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This is an excerpt from Penguin.ca


Jeffrey Simpson 

Jeffrey Simpson has beenThe Globe and Mail’s national affairs columnist for more than twenty-five years. He is also an award-winning author of eight previous books—including Discipline of Power, which won a Governor General’s Award—and is an officer of the Order of Canada. He lives in Ottawa with his family.




Jeffrey Simpson

Chronic Condition first chapter

Letter Dr. Jeffrey Turnbull glances at the top line of the patient’s chart. He blocks with his hand the subsequent lines that describe the patient’s condition and treatment since being admitted the night before. “I know the rest,” Turnbull predicts.

The patient, R, is a ninety-four-year-old male. Turnbull’s quick assessment: “This will cost about $50,000 for the twenty to thirty days he is here.” Turnbull reads the rest of the chart. R came from a retirement home. He was given a battery of tests after being admitted to the Ottawa Hospital. The chart, all handwritten by nurses and residents, shows R’s vital signs are acceptable, but he has a urinary-tract infection, lesions (likely malignant) on his back and a form of dementia.

“That man should never have come into an acute-care hospital,” Turnbull observes. “Someone should have made arrangements a month ago for him to go somewhere, but now it’s happened.” Turnbull continues: “There are maybe 160 people in the hospital at $1100 a day waiting for long-term care. So we’re spending maybe $180,000 a day for care that is crappy, not in their best interests. In a nursing home, it would be about $200 a day. The care itself here isn’t crappy, but this man won’t have rehab. He’s not going to have his family around.

“They’ve done ten tests so far. What will happen now is that we will treat his urinary-tract infection. We’ll stabilize his condition. We’ll call the family and we’ll agree that he should be sent to a long-term care facility, and then he’ll wait for a bed. We’ll transfer him to our waiting unit, and then he’ll wait.”

Turnbull’s Monday-morning prediction introduced me, in the fall of 2011, to a week learning what goes on in the Ottawa Hospital, one of the largest teaching hospitals in Canada, with an annual budget of about $1 billion, and a template for similar institutions across Canada. The week allowed me to watch one part of Canadian health care across wards, operating rooms, the emergency department, administrative offices, inner-city outpatient care. It became evident throughout the week that at the Ottawa Hospital, as at other large acute-care hospitals across Canada, brilliant medicine is practised, caring staff offer succor and support, technologies and drugs unheard of several decades ago help patients with their ailments. Some of the very best features of the Canadian healthcare system were on display; so were some of the worst. A hospital is a…

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This entry was posted on Monday, March 18th, 2013 at 11:38 am and is filed under Longwoods Online.