Assembly line medicine

There is one patient. Ageless. Without gender. The patient lives within a few kilometres of a large modern and complex hospital. Before the stretcher bearing this individual is pushed through the swinging door—his or her medical path has already been determined. The outcome has been predicted. Costs calculated. Everyone knows their role. They understand what the system expects of them. The clock is running. Time is money.

How else are we to put order to this chaotic, multiheaded beast that is modern health care? A system in which no one is in charge. One in which we insist upon the best technology employed and the most skilled folks to the task of protecting our loved ones. But we also need it to cost less—because we can read the demographic and financial trends and we know the path we are on can’t be maintained.

So we ask some smart folks to go away, sit in a room and come up with a better plan. After a few false starts they spew forth notions about productivity improvement. Inspired by manufacturers of the last century they conclude the only way forward is to take the human out of the being.

The problem, as they see it, is that we’ve historically looked at health care patients as individuals with their own set of unique circumstances, medical history, vices, prospects and aspirations. It seems folks have different needs and expectations of the health system at 85 than they do when they are 20. Boys are made differently than girls. It is all very untidy. It’s tough to build a cost effective machine to manage all these variables.

So what if we could overlook the things that make us different—focus instead on the things that we have in common? After all, genetically speaking at least, we are virtually clones of each other.

Aiding us in this new way forward is our improving ability to gather vast amounts of data, compile and process it and deliver objective truths. We have become very confident in our ability to divine the right answers in this way. Practitioners of this art give their findings officious sounding labels such as “best practice” or “evidence-based.”

We are getting close now to piecing together a method by which we can process these human widgets through a finely modulated and predictable machine. With reliable outcomes and decreasing costs.

There is no evil intent in this approach—just the blindness that comes when you believe you are smarter than everyone else who has come before.

Hospitals emerged in the community. To serve the community. They grew to become the focus of health care in the community. They were places we sought comfort, had our flesh mended, our illnesses brought to heel. They were places we prayed for relief. Said goodbye.

No one asked that Prince Edward County Memorial provide the same array of services as Sunnybrook or Sick Kids. We asked only for compassion, commitment and the wisdom that defines our community hospital.

It is worth reminding ourselves that PECMH wasn’t the problem with health care in Ontario. Nor was it other rural and community hospitals. When it was swallowed up by QHC, the Picton hospital had managed to balance its books for years.

Since then it has been robbed of its resources and capacity, each and every time BGH has felt a squeeze on its funding. Perhaps the cruelest irony of this most recent reform epiphany from the Ministry of Health is that small community hospitals were left out of the new funding formula. This means that if PECMH had never been amalgamated into QHC, BGH would have had to look elsewhere to balance its budget.

But it is far too narrow to look at the current threat to PECMH as a struggle between Picton and Belleville. Driving this latest flavour of reform is the notion that we are all one person, with one set of needs and a common set of expectations.

It does not consider geography or demographics— or the way these factors shape health care needs and define access. It does not consider the unique character of a community like this one.

For this reason it is doomed to fail. But likely not before it further erodes Prince Edward County Memorial Hospital.

The folks who conjure new ideas about reforming health care, I think, need to spend more time out of doors. Somewhere where life is little less ordered. A place like Prince Edward County perhaps.