Issue: BCMJ, vol. 45, No. 8, October 2003, Page 364 Editorials

I have always been impressed by the seeming ease with which cartoonists convey complex thoughts and ideas in their limited medium. One cartoon I remember clearly shows a character, index finger pointing skyward, face awash with wonderment, and a big thought bubble containing the single word “EUREKA!” This simple, one-frame cartoon clearly communicated a sudden realization that, for whatever reason, imbued the character with understanding and instant joy. We have all had the same sensation when the answer suddenly becomes obvious and all the little unconnected bits and pieces instantly become connected.

For the most part, sudden realizations make physicians happy because clear answers to often complex problems in our business allow us to make a plan, institute an intervention, and move on to the next complex problem. All of this is done according to a fairly large set of related assumptions. We assume that our answers are correct and most of the time they are, given the extremely sophisticated diagnostic technologies available to us. We assume that the intervention plan is the right one, and for the most part it is, given that today’s surgical and medical therapeutics generally work pretty effectively (depending on the pathological process we are attempting to intervene in).

However, once the plan is designed and the therapeutics initiated and the doctors have moved on to the next complex problem, there is another assumption, and this is where I had my most recent sudden realization. I have assumed in the past few years that when we hand off to the social worker and home care liaison nurse to organize the home care/palliative care in the community that everything is well looked after and the continuum of care is seamless and properly funded. This assumption was based on the BC government’s claim that the “Closer to Home” initiative was well funded and adequately staffed with skilled professionals. However, I had a talk with a very concerned social worker at VGH recently about home care/palliative care for a family member and was informed that my assumption was wrong. At that point I had a EUREKA! experience and all the little unconnected bits and pieces came together for me. All those little complaints I had been hearing were true, and suddenly I understood—but joy was not my emotion of the moment. The very concerned, committed, and somewhat disillusioned social worker made it clear that the home care situation is in a shambles, adequate staffing is an illusion, and funding cuts are occurring every day. She was extremely frustrated with her inability to get any kind of effective services for many of the elderly individuals she was ushering out of the hospital virtually every day and who had no or extremely skimpy family supports in the community. She said that she was asking everyone she came in to contact with professionally to write to their MLA, the newspapers, or just talk to anyone who might have some influence to try to get this government to listen.

So, I listened and this is my little bit. Letters to this publication, to any newspaper, or to your MLA have enormous impact politically, and I know my mom would appreciate it too.


James A. Wilson, MD. EUREKA!. BCMJ, Vol. 45, No. 8, October, 2003, Page(s) 364 - Editorials.

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