Health Care in Canada on Hold — Dr. Michael Green, Dr. Christian Finley, Dr. Kishore Mulpuri and Laura Greer

Avis Favaro

Hello, and welcome to the Canadian Health Information Podcast. We call it CHIP for short. My name is Avis Favaro, and I’m happy to host a brand new season of this podcast from the Canadian Institute for Health Information, better known as CIHI. Our goal: an in-depth look at the Canadian health care system as we talk to experts, health workers and patients about the challenges and potential solutions.

A note: the opinions presented here don’t necessarily reflect those of CIHI, but it is a free and open discussion about our beloved health system and the work that’s being done to help keep Canadians healthy.

On this week’s show, health care on hold. CIHI data is showing that wait times for priority procedures have gone up across the board because of the COVID pandemic, with the federal government reporting an estimated 780,000 delayed surgeries just to the end of 2021. So we will hear from the front lines about how COVID has impacted critical medical care for those with other illnesses, and why doctors are reporting seeing a tsunami of patients who need urgent attention.

So we’ll hear from the front lines how COVID has impacted critical medical care for those with other illnesses, how screening for cancer was slowed and how doctors are now reporting seeing a tsunami of sometimes preventable conditions, all while trying to catch up with exhausted, overworked health teams and prolonged staff shortages.

Dr. Christian Finley

This tidal wave that hit us, you know, just pause in a system that just keeps coming, so it just backed up and now it’s rushing at us. And compounding that is our human resources have never been more tenuous.

Dr. Michael Green

If I wanted to send my patient for a Pap test or the stool test to detect colon cancer, the lab would send the paperwork back to me and say, no, we’re not doing those right now.

Dr. Kishore Mulpuri

If you’re a patient, or your provider, you know that these people are suffering, and it’s easy to fix those suffering.

Avis Favaro

I’m joined by 4 guests: 3 doctors who have worked through the pandemic — good day to you all — and to a patient who’s dealt with the firestorm and had been in the middle of it.

So why don’t we start with a quick introduction of who you are and why you said “yes”? You all said “yes” very quickly to the podcast. Dr. Green, why don’t you introduce yourself briefly?

Dr. Michael Green

Hi, I’m Mike Green. I’m a family doctor in Kingston where I’m head of the Department of Family Medicine and a professor at Queen’s. I said “yes” because access to us as family doctors is the critical first step for people receiving the care that they need. And we’ve been super busy through the pandemic working assessment centres as well as in our offices, but there’s still a big backlog of care and we’re really playing catch-up. So I thought it would be nice to share what I’ve learned about that through these past couple of years.

Avis Favaro

Good. We’re going to be talking about that.

Dr. Mulpuri, introduce yourself and why you said “yes.”

Dr. Kishore Mulpuri

I’m Kishore Mulpuri. I’m one of the pediatric orthopedic surgeons at BC Children’s Hospital. I’m a chair of UBC Orthopaedic Department, and currently I’m also president of Canadian Orthopaedic Association.

My main reason for joining is to, again, share our story for musculoskeletal care, either for waiting to be seen or, more importantly, waiting to have procedures done was not great pre-pandemic and it’s only gotten worse, I think, with what happened.

Just to share, I think, some of the lessons learned. With everything, there are some positives. I would say there are some positives that came out of this and, if so, what they are, and what can be done, how can we work together to improve care for those patients and families.

Avis Favaro

That’s it. Those are the topics.

And, Dr. Finley, introduce yourself.

Dr. Christian Finley

Hi there. I’m Christian Finley. I’m a thoracic surgeon here in McMaster. I’m also Expert Lead at the Canadian Partnership Against Cancer and also work as the head of Ontario Lung Cancer Screening. And so many of those domains have seen the direct impacts of COVID and its effects on the health care system from a cancer lens, but also as a surgeon who works with the lungs. And so I did all the tracheostomies in our hospital on people with COVID. So I have been at the bedside through this and am happy to speak to that. And I’m always keen to have a conversation with patients and the public.

Avis Favaro

And Laura Greer — we crossed paths when Laura was working at SickKids Hospital and here we are in a different context. Laura, introduce yourself and why did you decide to say “yes.”

