A brief to the Health Minister regarding the state of health practice in Alberta (draft copy)

This brief is directed to the minister of health and concerns the health service offered in Alberta.
My bias should be stated to start and the following descriptions of problems with health care
should suffice. Person A was having difficulty with front line staff at various endocrinology clinics
where they insisted “A” give personal information and then berated “A” for not doing so. My
expectation is that after resolving the problem I would deliver a qualitative style report/brief to the
government on the weaknesses and strengths of the health system in Alberta.

I hold a Master’s degree in research, specifically in Education This degree has, I believe, given
me the critical skills and a view toward thinking outside the ‘box’ that the corporate complex holds
society in, requiring conformation in thought, media, disposable (‘lifelong learning’) workers and
may other toxic societal issues. I suspect a disconnect between the Medical model and other
models.

Method

I followed Person A and recorded my views of different dialogues that “A” had with health
practitioners, sometimes even sitting in on the discussion with doctors. This allows me to inform
within a framework that the reader can use in assessing the situation qualitatively.
(http://isites.harvard.edu/icb/icb.do?keyword=qualitative&pageid=icb.page3408906)

First Steps

Person A was advised to call COPS (The council of physicians and surgeons) by the Minister of
Health’s team. The council in turn advised “A” that there is a health report line for the AHS which
“A” then contacted. On calling this line, Person A had some trouble getting the people there to
understand that the ‘triage’ group for an endocrinology clinic had refused accepting “A” on the
grounds that “A” declined to give some personal information. Once the secretarial groups got this
straight, they rebooked with the same endocrinologist and “A” had a successful visit.

Background

Person A is suffering from PTSD that was originally diagnosed after severe depression sent “A”
off work in 2013 shortly after the death of a close family member. Complicating factors included
medical issues such as metabolism, sleep apnea, etc. Despite a number of trials of medicines,
the depression continues, although a visit to a private endocrinology clinic has proven helpful.

Dialogues

I will encapsulate my qualitative and narrative investigation into Person A’s problem with a
description of “A’s” visit to a psychiatrist, noting the many psychiatric situations and the
psychiatrist’s comments both verbally and in his report.

This psychiatrist and this visit were required by the insurance company overseeing Person A’s
sick leave from work. His assessment was very frank and, as I was in the office with them, I can
report this accurately.

He stated that he believed that Person A was impaired for life. His assessment went as follows:
treatment resistant depression does not respond well to therapy. Anti-depressants have a 65%
chance of working on the first try, as against a placebo that works 35%, and successive attempts
show a diminishing rate so that at 3 antidepressants there is almost no success. Person A has
tried 7 anti-depressants under the care of “A’s” physician. He also described that the number of
therapists shows a similar pattern, with the third therapist having almost no chance of success.
Seeming to follow this, as Person A has seen over 9 therapists for treatment and insurance
testing, there did not seem in his view to be much difference in “A’s” symptoms since this
psychiatrist saw “A” at the commencement of the problems two years earlier. Despite this opinion,
the Social Service model used by a PTSD specialist got Person A off alcohol and constant
suicidal ideation. In what seemed to be hesitancy on his part, he recommended a treatment that
he told “A” would ‘freak you out’ and described ECT, that is shock treatment. Although the
treatment is said to have changed since the days of Hollywood horror flicks, the only real change
seemed to me to be a paralytic administered to the patient to prevent the thrashing and wind
milling of limbs. After research into the recidivist rate, I am of the opinion that this treatment
would probably have to be life long, not a fate any of us would happily choose. Person A of
course stated that death would be preferable and rejected this option

Despite verbal announcement of the chance of any therapy failing, the psychiatrist still
recommended CBT psychotherapy in his formal report to the insurance company. He also stated
that Person A had reacted badly to his suggestion of shock therapy. A follow-up from Person A’s
physician raised ethical questions as well as moral ones should that company force the shock
treatment route.

As for CBT, my initial research into the practice shows it to be dependent on variables that would
seem to send “A” off on another roller coaster ride of visits, tests and varied degrees of success.
(http://www.healthcentral.com/anxiety/c/84292/150063/5-behavioral-work).

Follow up

Since reporting the above sessions, Person A was encouraged to address the physical situation
of metabolism, sleep apnea, etc. with a couple of endocrinologists, one of whom was the initial
cause of this report. The second endocrinology visit to a private clinic was arranged by “A’s”
physician and was intensely positive as the introduction of a new medicine that is often used in
the treatment of diabetes was highly successful. My following “A” to various such appointments
gave me a clue as to the real problem in the health system.

It seems that the front office staff is not always up on the diagnosis or record sheet of the visitor.
This bureaucracy seems to only be able to follow ‘protocol’ and requires filling sheets, etc. Very
few of them are nurses, and the comparison to private clinic practitioners is startling. Private
clinics hire people who view themselves in jobs similar to lawyers, etc. In fact the psychiatrist
mentioned above shared a space with just such professionals. In such cases, one can expect
that charts will be ready in 24 hour periods, updated professionally and generally competent. In
cases of the AHS it would seem that the same activities take days or weeks to accomplish, and
are often haphazard. Further regard to this matter will be taken in interviews published in my
appendices.

Appendix 1 – meds
Appendix 2 – another case, a simple care operation gone wrong
Appendix 3 – another case, palliative care
Appendix 4 – an ALS case