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With Canadian health care, care is paramount

July, 2010

Those who work within our health-care system and make it function deserve our awe and gratitude. To appreciate their efforts, we must first accept that no system is perfect and then make sure to distinguish between the problems of the system, which are often political or financial, and the efforts and accomplishments of those who work within it.

I recently experienced our system personally when someone close to me became ill.

It was Sunday and although we did not realize how serious the situation was, the triage personnel at the Royal Victoria Hospital did and within minutes the patient was surrounded by nurses, technicians and medical residents as well as staff physicians from cardiology and endocrinology, all expressing concern verbally and through their efforts.

This attention and care continued during a two-week period in the emergency, coronary intensive care and surgical units. During this time, the occupation rate of the emergency ward was constantly in excess of 100 per cent and still the testing and care continued. This is all the more amazing when we consider some of the burdens placed on hospital workers by the nature of the system in which they must function.

Our hospitals and all those who work within their walls are governed by a myriad of federal and provincial laws and regulations. The Canada Health Care Act (CHCA), a Canada-wide federally funded health-care program, establishes a national set of standards for health care. But each province has its own health-care insurance plan through which health-care services are provided, and its own laws governing hospital administration and services.

The philosophy underlying the CHCA is that continuous access to quality health care without financial or other barriers is critical to maintaining and improving the health care and well-being of Canadians. The primary objective of the act is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.

To accomplish this, the act establishes criteria and conditions in respect of insured health services provided under provincial law that must be met before a full cash distribution to the province will be made.

In order to qualify for federal funding under the act, the provincial plan must be publicly administered, that is, not for profit; it must be universal, that is to say that all residents must be covered for “medically necessary” health services; it must be portable, which means that all residents are covered no matter where they may be in Canada; and it must be accessible, namely available to everyone without discrimination because of age, sex, financial circumstances or health status.

In the province of Quebec, the Act Respecting Health Services and Social Services governs health care. This act provides that the function of medical institutions is to ensure the provision of safe, continuous and accessible quality health and social services that respect the rights and spiritual needs of individuals and that aim to reduce and solve health and welfare problems and respond to the needs of the population.

To that end, institutions must manage their human, material, information, technological and financial resources effectively and efficiently. This is the idealistic background in which a hospital is expected to function. In addition, hospitals must create a Council of Physicians, Dentists and Pharmacists, which controls and assesses the quality and pertinence of its services, assesses and maintains the professional standards of its physicians, dentists and pharmacists, and regulates their pri­vileges and obligations.

In addition to being governed by the various rules imposed by the council, physicians are expected to participate in the clinical activities of the hospital, undertake on-call duty, teach, do research and participate in a variety of committees.

Doctors must establish and maintain a relationship of mutual trust with their patients.

In accordance with their code of ethics, physicians must protect and promote the health and well-being of their patients while respecting the life and liberty of the individual and discharging their professional obligations with competence, integrity and loyalty. They must establish and maintain a relationship of mutual trust with their patients and refrain from practicing in an impersonal manner. And all the while, they are instructed to be judicious in their use of the resources dedicated to health care.

Nurses, too, are governed by a code of ethics that imposes numerous obligations on them with regard to the quality of the care they administer, their professional knowledge, their relationship to and communication with patients, the respect they must accord patients, their integrity and diligence in the performance of their duties and which requires that they are fully committed to their job.

This is a partial description of the legal background in which our health-care workers operate. The limitations placed on hospitals because of financial considerations are well documented and affect these professionals as well.

What I witnessed during the two weeks of spending my days at the Royal Victoria was a first-class standard of excellence in the administration of care by professionals and a genuine concern for the patient by all hospital employees.

So from now on, when matters relating to health care do not go as I might wish, I will try to remember that no system is perfect and to distinguish between the system and those who work within it and are trying to do their best.

And to all those who toil within the walls of the Royal Vic, the technicians, transporters, cleaning staff, meal servers, orderlies, semi-professionals and professionals, congratulations on a job well done.



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