Two medical doctors, co-chairs of a task force to investigate wait times in Manitoba’s health system, heard an earful in Hamiota at the first of five public consultations scheduled throughout the province.
Manitoba Health was chastised by some for doing a poor job of advertising the meeting. However, that didn’t stop almost twice as many people as were expected from turning out to the meeting.
In the banquet hall of Hamiota’s District Sports Complex, 100 chairs were set for the 6 p.m. start, Monday evening, Apr.3, but over 175 people crowded the room.
Dr. John Ross and Dr. Alecs Chochinov, co-chairs of the Wait Times Reduction Task Force facilitated this meeting designed to hear from the public. In a round-table format each table of roughly 10 people were encouraged to discuss the assets and concerns they had regarding emergency care and priority procedures such as surgeries and diagnostic tests.
Dr. Ross is an emergency physician at the Halifax Infirmary and professor of emergency medicine at Dalhousie. He was appointed the first provincial advisor on emergency care in Nova Scotia in 2009.
“I’m 30 years in the business, I did some projects back in Nova Scotia around wait times,” said Ross. “That’s why we’re here, to try and make a difference.”
Dr. Chochinov is the medical director of the emergency program with the Winnipeg Regional Health Authority and an emergency physician at St. Boniface hospital in Winnipeg.
“Nobody is happy with the status quo,” said Chochinov regarding Winnipeg wait times and service in rural Manitoba.
Chochinov assured at the outset, they brought no agenda and were not there to sell any pre-arranged program. They came to hear from the public and “make some sense of this puzzle”. Never-the-less, increased ambulance service was presented throughout the meeting.
As ideas came from each table, a recurring theme rose to the surface – that of intermittent emergency room service.
“If you perceive you have an emergency, you shouldn’t have to guess. The on and off business is unacceptable,” stated Ross; echoed by Chochinov.
David Juce from Hamiota said that rural emergency rooms (when open) mean a wait time less than in cities. He called local medicine “cradle to grave health care” and pointed out that fibre optic cable coming to Hamiota and in other rural communities will enhance what local physicians can provide for their patients.
Ron Knight pointed to centralization and the lack of communication within PMH region as problematic. “Proximity is important to us. Even though we may not have all the fancy tools and specialists, at our table, we still felt it was more necessary to have access close.” He suggested a patient could be stabilized locally and then if need be, taken to another facility. “There was a time when the health centre and the community were much closer, we knew what was going on...it was a community health centre and we lost that with the RHA.”
Reeve of the RM of Yellowhead Don Yanick of Shoal Lake asked for a better allocation of funds and less bureaucracy.
A Hamiota family physician, Dr. Kristjanson acknowledged, “There will be times that I can’t definitively deal with something. My role might be to stabilize the patient and get them somewhere where they can get a definitive level of care.” He said a nurse practitioner or physician assistant would be the same way – they have a certain skill set and could be “quite capable to deal with 80 to 90 percent of what we see in an emergency room”. He explained, “For that 10 or 20 percent that they can’t deal with, they can stabilize [a patient], get EMS involved with transport to another place where they can get the care.”
A robust EMS system ranked high in the discussions.
However, Kristjanson also pointed out the cost to rural people. “I think we have to consider the financial downloading on patients. We have to have an equitable system, so we are not putting an unnecessary burden on people who might be more remote or more rural.”
Chochinov acknowledged that our medicare system does not cover EMS. “If we truly believe this is an important part of connecting all the dots, we need to find ways to [fund it].”
It comes down to tax dollars and whether to raise taxes, he said.
Toward the end of the meeting Chochinov left the public with the question of whether they would rather have emergency service intermittently available; or have all emergencies handled by EMS ambulance service, with highly trained technicians able to network with medical expertise as needed.
Dr. Ross explained that in Nova Scotia, a potential heart attack victim, upon ambulance pick-up, would have an EKG test. The reading is sent to a medical expert who makes the decision and can advise the EMS technician to administer life-saving anti-clotting drugs, or whatever the test would indicate.
This reflects a change in practice in NS that did not require new laws or new training, just a new mindset.
Chochinov called the current system, “provider centered” rather than patient centered and the doctors admitted the current remuneration system encouraged doctors to do simple things that a nurse practitioner could do, such as blood pressure readings.
Discussion also covered the need for nurses to do more routine clinic work, freeing up doctors to see patients in a timely manner.
Two EMS practitioners will be included in the working group studying the outcomes of the wait times review, as well as a means to improve service to physicians. Chochinov described a program, Provincial Emergency Consultation Services (PECS) to ensure that nurses, doctors and emergency technicians will be provided 24-hour access to a consultant, an emergency physician or specialist in their area, “without waiting an hour on the phone.”
Wayne Chacun, a front-line worker with Virden EMS, summed up what he saw from this meeting for rural Manitoba, and what he knows from his 20 years of experience as a career paramedic. “We can still have good health care - if there’s changes. EMS has really changed in the last 30 years from volunteers and basically giving people a ride to the hospital. We’re bringing [medical service] to people and giving them a lot of care.”
Future consultations followed in Dauphin, Swan River, The Pas, and Thompson.
Additional community meetings are to be held later in April. The public is also encouraged to share their thoughts and experiences by completing an online survey at www.gov.mb.ca/health/wtrtf.html.
