Brief

Tuesday, July 13, 2021 4:08 PM

A brief to the Health Minister regarding the state of health practice in Alberta (draft
copy) 2015-2017

This brief is directed to the minister of health and concerns the health service offered in
Alberta. My bias should be stated to start ; As a retired educator I firmly believe in the
power of change through information technology and teaching. I will describe the
observations of this sample through my following of people whom I interviewed.

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 used a statistical method known as snowball sampling, this being a framework
involving encounters by the researcher as participant.
(https://en.wikipedia.org/wiki/Snowball_sampling)
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 was 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 under the Notley government.
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
allowed 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.

Part 2- 2020-2021
Using the snowball sample
Using the above method, I began a snowball sampling of the health care
system as I needed and used it. The remainder of the brief will deal with
issues behind what I found. As this is not supposed to be an exhaustive
description of each issue I will attempt to only include pertinent points and
citations. The marvel of the internet allows me to both embed citations as
well as list some reading material at the end of this brief.
In many cases a cursory examination of the facts in medical journals will
yield the truth of the matter vs the misinformation campaigns. Should
more exhaustive reporting be required in the future I am willing to provide
a more lengthy paper.
Person B
An elderly lady of 80 some years sought our help in medical
appointments. She was losing weight and.not being able to keep food
down. The booking was a nightmare of cancellations, rebooking and
impatient or inefficient staff. All of this was blamed on triage for Covid.
After eight months of this the problem was resolved, the lady having a
diabetic stomach emptying problem resolved by medication.
Person C (me)
My decision to get a new CPAP mask in July 2020 was met with very
honest and pleasant people working near Minister Shandros office. They
had just returned to operation and I was served in minutes. Very
professional.
At the same time all attempts to see my family doctor on various issues
were rebuffed by staff insisting that he was seeing only emergency cases,
and should I have an emergency to go to the hospital. This doublespeak
was incomprehensible at times. The office finally closed permanently with
retiring doctors early in 2021.
The pandemic
The nature of the disease was not fully realized and indeed information
was apparently distorted or covered up, until it was too late to stop it.
Countries worldwide failed to contain the spread and realized too late how
vulnerable many of their populations are. The media and internet speed
conspired to work at odds as information was poorly organized and
received. https://www.nature.com/articles/d41586-021-00162-4
The pandemic and politicization
The media thrive on providing a foil for political truth. Adding to the above
media and internet misunderstanding, outright falsification or advertising
for profit by various groups made a static that destroyed making sense of
what was occurring.
https://www.wraltechwire.com/2020/11/02/why-were-predictions-about-a-
pandemic-vaccine-wrong-experts-say/

Discussion
The need for more rigid standards and retraining is clear. Due to the
required brevity of this report I have left out the various other persons
whom I followed. As the intent is to inform government ministers consider
this as a cover brief to a more extensive research that can be made
available. In the meantime the reader should familiarize themselves with
the embedded citations, designed to explain and expand the discussion.

The norms and protocols of two main groups have become illustrative;
The first group, physicians and their nurses are patient centered, while
other than medical personnel are under the office manager who is
responsible for booking and other staff items. This focus would not help
allay the fact that “Many corporate business owners and managers give little
thought to staff education”
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835475/)
For many of the issues in my snowball samples this is identifiable as the
situation.
Conclusions
What can governments do that is within their power? The standardization
and training of front staff can always be improved. In addition the
adoption of some if not all of the OECD draft report on crisis management
points the way to more efficient inclusion of media formats in order to
combat disinformation and other agendas causing misinformation. (
https://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?
cote=GOV/PGC/HLRF%282012%294&docLanguage=En
OECD regarding disinformation https://www.oecd.org/coronavirus/policy-
responses/combatting-covid-19-disinformation-on-online-platforms-d854ec48/)
How governments can encourage honesty in other governmental,
corporate and activist venues becomes then a matter of creating a
coherent centralized body serving the government and attempting
accurate verifiable information, sticking to the matter at hand and being
flexible enough to recognize and solve changing situations.
An example of this might be referrals to StatsCan products such as the co
morbidity files, or the exposure of online scams as listed by the OECD.
Despite disagreements and imperfections, the Federal Bill C10 should be
treated as a working document, declining draconian results but
recognizing some value if the thrust of the document were changed: an
issue far beyond the scope of this paper.
Citations
Government suggestions
https://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?
cote=GOV/PGC/HLRF%282012%294&docLanguage=En
OECD regarding disinformation https://www.oecd.org/coronavirus/policy-
responses/combatting-covid-19-disinformation-on-online-platforms-d854ec48/
OECD on online scams https://www.oecd.org/coronavirus/policy-
responses/protecting-online-consumers-during-the-covid-19-crisis-2ce7353c/
StatsCan co morbidity
https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00087-eng.htm
Bill C10 https://parl.ca/DocumentViewer/en/43-2/bill/C-10/second-reading