Tis the season

Re O Come, All Ye Ache-full: The ER Is Open (Dec. 24): I challenge columnist André Picard’s suggestion that hospitals do not gear up to accommodate the forecastable seasonal demand. - Globe and Mail, December 30

Sometimes I wish I could write a letter to the editor to rebut a letter to the editor.

In this case, the board chair of Quinte Health in Ontario takes Mr. Picard to task in the assertion that hospitals do not prepare for the expected exacerbation of chronically crowded hospitals.

"In Ontario, the government has been providing additional in-year funding to accommodate seasonal demand, but getting highly qualified staff for short-term employment is not as easy as hiring seasonal staff in a retail environment."

"Hospitals plan for the flu season months ahead of its arrival and do everything possible to free up bed space and add staff on a planned, programmed basis."

It is, in my view, a defence of the status quo.

I think, having reread the column from the now-framed picture on my office wall, that the Board Chair entirely missed the point.

Here is the long and short of what @picardonhealth actually had to say:

Our health system is beset by what academics call “inefficient processes of care.”

"Far too few Canadians have adequate primary care, hospitals are perennially overcapacity, home care is under-resourced and long-term care beds are severely lacking. "

"All of these issues need to be addressed if we want to ease overcrowding in emergency departments."

And here is what really resonated with Canadian emergency phsyicians:

"Telling sick people to “find alternatives” to the ER is not going to solve our overcrowding woes. Frankly, it’s as insulting as it is unethical."

This was the point of the article.

And my take is that "finding alternatives" is subliminal messaging for the inappropriate visit. The blame and shame of the 15 million Canadians who visit the ER annually.

The board chair states:

"I believe the provincial government’s move to establish Ontario Health Teams, which are custom-designed to support the geographic areas they serve, is the best hope for a radically new health-service delivery model."

"Bringing together the private and public sector to comprehensively cover regional health needs offers the potential to redefine roles and to have hospitals positioned to deal with what they were designed for."

While that may be and is yet another of how many pilot projects on timidly reforming health care, it would have been nice to see someone as a health care authority figure state something somewhat different.

Just once in my rapidly shortening lifetime, I'd like to hear a health care authority say something like "ER crowding is a public health disgrace in Canada that is reflective of poor system planning and inadequate bed capacity for our rapidly aging population"

And for good measure chime in with , Hospital crowding leads to dysfunctional and dangerous care for patients and puts whole communities at risk through ambulance offloading delays"

And then perhaps "If we don't address ER crowding now, in the next pandemic or natural disaster we are all screwed"

And also and why not "We are sorry for all the time wasted on the attempts at diversion of patients to walk-in clinics and even though primary care renewal is necessary, it will likely do diddly for the crowded hospital. We listened to health care experts who actually know squat"

"So please forgive us for not doing the right thing and increasing, at least for the last two decades, hospital bed capacity. It cost too much money and we just preferred to mislead you all rather than tell you we are to broke to fix it."

That would have been the letter I would have preferred to read in today's Globe.