A recent study of a Vancouver hospital showed that a significant number of its admissions resulted from problems with medications. Dr. Peter Zed, the lead researcher, estimated that one of every five to six of the hospital’s admissions could have been prevented. Since Canada’s hospitals are already under tremendous strain, the number of avoidable hospitalizations is of great concern. Keeping the public fully informed of such issues is an important element in restoring a consumer focus to Medicare.
Drug interactions, allergies and other pharmaceutical issues are just one aspect of the issue of patient safety. Roughly a fifth of patients in American hospitals experience an “adverse event” that worsens their condition, whether from negligence, error, or just exposure to a contagion. There is no reason to believe Canadian hospitals are any better. In fact, given our comparative lack of competition and transparency, they could well be worse than their American counterparts.
Partly due to the nature of healthcare here, patient safety has a lower profile in Canada than in other developed countries. In most parts of Europe and in the U.S., market pressures apply to hospitals as to any other institution. If one centre has a poor safety record, or refuses to publish information about outcomes, patients can go elsewhere. In Canada, no matter how bad the local provider is, choice is limited if it exists at all. Only those who can afford to travel to another country for treatment can exercise real choice.
Most Canadians have no idea how good or bad their local hospital is. For decades, car buyers have had access to consumer reports, rankings and statistics about everything from crash safety to fuel efficiency. In the Internet age, we can research everything from paperback novels to major appliances. Why can we not also find out how one hospital compares to another, which doctors have the best outcomes and where infectious diseases have spread most easily?
Many European hospitals make public their record of containing superbugs, not as big a problem in Canada as there. But the SARS epidemic in Toronto showed how poorly our hospitals are prepared to identify and contain virulent illnesses. It also showed how quickly a small problem can become a national problem if it isn’t contained efficiently.
Canadians praise our approach to medicine and the law. Some of the more ludicrous lawsuits in the U.S. and skyhigh premiums for malpractice insurance should serve as warnings about the dangers of unrestrained litigation. But a climate in which doctors and hospitals understand that errors of this sort have consequences for them is one in which the medical system is held accountable for its performance.
Manitoba recently passed legislation requiring that patients be notified whenever an adverse event occurs in their treatment. This is a crucial first step. Even if the problem is corrected immediately and without complications, it is fundamentally wrong to conceal this information from patients.
Reporting mechanisms should be in place at all healthcare facilities, as they are in Europe and the U.S. It isn’t enough for care providers to acknowledge errors and seek to remedy them. The circumstances that led to the error must be reviewed, and improved upon to make similar future errors less likely. Other staff should be aware of the adverse event, not to lay blame on the practitioner in question, but to alert them to the possibility of making the same mistake.
When reporting isn’t enough, consumers need to know that their concerns are heard. Just as we have institutions that promote consumer protection, we must establish medical ombudsmen in provinces currently without them, agents empowered to investigate complaints about treatment, practitioners and hospitals.
Finally, we have to empower Canadians by giving them all the information they need in order to decide how best to meet their healthcare needs. The privacy of medical staff and patients must be protected, but the number of complaints brought against a practitioner, the nature of the problems, and their resolution should all be publicly available, just as Better Business Bureaus provide these facts about complaints against private sector businesses.
Resistant bacteria aren’t yet as big a problem in Canada as elsewhere, but consumers should know how many patients acquire such infections after being admitted to hospital. Hospitals or staffs with a record of negligence must be identified. Patients who have been harmed in the course of their care need access to a patient advocate, one who can address both their concerns and the underlying causes of the problem.
Most of all, though, it is time for Canadian healthcare consumers to see how patient safety is handled at the local level, and how their healthcare compares to that in other provinces and in other countries. That information will empower them, and also the dedicated healthcare workers who tend to their needs.
This article originally appeared in the Saskatoon Star-Phoenix December 1, 2006.