Laura Greer

Thanks, Avis. Hi, I’m Laura Greer and I’m the national health sector lead with Hill Knowlton Strategies. So my day job is doing health policy and health advocacy consulting. And I was working on the problem of delayed, particularly cancer screenings, backlogs of surgeries, et cetera, when I found myself diagnosed with metastatic breast cancer at the end of 2021 after delayed mammograms.

So I then became a patient in my own advocacy coalition, you could say. I’m working with a number of patient organizations and health professional associations around the need to address what are significant backlogs with cancer. So I’m here today because I know a lot of other patients in my situation are not in a position to talk or maybe, and I say on a weekly basis, if I didn’t do what I did for a living, this would be a lot more challenging than it is too. So I think it’s an important perspective to bring forward. I think we’ll hear from all of the physicians what the impacts have been on them, but I’d say experiencing this and experiencing a cancer diagnosis in the context of COVID is a whole other thing.

Avis Favaro

Are you currently in cancer treatment because of this?

Laura Greer

I am. I am on an oral take-home cancer medication, a targeted therapy, a CDK4/6 inhibitor, for all of my physician friends, and a hormone blocker, so which is working currently, which is good. I’ve been on treatment since January. I started treatment at the height of the Omicron wave, so, and did get to experience the challenges here in Ontario of the Ontario government not covering take-home oral cancer meds. So I will do a plug for the need to change that too. I’m lucky it’s covered with my private insurance through my employer. But still delays in treatment of a number of weeks while waiting to access that.

Avis Favaro

How are you feeling?

Laura Greer

I’m feeling — I mean, and the strange one, I also was diagnosed with no symptoms, so everyone was quite surprised when I ended up at stage IV. I’m feeling quite good. I’m working full time. I’m still doing all of my mom things, et cetera, but it’s been quite the challenging journey.

I’m lucky in a number of ways that my family doctor — I went last spring because I had some abdominal pain — and for context, the hospital closest to me had a field hospital set up in its parking lot, so Sunnybrook, so I was not going to the emergency room because of that, but my doctor did see me and we didn’t sort out really what that abdominal pain was, but I said, what about — I had just turned 50, but I’d had previous mammograms because my mother had had and that. So I said, what about my mammogram? What about this? It was kind of like the list of grievances I’d compiled over the year and then did get the referral for the mammogram, but again, I had to ask for it. No one was reminding me to do it. I still faced like a 7-month wait to get in at Mount Sinai.

Avis Favaro

So it took you 7 months to get a mammogram, even though you were at high risk?

Laura Greer

And even, [et cetera] again. And then like my sister, who also would have been in the same similar, so in November, when I was diagnosed, she was told it was at least 5 months to get in for a mammogram. And this is us in midtown Toronto not dealing with, I’d say, other access issues if I was living in another part of the province.

Avis Favaro

How does that make you feel that you’ve been caught up in the delay and the efforts to control COVID?

Laura Greer

I mean, I was angry and then had, I’d say, an unusual response that I like reached out to colleagues and was like, we need to get this in the platforms for the election. What do we need to change? So I kind of quickly pivoted to the how-do-we-fix-this mode because it’s going to be an even bigger challenge. Like, I’m at the start of this. We don’t even know all of the ones that are waiting to come there.

So I think I was angry and I’d say — and I think, Avis, you’ve asked me this, or others as well, of what would we do again? Putting a pause on people accessing primary care or important screening programs, I think in retrospect we’d all look back and say that wasn’t the right decision.

Avis Favaro

Well, that leads me to Dr. Finley, ’cause I saw — I think you’re nodding there about this. Are you hearing other stories like Laura?

Dr. Christian Finley

I’m so incredibly sympathetic. You know, it’s so hard just to go on the back of a very personal experience with numbers and from the clinician side of things. But, Laura, with your permission, I’ll throw some numbers out for people to contextualize.

So we’re thinking that people have tried to model what the effect’s going to be of this interruption and then delay, and the thinking is really that there’s going to be probably 20,000 excess deaths from cancer. And that for breast cancer specifically, there’s going to be 3,500 more breast cancers than we normally would find showing up at the doors. And 550 of those are going to be late stage.

This speaks to this huge surge of cases, and I’m sure Dr. Mulpuri and Dr. Green will speak to their lived experience of this tidal wave that hit us, you know, there’s this pause in a system that just keeps coming, so it just backed up and now it’s rushing at us.

