No money is ever enough

(or “The Health Canada needs innovations to save money”)

Weather you are opening a newspaper or turning on the radio or the TV, like it or not you will not avoid getting some news about what is wrong with the health care in our country. Unfortunately, something negative happens more often than something good. It makes me wonder how good news usually very quickly turns into problems. The only thing that is certain is that if the government puts enough money into the health care system everything will be OK. Maybe this is true, but how much money? That is the question.

The amount should be approximately in the middle between the recommendations of the Romanow Commission and what pleases each of the premiers. Negotiations between the federal and provincial governments have been concluded with compromises from both sides. Will the health care problems be addressed? Can anybody answer this question?

So, is money the panacea for fixing our health care system? If this was true, I assume the necessary money will be easily found from the support of Canadian citizens.

Unfortunately, the fact is that no money is ever enough. Tomorrow health care will require more money then today. The growing and aging population, new technology, expensive equipment, doctors, nurses shortages, pharmaceuticals are getting more and more expensive. After tomorrow it will need much more money and so on - in geometrical progression. Is there a country in the world that would be able to afford all this?

Yes, the system needs money for new modern equipment, for hospital renovations, to solve doctors and nurses shortages, etc. Every hospital administration believes that they desperately need money much more then other hospitals. Money can improve the health care system only if the taxpayers’ money is spent effectively. That is exactly what health care officials should be aware of before allocating any funds. In our point of view “effectively” means to discover a path towards how to reduce health care expenses using new effective ideas, innovations and advances. Have you heard or seen up until today any real convincing examples of these? This is the main question.

Everybody believes that prevention is better than a cure. Yes, we can see that some funds are spent on vaccinations, printing health related information, TV programs used to educate people on how to prevent illnesses and keep a healthy life style. It may be useful for some and meaningless for others. And finally we do not know how effective this method is, how much money has already been spent and how many illnesses were prevented by doing so.

Folk wisdom says: “It is not possible to buy health with money”.

A lot of things should be done such as: a healthy life style (those who believe in it), healthy diet (those who believe in it), healthy environment (where is it?), and so on.

I assume that most of us basically believe in a “good doctor", experienced and professional, who is able to quickly identify our illness and provide an appropriate effective treatment.

This is a major problem. The proper diagnosis. The proper medications. Is the doctor 100% sure of his/her diagnosis, or the prescribed medication?

As usual your doctor will tell you: “Lets try this medication, we will see how it works”. For me it is a good idea, to check how the doctor’s prescriptions will work, but only if the doctor is able to take into account all my health conditions.

According to medical science, humans have nine body systems (digestive, intestinal, circulatory, nervous, immune, respiratory, urinary, glandular, structural). Each of them should be considered when doing patient examination. Let us add to this list also a psychological aspect, which could be the most important.

Of course, not everybody’s system has to be ill and has to be examined in single visit and not all side effects of prescribed medication could be taken into account. Not all, but who knows what will happened if “not all”? This is a question.

Please, excuse me for providing you with brief script of a realistic (if you allow – typical), well known picture of visit to a family doctor.

The patient was greeted and registered at the reception counter and spent a short amount of time (1-2 hours) in a waiting room, until finally invited into the doctor’s room where he will get a once-over examination.

The best scenario – the doctor will check only two or three of the patient’s body systems may be using a physical and/or biochemical analysis.

The worst scenario – it will be just a brief anamneses of patient.

The majority of us are not professional medical specialists, but health care issues concern each of us and most of us have enough experience and information from people around us, about how many mistakes are made by the medical personnel, due to their inability to take into account the potential abnormal functions of our body systems during the time of the visit.

Yes, there are a lot of parameters/characteristics that in the ideal case should be examined and considered. How many abnormalities does the patient’s body systems have? How long does it take for the doctor to consider them, and to find the optimal way for the best treatment that will lead to fixing the worst symptoms? It is not possible to achieve this even with the highest professional and most skilled doctor. This is not a question.

The best scenario – the most talented, skilled and experienced medical doctor will be able take into account a very limited number of the patient’s body systems, and using his own intuition will choose a treatment that he will consider as the best for the given patient. Of course, some times it could work.

The worst scenario – the patient will get an once-over examination and prescriptions to medications “covered by the government”. Let us see what happens.

Maybe I am wrong, because in some cases, the last one could be the best scenario. It reminds me of a popular joke. One doctor asks the other regarding their patient: “So, do you have any intention to provide treatment for him or leave him alive?” I guess you know the following expression too: “You need great health to endure medical treatment”. All of this would be very funny, if it wasn’t so sad.

Try to imagine: how many of your body systems characteristics your medical doctor keeps in mind? What does he/she know about your visits with others medical specialists?

Is he/she able to takes into account what you have got during your previous visits? So, do you really believe that in this situation he will be able to provide you with the most proper treatment (this is the only treatment any of us need)? Do you? This is a question.

No, I have a perfect family physician and I like him very much. He is very skilled, very analytic, very experienced, very smart and very careful. He is doing everything possible to keep me alive. This is a reason that I am grateful to be granted to use his office and his care.

Unfortunately, there are a lot of family physicians, which work as “dispatchers” between other medical specialists and are not able to consider all sides of our health conditions.

