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Holiday greetings, from Brian Day

Dr Brian Day, reluctant to take even a day off from his campaign for reform, managed to turn this year's holiday card to doctors into a political treatise:

Everywhere, my messages have been received with enthusiasm. Well, perhaps not quite.

I remain a target of some critics for pointing out that change is occurring and that more is on the way, whether we like it or not. So be it. [...]

The refusal to consider change in the face of these facts doesn't make sense to me, and I will continue delivering that message long after my days as president are over.
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Ontario's top five healthcare problems

Ontario's Liberals may have won another majority mandate in this fall's election, but they've still got a boatload of healthcare battles left to fight, according to Michael Decter, the former chair of the Health Council of Canada and the Canadian Institute for Health Information.

In today's Peterborough Examiner, he enumerates Ontario's : chronic disease, effective regionalized administration, electronic records and prescribing, the doctor shortage, and wait times.

Despite the scope of the problems Mr Decter describes, he sounds like he's got at least a modicum of faith that the government, led by the team of Premier Dalton McGuinty and the "now-experienced" Health Minister George Smitherman (both pictured above, flanking Roy Romanow), have a chance to ameliorate some of the trouble areas.

Mr Decter, an experienced healthcare analyst, describes the five problems as:

Chronic Disease - We are living longer than our grandparents, but not in perfect health. Two million Canadians have diabetes, soon to be three million. Heart disease, arthritis and asthma afflict millions more. Our health services were designed decades ago to treat acute episodes of illness and injuries from accidents. We cannot sensibly or affordably treat chronic illness in our hospitals. We need a broader set of services and much more patient self-management to succeed.

Integrating Health Services
- Local Health Integration Networks, or LHINs, represent massive and needed realignment of decision-making in the health sector. The LHINs need to bring together community health services and hospitals services into a genuine system that is sensible and affordable. Vast numbers of hospital services could be more efficiently delivered in clinics. An excellent example is the success of the not-for-profit Kensington Clinic in reducing wait times for cataract surgery. Hospitals are likely to fiercely resist movement of dollars and services elsewhere. The LHINs will need to marshal evidence and public support to bring about necessary change.

Making Smart Systems Smarter - Smart Systems is the organization charged with bringing Ontarians modern, safe electronic health records and information management. Only recently has new leadership given this effort a chance of succeeding. This is a mission-critical challenge for the health system. Without electronic prescribing, thousands of Ontarians will continue to die from medication errors. Without electronic health records, patients will continue to receive slower and less informed care.

We Want More Doctors But We are Getting Family Health Teams - There is a large gap between how ordinary Ontarians frame their needs and how health policy types design reforms. Family doctors are in short supply and many will retire over the next two decades. Newly graduating doctors do not want the work-dominated lives of their solo-practice predecessors. The answer is larger teams with doctors, nurses, nurse practitioners, pharmacists and others. This essential reform needs a vast communication effort. Without popular support it will be drowned out in a chorus of voices simply demanding more doctors.

Extending Wait Times Reductions - Wait times for cataract surgery, heart surgery, hip and knee replacements and cancer surgery have gotten shorter. In term two it will be important to solve the overcrowding and waiting in emergency rooms. It will also be critical to move the techniques that have reduced wait times in specific areas to a more efficient, faster health system in total.
Photo: Rick Chard, Ontario Ministry of Health

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