Nikhil Joshi, M.D.
Doctor, Author, Leader
Nikhil Joshi is a young physician, writer, and speaker. He is passionate about furthering his ability to touch the lives of people positively.

Tips on not destroying Newfoundland’s Healthcare

Tips on not destroying Newfoundland’s Healthcare

Even if Muskrat falls was not driving our province to the brink of bankruptcy, the healthcare budget needed to be optimized. What’s going to happen will not be optimization, but deep cuts through the bone. There will be sacrifices and this is going to hurt patient access to the medical system terribly.

But in these cuts, there is room for efficiencies, optimization, and at least some semblance of sense. How could we maximize efficiency? How can we provide leaner, more cost-effective health care? Here are a few ways we can do a better job. They all require sacrifices, but no sacrifice we make should be needless or careless. That’s how we’ve gotten into this financial situation in the first place- careless mistakes piled on top of each other by successive provincial governments.

How should we save money? Start by having the government actually ask rank and file healthcare workers: where is the waste? Where can we save money? Where is their abuse of the system?

There is abuse of the system with regards to certain people who misuse our healthcare resources. Let me give you an example. A stubborn man with chronic pain often abuses his opiate prescription and refuses to be changed to any other medication. He does not want help. He often comes in with an overdose which requires Narcan and sometimes, an ICU admission. In 4 months he has come in over a dozen times. This patient has cost the system tens of thousands, to hundreds of thousands of dollars. This is just one example. There are hundreds more. People who call ambulances because they’re lonely. People who skip health care appointments because they’re too wrapped up in themselves and demand to be rescheduled. Health care has become so unattached to any sense of personal responsibility. There are specific individuals who cost the system an unreasonable amount of money. I’m not talking about someone who gets a breast cancer diagnosis. I’m talking about people who clearly abuse the system and face 0 repercussions.

For every 20 great Newfoundland patients and families, there is 1 which is an unmitigated nightmare. The kind that harasses nurses, physicians and hospital staff. The kind that makes unreasonable demands for expensive diagnostic imaging, or costly ICU interventions for their chronically ill family member, who is steadily deteriorating. If our ICU’s and hospitals were only used for those we felt had the potential to benefit for years rather than weeks, we could find efficiencies. But this means saying ‘no’, and that’s not something easy for people to swallow. And if it was your loved one, you would have issues with that as well. But unless we make that choice, we will deny healthcare for thousands of others.

What’s a cheap way to improve healthcare? Treat physicians and nurses with respect. Something our government could do a better job of.

Family physicians were told their services in providing flu shots weren’t needed and they could be replaced easily. Now clogging our emergency rooms are people with the flu. Who would have thought that making sure thousands of people weren’t inoculated would somehow lead to more serious cases of the flu? Family physicians. But their opinions and contributions were clearly not valued. They deserve an apology, and should be asked as individual healthcare providers how they suggest we save money. Their insight can help.

In our hospitals nurses experience workplace violence. You can imagine that this would add to burn out, sick leave and overtime. We need to take better care of the people who are taking care of people. It starts at a basic level of communication. When I take over service I tell the nurses I work with that they don’t have to deal with harassment or violence from anyone, and that I’ll support them if it does happen. It still does, but at least we’re in it together.

We can enforce ‘Choosing Wisely’ not as advocacy but as rules for ordering lab work and diagnostic imaging. This means less access for testing for issues that many people want testing for. But at some point we have to apply some common sense.

In terms of finding cost reductions with regards to pharmaceuticals, we should talk to the other maritime provinces and see if we could have a yearly agreement for bulk purchases of agreed on medication formulary. This could help us with some cost savings before universal pharmacare becomes a welcome reality.

Speaking of pharmaceutical companies, Newfoundland used to do lots of world class research in the field of biological medications. These cutting edge pharmaceuticals are crazy expensive- we used to provide access to many patients who had terrible chronic illnesses the very latest drugs by having clinical trials run here in our province. Unfortunately, this has slowed down terribly as the ethics board is swamped. We need to provide a separate ethics board that specializes in pharmaceutical clinical trials. It’s no secret that most University staff looks down upon clinical research sponsored by pharmaceutical companies and hasn’t kept up with approvals for these trials. We’ve lost millions of dollars in clinical trials that could have helped people. We can’t afford to look down our nose at pharmaceutical companies because of our personal politics. Their drugs have the capacity to help people, and providing access to them saves the healthcare system money.

The worst part of this is I write this from Alberta. I’m in Calgary working a temporary job while I daydream about what it’s like at home. While I think about what the consequences of these cuts are going to be for the people I love the most. I want to have hope that I could one day come home to a system that wasn’t entirely in shambles. Because it’s a great accomplishment, full of wonderful people looking after wonderful people. That’s why I care.


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