And compounding that is our human resources have never been more tenuous in almost all aspects. There’s been an 80% increase in postings for jobs.

I had a patient the other day who went in to have cancerous fluid drained from around her heart and she was in the hospital overnight and there’s nobody to help her neighbour get out of bed and go to the bathroom. So there she is post-operatively having had a chest operation, getting out of bed to help her neighbour get up to go to the bathroom because the staffing’s so short.

So, you know, it’s all in a time when we’re being asked to try catch up. So I feel so incredibly sympathetic to Laura’s experience. And I also turn around and, as I walk out of the room after this, have to go and face an onslaught of 70 people that have been referred sitting outside my door, so.

Avis Favaro

How do you feel when you go home?

Dr. Christian Finley

Yeah, it’s exhausting. You know, like I think that we all have our own personal experiences and tales of burn out and how we keep going, but there’s a lot of people gone. Like there’s just a lot less people on the ground than there used to be and we’re doing a lot more work. So it’s a vise on both sides, but I think that people just keep on going.

Avis Favaro

Another area that was very badly affected were orthopedic surgeries: hip and knees. I had one friend waiting for a hip replacement for months and months, and I know she got worse and it played a number on her head. It’s just so debilitating. I asked you to sort of scan your membership. What kind of stories of delays are you seeing and the effects on patients?

Dr. Kishore Mulpuri

Yeah, I think pre-pandemic, musculoskeletal care, especially surgical access to that, has been really badly affected. Didn’t matter which province you’re talking about. There was about 180,000 patients in our country that were waiting for surgery, and that accounted for, I would say, 20% to 30% of all the backlog was MSK, was somebody waiting for orthopedic care. And that’s only gotten worse.

What happened is the provinces, in trying to keep the numbers up, and also because you didn’t want to occupy any inpatient bed, they’ve given more access to anyone that’s doing outpatient care. So, for example, it could be urology, it could be [passed], it could be — you know, that OR time was given to people doing outpatient care.

So provinces are coming up and saying, well, we caught up. They’re talking about the number of patients that are waiting probably. If you’re 180,000, probably now it’s 200,000. But what happened with orthopedics in most provinces, if they were at 20% of all the wait-lists, they’ve gone to 30%. If you’re at 30%, they’ve gone to 40%. So our specialty is badly affected in terms of, you know, especially what you’re talking about. A lot of those procedures that require even a 1-night stay were affected badly. And, you know, provinces are talking about, like, catching up, but I would say we have a long way to go, because it was bad to start with. It’s gotten worse now.

Avis Favaro

Right. In terms of disability of patients or what are they seeing happening to people waiting for hips and knees?

Dr. Kishore Mulpuri

We, as orthopedic surgeons, always say what we’re dealing with is not cardiac and cancer. But if you are a patient that’s suffering with an arthritic pain — I have a shoulder pain myself and I could tell you it’s not great to sort of live with a half an hour to an hour of sleep if at best. And that really affects everything else, right from your physical well-being to your psychological well-being to your workforce and your family.

There are significant downstream effects of dealing with intractable MSK pain. So if you’re a patient or you’re a provider, you know that these people are suffering. And it’s easy to fix those suffering. There are some, as we’re hearing with cancer, you might not be able to fix, but musculoskeletal health is actually quite a gratifying thing to fix. And that’s why people like me get into orthopedics, because 90% of the patients leave after you’ve done some intervention, happy because you’ve actually taken away their pain and suffering. And currently, we’re not able to help those patients.

Avis Favaro

You brought up an important word and this takes me to Dr. Green about the downstream effects. Do we even know the impact of the policy of delaying non-urgent care during the waves of the pandemic?

Dr. Michael Green

No, we won’t know for quite a while. I mean, there are some studies that have tried to, you know, use mathematical models to figure out some outcomes, as Dr. Finley mentioned. But what we’re seeing in the office is people have had their care delayed, and sometimes their other conditions progressed to the part where maybe they’re not a good surgical candidate now because their other medical conditions have advanced, or they’re a higher risk for anesthesia. The psychological and disability impacts we see.

So what’s happened to us in family medicine is for every patient on a wait-list for an extra day, that’s an extra day of them coming to us for care for their pain, for assistance with their disability, for social services to help them ’cause they’re stuck in their house. So there’s these downstream impacts of all these delays, and it’s pretty substantial.