Just one more thing, I am sure some times you have witnessed that your doctor does not remember your previous indispositions and what kind of treatment you have used for the last illness, so as usual they have to check yours archive file during your visit time. If in some case the medical doctor doesn’t remember or doesn’t take into account important characteristics of the patient’s health it could result in a tragic final. This is not a question!

Let me provide you only several examples.

The closest friend has died in terrible pain after more than eight months treatment in the hospital, because her family physician has forgot and didn’t take into account her surgery two years ago and didn’t pay attention to the references of the ultrasound examiner, for it was necessary to provide for her an urgent examination using MRI.

The son of another friend died in the same situation, because the family physician did not consider providing a colon examination for him.

The son of our colleague died after six months of treatment in a hospital as result of wrong vaccination. Nobody took the time to verify if this particular vaccine would be acceptable for him.

I believe, my reader, that you too can add to this tragic list many more similar cases. I am stopping, because it requires more strength of mind to continue with it. USA statistic data shows 30% of all deaths are caused by medical errors.

It is a really tragic situation, but often we cannot blame the medical personnel, because the inevitability of medical errors in many cases is a result of the inability of medical doctors and other medical staff to concurrently consider all the factors that influence the health of any specific patient. Unfortunately this is true.

Please, dear reader, now imagine a fictitious scenario.

Each doctor’s office has a computer and software that we* call “Computerized Medical Advisor” (CMA).

A patient in the first visit to the medical doctor (of any specialty) is to be greeted by the receptionist who is checking the patient’s health card and will be able to provide access to the doctor. Due to the information on the Health Card the doctor will have access to a computerized file with all available information about the patient’s health history until the current visit. Of course, privacy standards will allow access to specific information only for appropriate medical personnel. The family physician must have a full access to all health information of the patient-visitor.

Using this information the doctor will able to take into account all the factors that influence the patients health.

CMA provides the medical doctor (family physician or others) with information in standard medical forms including results of anamneses, physical and biochemical examinations. The standard forms should be developed on a basis of a computerized system analysis and the latest scientific data ofof medical science. Information will contain the complete number of health characteristics, which must be taken in consideration in this particular case. Most of such standard forms already exist and need only be transformed into the CMA Knowledge Base.

During the visit a medical doctor (or doctor’s assistant) will fill out the standard CMA forms with new information about the patient’s health.

In the end, the CMA will provide the doctor with an optimal (or several sub-optimal variants) set of means for the best treatment of this particular patient (instead of an abstract illness name). The optimal variant of treatment will include not only the medications selected with the considerations of their side effects, but will provide recommendations regarding diet, physiotherapy (if necessary), etc. The family physician will able to co-ordinate treatment with others medical doctors and will be able to make the final decision regarding the best possible treatment as proposed by the CMA.

Please, dear reader, allow me a little more fantasy.

So, you live in a remote area, you do not have access to the high professional medical specialists - all of them work in big city hospitals. Don’t worry; your doctor using CMA will be able to provide you with service of the same quality as the highest qualified family physician or other medical specialist.

Further more, you are educated foreignly and an experienced specialist-newcomer, you do not have a medical license and it is prohibited for you to treat people. Don’t worry, the Ministry of Health will provide you with a CMA and you will work under a “mentor” – licensed medical doctor, who on a base of your advise will take charge for prescribing medications and other treatments.

It is impossible for any society to afford the expenses of a Health care system that allows medical errors, which could be avoided. It makes tremendous expenditures. Statistics can be collected that illustrate how improper diagnosis or treatment reflects on hospitals’ expenses, cost of medications, treatments of chronic illnesses, etc.

We (initiative group of specialists) are able to enumerate many more benefits of CMA, but were afraid to make you overexcited and you will demand the Ministry of Health to provide you with CMA immediately. Do not hurry up. We are trying to introduce a scientifically developed Model of CMA to Ministries, but government officials until now have kept silent. It is not understandable; how could they not care about medical errors? Do they prefer to show people how they ready to spent money in the Health care rather than save them?

The CMA is a model of technique that can be used by any medical staff in order to provide the highest level of treatment to a particular illness. Due to the CMA it will be possible to achieve a sufficient reduction in the number of medical errors, resulting in financial savings and shorter waiting lists; focusing on the best possible treatment for particular patient vs. an abstract illness; allowing remote areas of the country with shortage of medical institutions and medical staff to provide the same level of health care as in the big cities; facilitating the training of medical professionals in Canada.

This Model of CMA is based on “The Methodology of Computerized System Analysis and Design (MCAD)”**, Methodical software complex “CoSMoS” as realization of MCAD (result of more than 20 years development) and that will provide all existing scientific knowledge to any doctor in real time. It is not a medical library – it is an Artificial Intelligence device that works as Intelligent Information and Expert System on a base of all available scientific data.

The Project – Proposal was submitted in March 2004 to the federal and provincial (Ontario) Ministries of Health. Not getting an answer we addressed the Prime Minister of Canada as well as the Premier of Ontario and (thank God!) we got a response stating that the proposal was sent to the same Ministries. Everything falls back. So, will we get reply in this case? This is a big question!!! But we keep hoping.

On behalf of initiative group of specialists

Vitali Guitberg, Ph.D.

President of Alliance of Technology and Science Specialists of Toronto Inc.

* Members of the Alliance of Technology and Science Specialists of Toronto Inc. & DISK Co.

** Copyright in 2004.