Nobody is Responsible! Lack of accountability and the erosion of social license

Many parents who read this blog will sympathise with the difficulties of having a sick child. Despite outward appearances of physical fitness and good health, last year my daughter contracted every single virus that was going around. The poor child has listened to endless lectures on hand washing and other hygiene tips and tricks, but still the problem persisted. Last school year, I estimate that she missed at least three days every month. (Fortunately the curriculum in public schools is thin so that she seems to be able to cope with the work despite her frequent absences, but that’s a topic for another day.)

My family doctor (mother of three) was relatively unconcerned when I appeared in her office desperate and unhappy when faced with the third illness of the fall 2014. “Some children just get sick.” I tired to receive this practical wisdom in the spirit in which it was offered. The illness trend continued through the winter and into the spring. In June when my daughter was in midst of yet another virus (and missing more school) I started to wonder if there was an underlying problem. We went back to the doctor, who, to placate me, agreed to some blood work.

Summer came and my daughter recovered from her June cold. In fact, she was the picture of good health (excepting a buckle fracture) for July and August. Not a sniffle or cough to be heard. No stomach issues. She swam with her friends, played basketball and went to summer camp on the ocean. We had the blood work done at the private phlebotomy clinic affiliated with my doctor’s practice. Weeks passed, and since I heard nothing back from the doctor’s office, I assumed that my anxiety had been irrational and there was indeed no problem.

Flash forward to September and within two weeks of starting school my daughter was sick again. Really sick and her neck was sore. A friend’s older brother had recently been hospitalized with meningitis, so I wondered if it was possible that she had somehow contracted meningitis and decided to go to the after-hours clinic. The on-call doctor confirmed that this was yet another nasty virus and nothing to be overly concerned by. While there, I mentioned the blood work so he looked at the report and saw something that did concern him. He gave me a requisition to have her retested for a few specific markers. Of course I went through about 99 emotions (especially after a visit to the Mayo Clinic online) but in the end I decided to take the reasonable position that if my GP had believed there were an issue with the results, we would have been contacted. For the most part I have confidence in our GP, based on our long term relationship, even if she is not interventionist. Still I was anxious to hear her perspective on the issue identified by her colleague. I wanted to know if the original problematic result were an anomaly or error.

The next morning we were back at the phlebotomy clinic to have the second sample drawn and we scheduled an appointment to meet our GP to review the results a few days later. And so the trouble began. We appeared at the appointed time to learn that the doctor did not receive the results from the blood work. The lab was, of course, closed so we would not receive any information until the next day. When I called in the morning I did not gain a lot of confidence. The women who were chasing the labs did not have the facts in their possession, most importantly the date the test was done. I was reminded that it was not their fault that the test results were missing, and that they had made the necessary phone calls and now they were waiting on people, over whom they had no control.

I decided to take matters into my own hands, calling first the phlebotomy clinic where they assured me they had sent the sample to the lab. They had done what was required and it was not their fault that the blood work was missing.

Next I phoned the lab at the Children’s Hospital where the helpful woman, after long delays, told me they had never received my daughter’s blood work. She opined that: “Blood work from private clinics gets lost all the time.” That’s reassuring. Since their records indicated that they had never received any bloodwork there was nothing she could do other than to refer me to the adult hospital where I was told sometimes missing bloodwork for children turns up. I found this piece of information confounding as well.

The adult hospital did not have an accessible public line so I called the blood collection clinic back. My contact at the collection clinic now indicated the on-call doctor had provided me with an adult blood work requisition which required the sample to be sent to the adult hospital, not the children’s hospital. Since we know knew where it went, I asked if the results had been returned. Unfortunately, no. I asked how they could be “lost” and I was told they’re not lost, the hospital just doesn’t know how to look for reports on blood. Okay then.

After some negotiation they agreed to draw my daughter's blood again – at their expense this time. This sample was processed the same day. The test, most strikingly, indicated that my daughter is fighting a viral infection. NO KIDDING. I should buy shares in Kimberly Clarke, we go through so much tissue in this house.

Anyway, the reason I am writing about this is because in Canada we accept or tolerate all kinds of things when dealing with our healthcare system that would or should be totally unacceptable in the private sector. Everyone I dealt with was very agreeable but completely unaccountable. It is another case of friendly and helpful not being the same thing. No one has answers except they are perfectly clear that whatever is wrong is absolutely not their fault. In my opinion, if they put that much energy into solving the problem things would be much better. In our healthcare system nobody is responsible. Unless of course you are prepared to advocate for yourself or your loved one.

This topic also connects to the idea of “social license” which is something I have been focused on in recent weeks, particularly through the lens of the casino industry. Readers of this blog will receive a copy of a White Paper exploring social license and its impact on the business of gaming shortly. Social license applies to many sectors including healthcare. As we write in our paper: “Social license is a complex, mutable, multi-stakeholder calculation that grants the power to operate today, tomorrow and in the future.”

The strong relationship I have with my GP in part informs my perspective of the system overall, just as the experience of the lost bloodwork (which was never located by the way) undermined my view of the system. In Nova Scotia, where I live, the Department of Health and Wellness budget is the largest in the Province and doctors are the single biggest line item in the entire Provincial budget. Despite this huge investment there are endless complaints about wait times, access to services, the costs of pharmacare and lack of accountability. What we have is not working, although there are some very good individuals who are focused on wellness in patient care in all areas of this vast delivery system.

Surprisingly, healthcare has not emerged as a significant issue in the federal election. I say surprising because it is so closely tied to the economy. Premiers across the country, of all political persuasions, know this is a huge issue. Consider how the system needs to change to better serve the dynamic population with regional variances, in the face of increasing costs and the way in which new technologies and treatments alter our expectations for health. It is a complex and large problem that cannot be solved by traditional ways of thinking.

Canadians have been proud of our health system for decades. From my perspective, the federal and provincial governments no longer have social license to allow things to continue on the current trajectory. Any business operating as inefficiently as the Canadian provincial health care systems would be having a difficult conversation with its shareholders. And the CEO would be held accountable. Just as Volkswagen’s CEO had to resign over the fuel emission testing debacle.

Someone is responsible and if we all take responsibility for our little piece of the puzzle, I think things would improve. It is easy to feel overwhelmed by the size and scope of issues and we forget what kind of influence we can have just by showing care, ownership and pride.