So in family medicine, we do such a huge volume of visits. In Ontario, it’s somewhere around 800,000 visits a week to a family doctor in a normal week, and we did a study with my colleagues, Rick Glazier and Tara Kiran in Toronto, looking at the huge drop that happened in the first wave. It came back up, but it took a number of months. So if you were to count backlog of family medicine visits that’s sitting out there, it’s in the millions for Ontario alone.

And compounding that, if — I heard Laura’s story; I could so much sympathize with, you know, not being offered the cancer screening, but the context was that we were asked to pause cancer screening, which I agree was a mistake.

If I wanted to send my patient for a Pap test or the stool test to detect colon cancer, the lab would send the paperwork back to me and say, no, we’re not doing those right now. And then, 6 months later when the patient would need to go and get their test, they would say, sorry that requisition was 6 months old, you have to send a new one. And so they’re putting extra work on us to even just administratively catch up on the backlog. So I think there have been a lot of lost opportunities to assist in really trying to catch that up.

Avis Favaro

Why is it important to get data on exactly what’s happening?

Dr. Michael Green

Yeah, so, during the pandemic, there was a lot of delayed care. We were already actually looking at the issue of people who don’t have access to a regular family doctor, which is already a major issue across the country. And we were doing an earlier study about connecting unattached patients to care. And when the pandemic arrived, we extended the work we were doing, with support from Canadian Institutes for Health Research, to look at what happened during the pandemic to people who didn’t have a family doctor compared to those who do. So we’re really trying to explore the downstream effects of that.

It takes time. Cancer screening, as a measure of quality of care, means often people don’t need a screen every year. They need to wait a year or two. And those screens, they might be missed in the short term for some individuals, but in the long run, many of them, we won’t see the full effects for years. These delays are going to be showing up as cancers 5, 10 years from now, as well as the ones that are showing up at advanced stage right now.

Avis Favaro

I find that so disconcerting because I think that we’re not really talking about this, because it’s still largely COVID dominated. Am I right? Do we need to shift away? Should there be more discussion about delayed care?

Dr. Christian Finley

It’s such an interesting question and I’ll be interested to know the other panellists’ views on this. COVID seems to have recessed, in my mind at least, in terms of my first priority. I must say when it was during the multiple waves, it was very front of mind because I was going to the intensive care unit, because I was seeing those people every single day or my patients were getting cancelled ’cause they had COVID.

It’s been replaced by how are we going to get through this amount of work. And I think that you’re right that we don’t — not we collectively — but the payers don’t necessarily appreciate that we can’t catch up, but that it’s almost laughable to do 20% more work on the back of a system that has no surge capacity.

So I think Dr. Mulpuri can probably speak to the headache of — you know, I think, Dr. Green spoke to administrative problems. All of our lives have, you know, those operational administrative things that we do to get them to make things happen and we outsource them where we can, but when something breaks or there’s a bottleneck, it just — we can’t surge through it. It’s just that you think that you’ve increased the OR capacity, but you realize that you don’t have enough people to take care of them afterwards, or see them beforehand, or when they go home, get them the medications they need, or this system has some prehistoric boundaries that you can’t pay for certain drugs that could offload all those people so — that Laura spoke to. So I think maybe I would defer to my co-panellists, but I think that you’re right, that while I think COVID is going to be a problem and will be a problem for years to come in terms of recurrent waves, we need to move past it to all the other multitude of things that we still have to do.

Laura Greer

The biggest thing I would say is we can’t just pick up what we were doing before and think we’re going to solve what we’re dealing with. We need an actual concerted strategy to address the backlogs. We need to set more aggressive screening targets for, say, cancer screening to try to do that. But we can’t just pick up where we were, where we already had challenges of the system and weren’t being able to necessarily address it.

So I think that’s our biggest call for policy-makers is to acknowledge that we’ve got this problem and we need to do something and look at doing things differently, or else we’re not going to get out of it because we’ve had the acknowledgement of the health human resources shortage, we’ve had the acknowledgement that backlogs are coming and how to catch up, but what do we do about it? We’ve not seen, I think, enough of the — I’ll call it the bolder ideas to actually address it.

