Wednesday Night #1679

As there appears to be nothing that we can do to reverse the drastic situation in Ukraine, and we will wait until Peter Berezin’s return to WN on June 11 to delve into the varied reactions to the new economic religion provoked by Thomas Piketty’s Capital in the Twenty-First Century , we plan to address issues related to Quebec healthcare policy  with the expert help of our OWN Wednesday Nighter, Dr. Mark Roper.

With the advent of the new Liberal government headed by  neurosurgeon Dr Philippe Couillard, and with controversial [Gaétan Barrette: bulldozer, mais rassembleur]  radiologist Dr. Gaétan Barrette, a  former  president of the Quebec Federation of Medical Specialists, now occupying the post of  Minister of Health and Social Services, Quebeckers can once again hope that our  battered healthcare system will have the attention it deserves.  In addition, Dr. Yves Bolduc, former Minister of Health & Social services (succeeding Philippe Couillard in the Charest cabinet) is now not only  Minister of Education, Leisure, Sport, but also  holds the portfolios of research and science.
The report on the Health Innovation Forum of 2011 “Overcoming barriers to change”  gives some pertinent background to Dr. Couillard’s thinking on some of the broad issues, but what is in store for Quebec now?

What were the campaign promises of the QLP  and what do they mean?
Increase health spending by four per cent annually.
Phase out the $200 health tax over four years.
Create 50 “super clinics” that would be open 24 hours a day, seven days a week, in addition to completing a network of 300 family medicine groups [FMGs].
Create 2,000 nurse practitioners.
Cover the cost under medicare of medical imaging in private clinics by 2014-2015.
Invest an extra $150 million annually in homecare services.
Go ahead with the modernization of Maisonneuve-Rosemont and Verdun hospitals.

There is no mention of what is commonly referred to as the Sherbrooke Model whereby a hospital center serves [only] the population of a specific region.
More importantly, there is no mention of reforming the current system of  Plans régionaux d’effectifs médicaux (PREMs)  that restricts the establishment of family medicine practices by recent medical graduates in major population centers. [RVH petition addresses family doctor shortage]

Everyone has thoughts about how to improve our healthcare, starting with  Jeff Begley,President of the FSSS–CSN Five Priorities For Quebec’s New Minister of Health and Social Services)

As long ago as 2007, alarm bells were being sounded over Perceived shortage of family doctors in Quebec with criticism of the system under which  “all new general practitioners have been required to take on special medical activities (SMAs) in hospitals during their first 20 years of practice. If they do not, they are fined 30% of their income. Special medical activities are activities that are essential but less popular among physicians because they are paid for at a lower rate or performed at less attractive times of day: 24-hour on-call shifts, elder care, and obstetric and emergency services. In practice, very few hospitals allow physicians to work fewer than 25 hours a week, so the compulsory threshold of 12 hours a week is purely theoretical.  As a result, the physicians concerned limit themselves to hospital practice or complete their work week with walk-in clinics. All other physicians, who represent more than half the work force, are not under any obligation to take on SMAs.”  Wednesday Night’s OWN Dr. Mark Roper has frequently commented on the problem (e.g.  almost exactly two years ago, in May 2012 “Dr. Mark Roper recently delivered an-eye-opening presentation on the timely subject of family doctor shortages in Quebec.”
The excellent and informative Gazette story of May 2  The Big Move: Hospital transfer will be historic undertaking focuses on the logistics of the MUHC move as indicated in the sub-head Shifting patients and staff from the Royal Victoria to new MUHC superhospital will be a massive and complex challenge . We would have thought that was pretty self-evident. What is less so is the road forward in terms of healthcare policy, concentration – or not – of services to patients. Buried on page 3 of the story is this warning:

“Although MUHC officials have planned for every contingency, there are many unanswered questions regarding the future care of many patients. That’s because ultimately the redeveloped MUHC — including a renovated Montreal General and the Glen superhospital — will actually contain 107 fewer acute-care beds than what is currently available. By necessity, the MUHC will, over the coming months, redirect a few thousand patients to community hospitals like the Centre hospitalier de Verdun and the Lakeshore.
What’s not clear at this point is whether those hospitals will be given the resources to absorb the influx of patients. And many MUHC outpatient clinics are now grappling with the uncertainty of whether to book appointments for some patients in a year’s time.”

On a related matter – and one of keen interest to many Montrealers  — is the fate of the Royal Victoria and the Hotel-Dieu, once services are concentrated in the new super hospitals. There is an increasingly urgent  need for a clear vision of just how the old buildings — which are located within the provincially protected Mount Royal Historic and Natural District — will be used. (Forum to discuss new visions for hospitals on Mount Royal) Let’s keep in mind the sad fate of the Redpath Mansion.
We hope to also have comments on the issue of the new med school curriculum at McGill  [McGill students voice concerns over new medical school curriculum] – is this a cause for concern, or simply normal jitters that accompany changes in curriculum? Do we need to worry that “they say that in the class of about 200 students, 45 failed histology (the study of tissues) and about 35 failed anatomy”?  In the absence of explanations, we do not find it reassuring that medical students fail anatomy.

Innovators
Meanwhile, the indefatigable innovator and former Sauvé Scholar, Dr. Jeeshan Chowdhury, founder (with the unrelenting support of Luc Sirois)  of Hacking Health,  is introducing the ListRunner app, “inspired by the paper index cards and books residents carry along on the ward to stay on top of their patients. We thought by securely sharing our individual notes, the whole team could focus on what really matters, our patients.”
Another Wednesday Nighter, Dr. Ofer Avital, participated in the recent Hacking Health session at Ste-Justine, pitching a concept  for a mobile device-based software for screening kids for autism years earlier than is currently done.   The problem is that kids are often only referred for assessment for autism based on symptoms that manifest at age 3-4 and then spend 1-2 years on a waiting list to be seen.  However, we know that the brain develops 90% of its growth in the first two years of life, and treatment before the age of 5, and preferably before the age of 3 is critical (referral to speech therapy, occupational therapy, other treatments, etc.). His group ended up with a fully functional proof-of-concept, won 3 prizes, and received interest from a number of parties about different types of support for the project. [Update: Ofer writes: I will be presenting an exciting new health tool this week at a special event Tuesday evening titled Innovation in HealthTech organized by Hacking Health in partnership with Montreal NewTech.]
And Jeremy Jonas advises that his company,  Sparkup Inc., and Impactus Forum “recently applied to Grand Challenges Canada for a grant to pilot our Developing Areas Health Innovation Marketplace, in partnership with Johns Hopkins University and the Misr El Kheir Social Innovation Foundation of Cairo, Egypt. The Marketplace will support existing innovators and social entrepreneurs – and attract new leaders – to design, produce, and deliver developing areas healthcare.
Jeremy asks that you “Please go to our video page on the Grand Challenges website and LIKE the video there. Add COMMENTS also if so inspired! The more votes and comments on our video, the better our chances of being selected for a grant to accelerate this important project. Please vote!  https://applications.grandchallenges.ca/en/viewVideo/28735E6AA2EB3DB6B0AABFB5“

Finally, we should mention the death of philanthropist  Liliane Stewart, widow of David Macdonald Stewart, who was a major benefactor of a number of hospitals. Alan Hustak has performed his usual brilliant and timely obituary feat.