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.

Return to Fogtown

Return to Fogtown


I curse loudly. Another pothole. I weave down the road in a remembered but complex pattern that all Newfoundlanders learn to drive. How do police know who is impaired when driving in Newfoundland? Because they drive straight, the old joke goes.

But even the slight damage to the undercarriage can’t dampen my enthusiasm. I’m home. I’m alive. And anything is possible. I pull into one of our hospitals to see a complicated consult. A mans’ skin is sloughing off, and if we don’t get to him in time and get him to the ICU his chance of mortality is high.

I still notice the hospital as I run up the stairs. The place doesn’t look like much. It’s the people inside make it what it is. The way we all treat each other is our legacy, and one with so many stories we should be proud of, but never hear about.

Still, the ravages of our economic downturn are apparent to me. It’s in the downtown businesses which have shuttered their doors. It’s on the streets littered with potholes. It’s being hidden in the houses of my friends and patients who are putting on a brave front in the face of tremendous financial pressure.

The pressure is causing deep cracks in the care we are providing. For instance, let’s examine the Neupogen policy of the NLDPD. The current policy is that people receiving curative chemotherapy only are eligible to be considered for coverage. Previously people who were receiving non-curative chemotherapy were receiving this drug via special authorization. As the Telegram reported, this is affecting people who receive palliative chemotherapy dramatically.

What is Neupogen? It’s a medication used to increase white blood cells, which are important cells used to fight infection. What does it feel like to be injected with neupogen? Well you can read an earlier blog about that.

What is palliative chemotherapy? It’s chemotherapy meant to increase peoples’ quality of life. We associate the word palliative with the word terminal- that’s not the correct comparison. Palliative chemotherapy is for people with diseases that aren’t able to be cured, but still able to be treated. Just because someone is receiving palliative chemotherapy does not mean they are imminently dying. Some could live for years. No one who is in palliative or end of life care in Newfoundland receives Neupogen. But people who were receiving palliative chemo were.

Why were they? Because after several rounds of chemotherapy your bone marrow is battered and damaged. It’s not possible for it to recover the way it used to. Neupogen helps the white cells go back up, so people can receive chemotherapy on schedule, which increases their quality of life while they live with their cancers.

Does Neupogen cost money? Yup. Do we desperately need to save money? Affirmative. Will this save money? Maybe not.

Let’s say a patient receiving palliative chemotherapy does not receive 20 doses of Neupogen. (About 4 cycles worth of Neupogen) That saves about $5000.00. Now let’s say that same patient has a fever after chemotherapy- a condition known as febrile neutropenia. The risk of febrile neutropenia occurs after each chemo cycle. What do we do when someone has febrile neutropenia? Most of the time they’re admitted to hospital. A cost of about $1000 per day. How long do they stay in hospital? Maybe 5 days if it’s not complicated by infection, maybe 8 if it is. If an ICU bed is required that’s an additional large cost. So our attempt to save money has actually cost the system money with the addition of patients suffering.

It’s easy to sit and type this. It’s much harder to work in government and make tough choices. Choices and cuts no one will like. But I have not yet been convinced that this is the right way to proceed. I feel that physicians in charge of their various specialties should be part of committees that look to reduce costs and provide more efficient care in the province. Simply put, we all want to distribute scare resources equitably. We all want to save money so that the most vulnerable people in our province receive support when they need it most. Campaigns like ‘Choosing Wisely’ are very important to the future of healthcare in this province.

As for me, the way forward is clear. Being a physician in the place I love and am fortunate to call home is what I’ve always wanted. Potholes and all. See you in August.

Much Love

Comments are closed.