This article originally appeared in the Ottawa Citizen.
By David Zitner, September 23, 2024
As a retired family doctor, I get calls from former patients on a regular basis. These often-desperate people reach out to ask directly for medical advice or simply for help navigating the system as they struggle to access high quality care. Many of my former patients feel left in the dark — at the mercy of an opaque system that leaves them wondering if they’ve received the best care.
Canadian health care is struggling yet it doesn’t bother to recruit patient participation or collaboration. Ironically, patients are not only the ones on a health-care team most interested in an excellent result, but the ones whose participation incurs no additional financial cost.
Instead of being sidelined by the system, patients should be given the tools to understand the care they receive and to advocate directly for the care they need. Done properly, patient participation could have a huge influence on some of the biggest challenges facing our health-care system.
Consider, for example, the effect that more informed patients could have on crowded emergency departments. Many of the people waiting hours for emergency care don’t need the sophisticated approaches that should be reserved for complex problems and true emergencies. In many cases, people simply don’t have family doctors, don’t know how to deal with simple problems themselves, or don’t know what other resources might be available to them.
Unfortunately, administrators and regulators rarely encourage practitioners to become more efficient and make the best use of their clinical time to explain a diagnosis or treatment plan to a patient. Instead, layers of bureaucracy and unnecessary paperwork reduce the amount of time each practitioner has for patient care and patient empowerment. When provincial health departments encourage multi-disciplinary health teams, they also rarely promote and foster meaningful patient participation.
Patients are asked to make the final choices about whether tests, treatments or other recommended interventions are acceptable. Patients are, and should be recognized as, the CEOs of their own health care.
Normally, however, CEOs have significant knowledge about the things they are tasked to manage and have some way of understanding if recommendations made to them are reasonable. Canadian patients need to be similarly enabled.
Empowering patients has thus been a lifelong mission for my colleague, Dominic Covvey, an informatics expert and retired professor from the University of Waterloo, and me. We’ve both spent long careers in medicine and academia, debating the issues at hand, and we believe enabling patients is key.
Patients need to be brought up to speed on: the purposes of health care; ways to measure their health and any changes in health after receiving care; interpreting test results to avoid false reassurance or false alarms; how diagnoses are made; how to overcome the difficulties patients face when they suffer because of delayed diagnoses; how to evaluate the chances of benefit or harm from suggested remedies and where to find information; issues related to mental health, including meaning of the words mental health and mental illness, in absence of objective biomarkers; and common issues that arise around patient-doctor interactions.
In our recent book, Covvey and I have a simple hypothesis: Canadians without a clinical background can learn these things quickly, be better equipped to navigate our health-care system, and even put less strain on the system overall.
As proof of this concept, I taught a graduate course entitled “Clinical fundamentals for non-clinicians” and I found that students who had no background in clinical medicine when they started could easily learn to interpret medical issues and solve problems related to diagnosis, treatment, testing, measuring results and mental health.
About half of Canadian government spending is on health care. The system is struggling immensely while a massive resource — patients themselves — is being overlooked.
David Zitner is a senior fellow at the Macdonald-Laurier Institute. He has participated at every level of Canadian health care including clinical practice, research, administration, governance and patient and professional education.
