performance metrics in a way that is:

- easily accessible

- easy to read

- provides comparative data from different institutions, over different times, and provides costs

- is provided or audited by an independent party

Then we'll be doomed to the Ontario government's current system, and similar systems. These provide:

- piecemeal reporting, where you can find it

- confusing statistics, with NA, or ***asterisks*** throughout and little explanation

- no comparative data, or trends over time provided, and no costs provided

- statistics prepared by the government itself, amounting to self-reporting

[Smallc]

Agriculture costs, communication costs, manufacturing costs all go down over time. Inflation is not a real cost increase because your wages go up as well.

No, it is a real cost increase. In medicine, inflation increases faster than the growth of the economy.

[Argus]

Huntsville Hospital for one.

The Sault is another.

Royal Vic in Barrie

Niagara on the Lake Hospital

Uxbridge Cottage Hospital.......

I didn't ask you to name hospitals you've been to. I asked him to name hospitals he claimed he went to and had no wait times.

[Argus]

They are excluding outliers on both ends.

Rotate the little crank at the back of your skull and turn your brain on for a moment. Why on earth would they exclude the outliers for any reason whatsoever other than to make them look better? Excluding the people who were served fastest would not do that. Excluding the ones who were waiting the longest would.

Nowhere on their site does it explain why it excludes some patients, or for that matter, why not all hospital times are reported. I am thus left to consider the probable reasons based on the repeatedly demonstrated sleazy, self-serving dishonesty of the Ontario government.

Edited September 18, 2010 by Argus

[Argus]

With a minor condition, that isn't at all unreasonable. With a major condition, that's out of the question.

Why are your standards so bloody low?! Why are you so willing to accept really, really crappy service with a shrug and a "eh, what you gonna do?" attitude?

Have a look at the service standards in places like France sometime.

[Argus]

but if you expect ot be released the same day an ER is not where you should have been seen, ER's are for critical matters...you should have had the first option of being seen in a walkin clinic...

If you break your leg, you can't go to a clinic. For that matter, there are very few clinics in most places which even operate after 4PM, let alone at 4AM.

You know, the government pays a shift premium to its workers for working evening and midnight shifts. I don't know if they pay higher rates for medical services but they ought to in order to encourage these clinics to stay open later and take pressure off hospitals.

[Argus]

if it was major he would have been admitted...generally if you can walkin to an ER you're likely not major and you'll be triaged, come in in the back of a ambulance and you're seen immediately...

My mother - a frail senior - went in by ambulance three times with broken bones and she spent 8-10 hours each time waiting before a doctor saw her and treated her.

[Argus]

I think it's too long. I don't want to wait that long to be seen for something, that's all.

I would like to point out again that we have no way of knowing how they are even defining minor vs major. If you have a broken bone you will have to have x-rays, so does that qualify as major? Even though it's fairly routine?

[Argus]

Right-o. The province itself calls it the 'Wait Times' reports, so I was confused by that from the start.

2 hours sounds fantastic. 3 hours sounds acceptable. 4 hours... on average... not that great.

Two hours does NOT sound fantastic. Walking in, being triaged, and seeing a doctor within ten minutes sounds fantastic - as happened to me 15 years or so back when I went to the ER after banging up my chin on a sidewalk.

The medical system in France sounds fantastic. Two hour waits when you're in pain do NOT.

People need to stop lowering their expectations, for Gods sakes.

[Argus]

An as I already pointed out, the time listed isn't the actual wait to see someone.

In my experience the times they cite are actually considerably lower than the "wait to see someone" times in this region. The last time I went to an ER it was 3AM on a not very busy weekday, after pulling my back. I needed pain pills and they told me it would be at least 6hrs before I was seen. Since I couldn't sit down I went home and suffered until clinics opened in the morning.

[Argus]

Sick Kids in Toronto is the main example I was thinking of when I posted that, but I've had similar experiences at local hospitals in the GTA which I won't name (child having seizures was admitted with little delay). I don't doubt that there may be some very dysfunctional hospitals in Ontario though.

If you're actually in immediate danger of death, or at least, they think you are, then sure you'll get bumped to the front. But for the great mass of us, bleeding, in pain, we wait. And that includes those kids who go to Sick Kids, where the wait time for "minor" problems is still approaching 6hrs.

[Argus]

no one likes waiting but that's our life, we wait at traffic lights, we wait at the bank, we wait at the grocer checkout, we wait to get into theatres concerts, airports and buses that's just the way it is.

Bullshit.

When I wound up waiting at Scotiabank I moved to a TD which had more consideration for its clients. When the lineups grew too big at a Loblaws I started going to an Independant. I don't take buses because I don't like waiting. And I rarely, if ever wait for anything at a theatre. When the lineups diminish I'll go then.

But health care is quite different. Most people who go to an ER are either in pain or extremely worried about something bad. Making them wait 6-8-10 hours before seeing a doctor is sadistic. And how exactly does that save the province money? I'll tell you how - by discouraging people from seeking treatment. Of course, it's a false economy because many of those people wind up waiting until they have to go and then their condition has deteriorated. Unless, of course, they die in the interim, which happens often enough too. How many people are in pain and self-medicate instead of going in because they hope it will get better and they can't face spending the entire night in an ER waiting to be seen? How many die because of it? Bet the Ontario government won't be keeping statistics of THAT.

[Smallc]

Rotate the little crank at the back of your skull and turn your brain on for a moment. Why on earth would they exclude the outliers for any reason whatsoever

Because that's how you do statistical representations. You include people in the main part of the curve, and you exclude the outliers, because they'll drag the numbers in one direction or another, and won't properly represent a useful average number.

[Argus]

House calls are a waste of resources, so I don't think it's bad to cut them back. We have telehealth now as well as clinics.

They're not considered a waste of time in Europe. They're considered a life saving program.

[Smallc]

In my experience

I don't care about your experience.

[Argus]

Because that's how you do statistical representations. You include people in the main part of the curve, and you exclude the outliers, because they'll drag the numbers in one direction or another, and won't properly represent a useful average number.

It's been a few years since my statistics courses but I can't recall anything which said you should exclude 10% or more of the data in order to increase accuracy except where the outlying data was suspected to be faulty for some reason or wildly divergent from the mean.

[Argus]

I don't care about your experience.

In the experience of everyone I have ever spoken to or heard of in my entire life. How about that? No, of course not. A closed mind doesn't consider such input when it deviates with his own narrow preconceptions.

And yet even the "official" government statistics are wildly unacceptable except to someone with exceedingly low standards who twists and turns and desperately wrings every possible concession out of them to try and make the system look better.