Dr. Kishore Mulpuri

We need to work together. It has to be a dialogue, not a monologue, and often, as Dr. Finley was talking about, or Dr. Green, we don’t engage people that are on the front line. We don’t engage people that are on the ground up. Often, you’re engaging with people that you’ve appointed to send the messages that you want, and I think what we need is everybody to the table and really thinking about ways that we need to fix, not put Band-Aids on a bleeding wound, and I think that’s what we’re doing.

Avis Favaro

What do you think the pandemic is teaching us about the value of the health care system and what you need as a baseline to keep it resilient?

Dr. Michael Green

Canada is a patchwork of different arrangements, and even within a single province like Ontario, each community and area had its own strengths and weaknesses. I spent a lot of the pandemic serving in some different leadership roles around pandemic planning, and what was really evident was that in some places, the places where the medical community, and community and social services, and public health and municipalities were able to work together and had a really good strong working relationship and strong teams, they did much better. And the places where it was not connected, not linked, and particularly in the primary care sector, places where there weren’t strong both supply of primary care, but also primary care teams and primary care connected with their specialty and other colleagues, for example, in the Ontario health teams, if there was strong connections across the whole community, they did way better. Other areas struggled.

So in Kingston, for example, we had one of the highest early roll-out immunization rates for COVID in the province, and that was because our plan was coordinated by public health and primary care and the hospitals meeting weekly to all get together and get everybody on the same page to do it.

Avis Favaro

By putting all this health care aside, did we make a mistake? Or is there another model that we could have used to maintain cancer screenings, hip replacements and that? Any ideas?

Dr. Christian Finley

When you talk about models of care, and I think that Dr. Green was speaking to it there, that our ability to trust our neighbour, our sort of communities of care, give us robustness when things go wrong because you’re right, we can’t predict if it is monkey pox or whatever that will come down the road.

So I think facilitating good cultures and working relationships, being nimble, as Dr. Mulpuri spoke to, with regard to new models of care or addressing problems in unique and thoughtful ways and not being scared to be bold, that making sure that we’re good with our data that sometimes in Canada because we’re so disjointed and patchwork, we don’t collect comparable data, so having that benchmarking national standards and having people do those moonshots will make us better.

I think that there are many things to be proud of. There’s things that we did remarkably well, and I don’t look back with regret on those decisions to pause things, because at the time we were all terrified. You know, we were hiding in our houses and people made the best decision they could. So I don’t begrudge the decisions; we’ll deal with them now. But you’re right that we need to learn from those lessons and as we go forward, make ourself more robust, as Dr. Green has alluded to, to talk with each other such that those deficits don’t get us next time.

Avis Favaro

So what I want to do in the last minutes of our conversation is talk a little bit to the people who may have been affected by delayed care here. So number one, are efforts underway to catch up? And do we have the manpower and the planning to do it?

Dr. Kishore Mulpuri

We have a lot of our health care workers that were contemplating retirement that have gone into retirement, and there are some that have come back for retirement. Good for them, and they’ve actually come back to help the system.

But overall, we have a net loss on people without adding any more people. And we talk about running our health care at 98% or 95% efficiency. To be honest with you, when I hear that, I don’t applaud ’cause we don’t have fire stations because they’re being used 98% of the time to put out fires. We have fire stations and firemen. When fire happens, they’re there to support.

Same with the health care systems can’t be run at 98% efficiency. I would say — I would applaud a system that’s running at 80% that’s got 20% capacity to deal with issues that come up. I would say what we need in health care, we need that buffer. We never built that buffer with our human resource planning. We never built that buffer with our emergency care, our urgent or semi-urgent or our regular care. So we need to build a buffer in our health care system. If we start now, we probably have a chance 10 years from now.

Dr. Michael Green

I would fully agree with that. One of the other studies we just did looked at early retirement or stopping work for comprehensive family doctors in Ontario during the pandemic. And in the years ahead was running at a kind of fairly steady low rate, 1.5% to 1.8% per year of doctors would stop working. And in the pandemic year, it went up to 3%.

Might not sound like a lot, but, you know, there’s already 1.3 million patients in Ontario without a regular source of primary care, and there’s another 1.7 million patients whose family doctor is 65 years or older, and almost half of those have a family doctor that’s over 70. And how are we going to catch up on all of the care that we need to do if those people start to retire sooner than anticipated?

Avis Favaro

Is there any advice for people who are listening who are saying, yeah, I haven’t had a check-up, I haven’t had that test?

