“We’ve come to your case…” It’s the operating room calling. I have to squint to see the time displayed on the clock screen: 2:50 am. The previous night was also cut short for another case.
But the patient I’m called on tonight has been waiting for surgery for three days. His neurological situation is stable, no worries, but still. He has been fasting for three days. That doesn’t seem very acceptable to me… The problem is that I’m supposed to do another rather complex surgery in a few hours, around 10 am, a case that will take between four and six hours. The day before when I met the patient, he spontaneously told me: “Sleep well before my operation! »
“Don’t worry” was my response. But there, in the middle of the night, thinking about it, I tell myself that it doesn’t really make sense.
There is a management problem in the prioritization of surgeries. Getting up at night to do an emergency, no questions, no problems, that’s my job. But to do elective surgery, when I already have a big case planned for the next day, seems like nonsense to me.
Beyond considerations for my sleep, it seems to me that this is not serving either patient well. Whose fault is it ? No one, apparently. There is a lack of personnel, that is the problem at the root of our ills.
But we must also admit a MAJOR management problem in the delivery of care, a lack of planning and a lack of consideration for caregivers. And what disturbs the most is the lack of “accountability”!
It’s NEVER anyone’s fault. Even Gaétan Barrette, partly responsible for the deconstruction of the current health system, despite what he claims, is now a political columnist! Lack of “accountability”, I tell you!
Closed vessels
This can be seen at all levels in our over-compartmentalised healthcare system, managed in silos. Some examples :
The computer that allows me to consult patient files in my office is regularly dysfunctional. I find myself unable to connect to the network and see patient images every other day. I contact the computer help service of the hospital. I am told that they can’t do anything for me, because my office is served by the faculty. I contact the IT department of the faculty, I am told that the problem comes from the hospital network.
Two words sum up the main problems of our health care system: compartmentalization and “non-accountability”.
At 6:00 p.m., we receive a note telling us that clinicians will now be responsible for opening their clinic requests on the computer (you know, the one that works half the time!); this was once the task of administrative officers. In addition, we will now have to record our notes in the computer interface rather than on consultation sheets as we have always done.
The note explaining this process has 24 pages of instructions… someone (we’ll never know who, “non-imputability”) even had time to lay out a detailed flowchart of the procedure. But NO ONE (compartmentalization) thought to notify the clinicians a few days in advance.
Burnout
An internal memo from my institution recently reported increased availability for surgeries in the coming months. However, the exhaustion of the staff in the operating room (not taken into consideration in this planning, partitioning) does not stop increasing, which we note by departures and sick leave.
We are all anticipating a DISASTER in the availability of surgery rooms for the summer. Minister Dubé can repeat as much as he wants that the upcoming reform will allow a reduction in the waiting lists, ours are and will only increase!
The lack of integration of computer resources across the province is tragic! WHY was there NEVER an attempt to link all these resources? And if it was attempted, WHY IS IT A FAILURE? We will never know… (“non-imputability”).
A few months ago, I was performing emergency surgery on a patient transferred from Cowansville with a bleed in his brain. Unable to display the images of the CT scan done in Cowansville. A computer resource challenged will be unable to solve the problem. We will have to repeat the examination in our establishment before operating on the patient, wasting 30 precious minutes for the health of his brain, in addition to generating unnecessary costs.
If one of my patients has a complication after surgery, I AM THE RESPONSIBLE (“imputable”). Who are the “accountable” actors in the management of the health system, who failed to see the coming crisis and anticipate the crisis we are experiencing and who are struggling to correct its trajectory?
Me, I would like to know. And you ?