“We have to start to look at different ways of doing things,” says John O’Fee, board chair of Interior Health (IH). Speaking with The Journal about the future of health care in the IH region, O’Fee says that one issue is that younger physicians are less interested in the business-person model of providing health care that is still prevalent. “They have to rent or own part of a building, they have staff, rent, overhead; it’s a traditional, tried and true model, and there will be new physicians who embrace it.
“However, many younger physicians want to go into a clinic with no overhead, and be part of an inter-disciplinary team with more mobility. It’s a model they find attractive.”
O’Fee says that hand-in-glove with that is the clinical systems transition, which will see all patient records standardized. “The idea is that if you’re from Ashcroft and are walking down a street in Vancouver and get hit by a bus, they can pull up your health records there. Having standardized records allows for ease of mobility between doctors.
“Specialists’ reports would go there. Your entire patient history is there for your medical professionals to access, which tends to improve outcomes. ‘One patient, one record’ is the mantra. It’s starting, but it won’t be cheap.”
He notes that “We have to look at a hospital bed as the precious commodity it is. Resources are scarce, and there are fewer and fewer beds.” It costs between $1,200 and $1,800 per day to keep someone in a hospital bed. “It’s a very expensive place to have you, and you should only be there if you need imminent care. Maybe we can send you home with a monitor that plugs into your cellphone. That’s coming. You could be monitored remotely, and it’s not science fiction. We have to move towards that.”
He says that community paramedicine is where it’s at. “You don’t need to be occupying a hospital bed to have an IV changed. And no rational person wants to be in hospital. You’ll typically be more happy in your own home.
“We have to look at how to get people back in their homes sooner. We have to start to explore how to efficiently target health care spending, and become more innovative. And we need to think collectively about emergency room spending. Health care isn’t free; it’s very, very expensive.
“We all pay for it indirectly via taxes. Healthy people subsidize sick people. It’s the social contract we all make as British Columbians: those of us who are healthy subsidize those who aren’t.”
Physician turnover is a huge issue, but it is just one piece of the puzzle. “We have to have all the pieces. We’re expanding the nursing program in Kamloops, and the best chance of getting people in Ashcroft to come home is to train people for Ashcroft.
“I’ve seen Ashcroft’s charms; you probably have the best climate in the country. There are lots of positive things going for the town. If [health care professionals] like the outdoors, those are the people who will choose Ashcroft, especially if you start producing your own professionals.”
He says that the issue with nursing is not lack of people wanting to be nurses, it is lack of seats. “We have a huge wait list for every seat at nursing school. They’re full. Nursing is a good-paying job with a reasonable pension, and you’re going to see an increased use of nurse practitioners.”
He also notes that better use can be made of everyone’s time, asking if it makes sense for a doctor to take your blood pressure during a visit, rather than it being done before the appointment by another member of the team.
“Why can’t you go to a nurse practitioner, who can run tests and be in consultation with a specialist? Tele-health and video-conferencing are also a better use of everyone’s time, and enhances the liveability of small communities. You can meet at the hospital with the nurse practitioner.”
There is still a hospital in Ashcroft, and O’Fee points out that physicians can still make use of the hospitals in smaller communities. “But back when Ashcroft had a larger hospital, we had more beds per thousand people across the province. We can’t afford that unless we get more efficient, and hard decisions have to be made.
“Getting people back in their own homes should be our primary goal. Get people back to their community.”