Laura Greer

Advocate for yourself, and that’s one thing that I’m lucky that I do that as a day job, but there’s lots of room for things to fall between the cracks because the system is overloaded.

So I just had surgery a month ago and I just had to do a lot of follow-up myself, like is there a problem that I’m having a CT scan the night before? Does that affect the anesthesia? Like you had to stay on top of it or even to follow up and say, I’m going to book a physical in because I’ve not been for years; I’m going to do that.

I guess my takeaway would be I’d say I’d be less concerned about COVID, and I say this as an immunocompromised person who is at higher risk now, than I’d say delaying other things that may have come up, so take it into your own hands and then try to get the care. It may not be as smooth or as quick as what it would have been before. But if you don’t do that, if I hadn’t asked for the mammogram, I still would have been probably sitting here not having had a diagnosis, so.

Avis Favaro

But isn’t it true that people are still afraid to go to their doctors and to hospitals? I know there’s been a rapid expansion of virtual care that may be helping in some cases, but are you still seeing fear?

Dr. Christian Finley

I would jump on what Laura said and say “go.” It is an incredibly safe place to be and access care. I would definitely support the idea of keeping track of your own medical health and health literacy so that you know what’s going on with yourself and advocate, if you’re not getting near your mammogram when you should be getting it, or if you have prolonged pain, accessing care for an orthopedic surgeon.

I think that we need to be out there and active and literate, but I also think for people with elderly parents, for people who have relatives that may not be looking out for themselves as much as they should be, it behooves us to reach out to them and help them and show up to those appointments.

You know, it’s one of the sadder things in the world to me when I operate on someone, I get a little piece of paper that says who to call after the operation, and if there’s nobody on that piece of paper, that’s heartbreaking to me. And so I think we all need to leverage those relationships. Because all the time, you know, I’ll talk to a 75-year-old and says I don’t want to bother my kids yet. And like, wait a second, they’re going to want to know that you have a lung tumour, you know, I think that you need to reach out to them. And then the next meeting, they’re there.

So I’d say build those relationships, utilize them, advocate, keep track of things.

Laura Greer

And I’ll put a plug in for having patients to have access to their health data. That’s something that I’m a patient at Princess Margaret, but I get everything through the patient portal. I know different provinces have different access to personal health records. I think that is something, and to Dr. Finley’s point, that empowers you in health literacy, having access to your data and making it easier to navigate what is a complex system is an important part.

Avis Favaro

And, Dr. Green, you’re doing a study that’s going to give us data that will tell us what we’re up against in terms of delayed care being delayed opportunities. Is it important that we get numbers to what’s going on?

Dr. Michael Green

Yeah, the numbers are important because even from different points of view, the same thing can — 2 different things can be true, and I’ll use the access to family doctors in Ontario as a great example.

We were really busy through the pandemic. Our total visit volumes, if you combine virtual care and in person, overall for the province returned to pre-pandemic numbers over a year ago in terms of the actual number of visits. But the reality is also that those are not even across the province. So there were some patients who were still having great difficulty accessing their own doctor, and some people were having trouble accessing in-person care, and we were also running the assessment centres and all those sorts of things. But we wanted to provide that care and patients would be, you’re too busy, I don’t want to come in, how can I catch up? I’m not a priority. It was amazing to me how much people were trying to protect the system even themselves and we won’t know our need for capacity if we don’t plan.

I’m really worried about the health human resources going forward. Those retirements are coming. There’ve just been some announcements about new medical school spots and new residency spots. I don’t think it’s enough. I don’t think they’ve done the planning. I don’t think there’s been enough investment in teams to pick up the slack for where there’s not enough family physicians or others to do it. And I think that is going to need solid numbers to do a good job on building back.

Avis Favaro

Okay. So the message that I’m hearing is that if you’re a patient and you need care, call, don’t sit and wait because that’s not going to happen. Be more vocal about your care?

Dr. Kishore Mulpuri

Absolutely. Advocate. There’s no one better to advocate for yourself than you. If there’s anything I could talk about Canadians are, I mean I’m not because I live in this country, I emigrated. They said these are the nicest people that you could find on the planet. And I often joke and say, true Gandhism, if you slap somebody on the left cheek, they’ll show you their right.

