Clarkson's speedy care a heartbeat away for all

By ANDRE PICARD

Thursday, July 14, 2005 Page A15

You can see it in the snide letters to the editor, hear it in the
water-cooler conversations, taste it in the talk-radio rants: Many
people assume that Governor-General Adrienne Clarkson vaulted to the
front of the line to get surgery last weekend to have a pacemaker
implanted.

Nonsense.

This kind of response says a lot about the Canadian psyche: The strange
mixture of insecurity, self-loathing and pretend egalitarianism that
leads us to constantly demean our leaders (elected and non-elected) at
the slightest hint of privileged treatment (real or perceived), and to
badmouth our public institutions at the slightest provocation.

The assumptions made about Ms. Clarkson's care are also a shocking
testament to Canadians' ignorance about their health-care system, and a
sorry reflection of the all-too-pervasive notion that the medicare
system cannot possibly deliver care quickly and efficiently.

Without violating Ms. Clarkson's privacy any more than it already has
been, here is a brief recap of the facts: Last Friday morning, Her
Excellency went for a regular medical appointment with her family
doctor in Toronto. The doctor detected an arrhythmia, or heartbeat
abnormality. The problem was deemed serious enough that the
Governor-General was referred for a pacemaker implant. The surgery was
done on Saturday, and Ms. Clarkson was discharged the same day.

The same scenario is played out hundreds of times a week across Canada.
Patients go to the doctor feeling a little under the weather and a
serious heart problem is discovered -- a blockage in an artery or, as
in this case, a dangerously low heart rate -- and corrective surgery is
performed almost immediately.

Ms. Clarkson was not afforded any special privilege. The immediacy of
treatment was a reflection of her medical status, not her title. The
only special privilege she benefited from was living in a country with
a tremendous public health system.

The Governor-General was diagnosed, treated and cared for by wonderful
nurses, physicians and other medical staff. Her surgery happened on a
weekend because in major centres like Toronto, where there is a
shortage of operating-room time, that is when pacemaker surgery is
done. And when the Governor-General was discharged, it was without a
bill for services rendered, just like every other beneficiary of
medicare.

This is exactly how the health system should work. And, for the most
part, it is precisely how it works.

Instead of inspiring snarky comments, Ms. Clarkson's ordeal should
focus attention on the efficiency and cost-effectiveness of cardiac
care in Canada, and Ontario in particular.

As we wring our hands about the purported failings of "socialized
medicine" and the horrors of waiting lists, we should remember that,
according to a study published this week, cardiac surgery costs about
half as much in Canada as in the United States, though the outcomes are
similar in both countries.

We should also recognize that the waits for cardiac care are minimal.
In fact, the management of cardiac waiting lists in Ontario is a model
that has been emulated internationally.

Get on the website of the Cardiac Care Network of Ontario
(http://www.ccn.on.ca), and you can find the waiting times for major
heart procedures -- angioplasty, heart bypass and open-heart surgery --
right down to the level of individual institutions. The aggressive
monitoring and appropriate reallocation of resources has resulted in
dramatic reductions in waiting times and better health-care delivery, a
model that needs to be applied in other areas, such as hip
replacements, cataracts and cancer care.

If there is a failing of the Cardiac Care Network, it is that it does
not collect enough data on enough procedures, a shortcoming directly
attributable to a lack of funding from the province.

We don't know the average waiting time for surgery to implant
pacemakers, for example, or implantable cardiac defibrillators (ICD).

We should.

We should also have benchmarks for acceptable waiting times for these
increasingly popular procedures.

In many cases, the decision is a binary one: You can either wait, or
you can't wait at all for a pacemaker or ICD. In Ms. Clarkson's case,
the choice was either immediate surgery or keeping her in hospital for
monitoring (at thousands of dollars a day) until surgery was performed.

Acting with dispatch is cost-efficient. (The Governor-General, for
example, will be back on the job within a couple of weeks of her
operation.) With ICDs -- which are essentially pacemakers that also
have the ability to shock the heart back into action -- the reality is
even starker. The longer patients wait for surgery, the greater the
risk of heart failure and exorbitantly greater costs to the health
system.

The number of patients suffering from arrhythmias is rising
dramatically. We need to know that the procedures required to treat
these heart problems -- implanting pacemakers or ICDs -- are being done
in a timely manner.

The Governor-General's experience suggests that we're getting it right.
But we need the evidence and the data. A relatively small investment in
information technology can result in big savings, both in health
dollars and the health of individuals.

Physicians and patients alike should be able to get access to this
crucial information -- in a heartbeat.

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