I am a rural physician who works in Masset, on the Queen Charlotte Islands in a primary care facility. For the most part, I really like my job. The worst part is the on-call, mostly because the problem of finding beds just seems to be getting worse.
The other night I was lying in bed ruminating over the fact that a nurse in Prince Rupert had just told me that their emergency room was “closed to Masset people” because there were no emergency room beds. His call came in after I had referred one of my patients, who had a fractured leg, to the Prince Rupert on-call specialist. The orthopaedic surgeon on call had kindly agreed to take the patient, but now no bed was available. It dawned on me that the situation is a lot like that parable in which the emperor has no clothes. Health care bureaucrats and hospital administrators keep assuring the public that there are enough beds, but clearly there are not. The bcbedline system was supposed to fix the problem, but increasingly it seems to be making the problem worse because hospital administrators just have to say, “There are no beds here,” and sometimes there are no beds in all of British Columbia because all hospital administrators are saying the same thing—to protect staff from fatigue, burnout, and stress, I assume. Recently bcbedline started a new strategy: they only have to look within the health region for an available bed and if one does not exist, the response is, “Too bad. Our staff have done their job.”
I would like to propose a new referral system. The system would work like this. If I have a patient who requires investigations or management at a secondary- or tertiary-level hospital, I call the nearest facility and talk to the specialist on call. If that specialist agrees that the patient needs to be seen, then the patient is put on a waiting list to access that emergency room so that he or she can be seen by the specialist. If the patient (or weather) deteriorates, I simply write an order saying, “Patient (or weather) is deteriorating. Please notify the hospital administrator of the receiving hospital.” If the patient continues to deteriorate, I write another order saying, “Patient’s condition is deteriorating. Urgently notify hospital administrator of the receiving hospital.” If the patient’s condition worsens further, I write another order stating, “I believe patient’s condition is critical. Please notify hospital administrator of receiving hospital immediately.” If the patient dies, I can write an order saying, “Please notify hospital administrator of the receiving hospital that the patient has died.” The onus would no longer be on rural physicians or receiving specialists to find/beg for hospital beds, and the responsibility of adverse outcomes would shift toward administrators and health bureaucrats, where I believe it truly belongs. After all, as far as I can tell, no one asked the doctors how many beds hospitals would need when administrators and health bureaucrats rather arbitrarily slashed bed numbers after recommendations from health care academics.
Some feedback from my rural and specialist colleagues on this issue would be appreciated.
|Harvey Thommasen, MD
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