"The universe is made of stories, not of atoms."


—Muriel Rukeyser

Guest Post: Prevention — the goalie of the health care world by Dr. Dave Davis

My worry is that the current provincial government may reduce health-care costs without consideration for long term, down-the-road consequences

Hospital staff during the 2003 SARS crisis. Dave Davis worries that the current Ontario government could be putting cuts in place that jeopardize our ability to handle the next SARS-like crisis. - NYGH Archives


On the phone, my patient sounded as though her nose was plugged. Nasally. She said, "I've been sneezing, you know, Doctor. Runny nose, sore throat. Coughing a lot. I feel silly calling, but I heard about that poor nurse who died this week."

There was something else in her voice too: worry. The patient's daughter was a nurse, one of many who worked at the hospital where a second outbreak of SARS had claimed a staff member. Her daughter was unaffected, but she, my patient — well, you hear her.

I want to tell you two things about the call. Maybe three. OK, three.

The first: it was 2003, toward the end of the outbreak of Sudden Acute Respiratory Syndrome or SARS. Apart from the killer commute, I loved working in the large University of Toronto teaching clinic, seeing patients, teaching (and learning from) students and residents. I was as sleepless as my patient I think, but for a different reason: I was angry, frustrated that we had to close the clinic. And frightened too, a bit.

I still am. I'll tell you why in a second.

It was surreal: the clinic was closed for weeks, the product of the sinister, infectious, cold-mimicking SARS. Based in outpatient clinics and doctor's offices, most Ontario physicians were tied to their phones, as frustrated as I was. When we did return to work, we were gowned like astronauts, strangers in a strange land, our temperatures recorded outside the building before we were allowed in. SARS was a tragic thing: 40-plus deaths, many seriously harmed. It held many lessons, perhaps best captured by the calm, competent, late Donald Low:

www.ncbi.nlm.nih.gov/books/NBK92467/

It was also, to a large extent, preventable.

Ontario didn't fare so well with SARS at the outset: our public health and regulatory framework had been seriously damaged by an overly cost-conscious government in the late nineties. In the town of Walkerton, for example, fiscal conservatives had reduced or privatized many inspection services, compromising water safety: seven people died, hundreds became ill. A false economy, a tragic outcome.

And something like SARS could happen again: take MERS for example. Middle East Respiratory Syndrome is a viral illness with a fatality rate of over 30 per cent, especially among the young. Caused by direct physical contact with camel saliva (so, pretty unlikely to affect us), this virus, like many, can morph into an illness spread by sneezing or coughing. That spread would be something to watch (and watch out for), like a wildfire spreading across the globe. Not a probability, but clearly a possibility: from the camel markets of Oman, to the huge nexus of Dubai, one of the world's busiest airports, to every point of the globe.

That brings me to the second thing — anxiety. In 2003, my patient and colleagues had reason for worry: patients made seriously ill from something that started out like a harmless cold; health-care workers and others dying from contact with patients. I remember one death in particular, a family physician who attended our University of Toronto's continuing education events. Like the firemen of 9/11, he was a brave first responder, who, as they say, "had to go back in," to look after his patients.

Anxiety is important, so much so that we teach family doctors to be aware of the one — diagnosis trap: identifying and treating only the biological or medical aspects of a patient's illness may be necessary, but certainly not sufficient for complete patient care. For almost any problem, there's an accompanying (often underlying) emotional component — worry, anxiety, depression. Even a broken arm has psychological and social implications: will the patient be able to work? Will she be able to afford her rent? How, exactly, did the broken arm happen?

Many of us carry that second element with us, silently, often unaddressed, bringing me to the third point. Today, a decade and a half after SARS, my worry is that the current provincial government may reduce health-care costs without consideration for long term, down-the-road consequences, without the awareness of the false economy of Walkerton. SARS speaks to us today as clearly as it did then: prevention, the unsung hero, is not sexy. It's also crucial. It's easily ignored or reduced to denigrating important things like restaurant inspections.

Prevention is the goalie of the health care world.

Let's hope — maybe demand is a better word — that no patient has to worry that a common cold, or any other virus, can kill her.


Dave Davis, MD, is a retired family doc and medical educator. His first novel, "A Potter's Tale," published by Story Merchant Books, Los Angeles, is available on Amazon in Canada, CA and the US. You can visit him at www.drdavedavis.com, or follow him @drauthor24





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