So, you know, our “please, sorry and thank you for everything,” so we’re nice people. But advocating for your health care is your right and you need to advocate for yourself. Obviously, system need to advocate for you. We all need to advocate for our patients and families, but don’t ever forget, it’s your health. Advocate for yourself. Advocate for your loved ones, and be there. Speak up.

Dr. Christian Finley

But also to the government I would say, like there are so many people banging pots on their front steps when this all started, but we need to be banging pots in front of our government representatives because they take for granted the hardworking health care, the Dr. Greens of the world who probably was doing 200% of his job for years. They need to be supported, and that’s — you have to look and advocate locally and then also up.

Laura Greer

And I will say, too, of one thing that for sure the pandemic taught us is how central health of our society, how our health care system are to a well-functioning society. So we do need to build a more resilient health care system that can sustain this. So I think that’s one where I’d like to hope it has been learned, but like we saw how a virus brought the world to its knees and how much we had to adapt to keep our health care system from being overwhelmed. We need to do the work to ensure that we’ve got that resilient health care system so that it’s there when people need it.

Avis Favaro

Anybody hopeful before we conclude?

Laura Greer

I think there’s a lot of people who want to be part of the solution, and I think picking up on a point, we just need to be noisier that that is what we’re demanding almost is that.

And we need to get different people at the table to hear the solutions. That’s one of the first things I did when I was speaking with my oncologist at Princess Margaret was what would you change? What would you fix right now to help you address the problems? And so I think we need to ask, like, what needs to be done to bring that forward.

Avis Favaro

Let’s ask that, Laura, as a concluding comment. What would you need, Dr. Green, to make things better?

Dr. Michael Green

Well, I think across the country as well as even in Ontario where some of these exist but are very patchy. In family medicine and primary care generally, we need teams. We need to have mental health supports to work with our patients. We need navigators to help our patients access community resources so they can participate in things like those same-day surgeries. We need better connections with home and community care and support from allied health like nurse practitioners or others, so that I can work to my full scope and they can support so that we could take care of those patients who don’t have access to care. We really need that and for that, we need doctors to not be all on fee for service in family medicine across the country.

They need access to ways that will allow them to provide care for their patients that’s not in 10- or 15-minute visits that are on a clock.

Avis Favaro

Right. Dr. Mulpuri, your wish list?

Dr. Kishore Mulpuri

We need to focus a lot more on preventive care as we’re dealing with urgent issues. You know, I would say we need to put flood gates so that you’re not going to be swept away. You know, when that flood is hitting you, you cannot put emergency dams; you need to build them right now. So a huge effort on, as Dr. Green said, teams and preventive care.

Avis Favaro

Right. Dr. Finley, in regards to just resolving some of the backlog with COVID, what would be your wish?

Dr. Christian Finley

Yeah, no one wants to say, but there’s going to need to be a whole lot more money put into the system to make it happen. And I think we all dance around it, but that we are not pocket change amounts of money to make this better.

Avis Favaro

Yeah. And, Laura, last word to you.

Laura Greer

We need bold thinking and we need people at the table and commitment to have a plan to get out of it. And so that’s, really, I’d say the call, but let’s not get caught up in the politics of that. But, like, we need to acknowledge that this is a real issue, and it’s something that’s fundamental to our society. So we need to actually devote the resources and the time and the thinking on how to do that.

Avis Favaro

Yeah. Well, I want to thank you all again. I think such an important issue, and we’re going to be dealing with the effects of delayed care. We’ll wait to see Dr. Green’s study when it comes out, whenever you have it ready.

And to all the people who are awaiting care or have dealt with delayed care out there, just want to let you know that we’re thinking of you.

Thank you so much for listening to our show and we hope it sparks important discussion about the urgent need to deal with Canada’s non-COVID patients who are waiting for care.

It’s important to note that in spite of the challenges, there are signs of hope. Ottawa recently announced it would offer a one-time boost of $2 billion to the provinces and territories to help with the surgical backlogs. But as you heard from our guests, more creative solutions may also be needed.

Check in with us next time when we’ll look at other health topics that matter to you. Our executive producer is Jonathan Kuehlein, and special thanks to Aila Goyette.

If you want to learn more about CIHI and wait times, please visit the website cihi.ca. That’s C-I-H-I for the Canadian Institute for Health Information. And remember to subscribe to the CHIP wherever you find your podcasts.

I’m Avis Favaro. Talk to you next time.