Code blue

‘My conversation with the radiology resident reminds me that our overstretched healthcare system is precariously balanced on a knife’s edge.”

Such is the observation and lament of Dr. Brian Goldman, decade-long host of CBC Radio’s White Coat, Black Art and veteran Canadian emergency room (ER) doctor. In his second and latest book on the state-of-affairs in Canadian healthcare, The Casino Shift: Stories from an ER on the Edge, Goldman provides Canadians with the inside track on why our ERs and our health-care system are overwhelmed and prone to devastating oversights, errors and tragedies.

Most of us have had experiences with emergency rooms — as a parent of children with busy lives, as a service provider such as a school principal, as someone caring for aging parents.

Goldman has seen a tangible increase in the complexity of, and reliance on, emergency rooms in Canada. This was most acutely observable during the COVID-19 pandemic. Some of us may have even left an ER in fear of getting something worse.

As Goldman explains in The Casino Shift — a term to describe a type of ER physician shift that covers the gap between night and day shifts — the pathology of a sick system is predictable right in front of our eyes: “Either we define and fix what ails the ER and the system that surrounds it, or we turn out the lights and head towards an uncertain future that might well feature private for-profit health care.”

Goldman argues that a more nuanced and sophisticated health-care system, one that prioritizes primary care, field physicians and virtual ER doctors, will require political will and higher taxation — and progressive taxation.

A healthy public system ensures that those with more carry more of the burden. Private and for-profit health care ensures that those with more get more.

While not ready to suggest the state of ERs in Canada is verging on collapse, Goldman most certainly argues that the system is overwhelmed and in crisis. Backdropped on his own casino shift in his Toronto ER — think a season of the TV sensation The Pitt — Goldman speaks of the near misses, triumphs and frequent chaos that represents a shift in a Canadian ER.

Due to an aging population with greater health complexities, fewer doctors entering family practice, an increase in mental-health issues and drug and alcohol abuse as well as greater diagnoses of diseases such as cancer, ERs are flooded every day by people with a range of problems that would have been dealt with at the primary care level. As fewer med students see family practice as a viable financial option, the ER becomes a one-stop shop for patients without a family doctor.

The net result is an ER coping with violence, homelessness, mental-health issues and disease diagnoses that are often far too late. Many of us have experienced it — a packed waiting room where people aren’t able to get the treatment they need in a space with dignity. The calamity also results in nurses, technicians and physicians who are burned out, working outrageous shifts and are sleep deprived.

And mistakes happen, as is evidenced by the many stories that have appeared in the Free Press. Through Goldman’s interactions on his shift, he is forced to come to the realization that “the least bad option is a stretcher in a hallway shows just how stressed things have become in ERs across Canada.”

Moreover, according to Goldman, we are only witnessing and living through the tip of the ER iceberg. By 2030, Canada’s nursing shortage will be at around 117,000. As Goldman describes, “Baby boomer nurses are retiring, and younger nurses are far from satisfied with their work.”

But all is not lost. Goldman reveals innovative models geared towards relieving pressure on ERs and ensuring all Canadians have a primary-care physician. Similar solutions exist all around us — local medical clinics partnering with school divisions to offer daily primary care, for example, ensuring potential health issues in children are caught upstream.

In The Casino Shift, Goldman makes the case for upstream care and diverting non-ER complexities to the medical and social services that are designed for them. As Goldman argues, since the Second World War, “the mandate has expanded to include the diagnosis of acute illness regardless of the immediate threat to life.” ERs are catch-alls, and it’s not sustainable.

Shifts in how we view health care in Canada — a public good, much like public education — will require investment, political fortitude and deep, solution-oriented thinking that matches the ferocity of the wicked problems. Goldman provides insight into the current complexity with kindness, humility and expertise. While his observations are revealing of a society that is diminishing in its ability to co-operate and collaborate, his branded hopefulness is a rallying cry for all Canadians to support public investment in each other.

Matt Henderson is superintendent of the Winnipeg School Division.