N.S. must inform potential physician recruits of the dire state of our healthcare system

“In order to understand the world, one has to turn away from it on occasion."- Albert Camus Dr. Ajantha JayabarathanA number of events came together in June that led me to turn away from writing my columns.I faced criticism that the "negative tone" of opinions expressed in writings such as mine was causing doctors looking at job opportunities in Nova Scotia to question coming here. This came after the columns describing serious lapses within the Nova Scotia Health Authority (NSHA) mental health services and calling out the senior provincial primary care lead for touting that nurse practitioners offer better care than family doctors.Meanwhile, 30 patients in my practice, ranging from ages 13 to 60 presented with mental health crises. Six of them reported being suicidal and one of them had attempted a serious overdose. Six of them were seen by psychiatric staff in overcrowded emergency departments, in three different locations across the province. Each went through the "standardized suicide assessment."One of the assessments was completed in a hallway, surrounded by other patients being assessed by doctors. The checklist was completed and the person was deemed to have a low risk of suicide. When the patient persisted and pointed out that the checklist did not reflect the true urgency of what was happening, the staff member shrugged and said, “I have just seen three others like you, this is no different.”The staff’s cold and dispassionate words were shocking to hear. They point to clinician burnout.What else can you expect? Every day, the health system faces overwhelming demand, serious shortage of resources and inadequate staff numbers. Staff are forced to work in unsuitable surroundings where they conduct patient assessments with flawed and incomplete assessment processes. There is no other choice. Those that resist are blacklisted and forced out of the system.The patient was asked to call mobile crisis if the suicidal feelings intensified; when that happened, they received a voice mail that someone would call back later. They also received a letter stating that it would be up to six weeks before further mental health services could be offered and to followup with their family doctor.Back in February, at the Chronicle Herald editorial board meeting, I asked Dr. Linda Courey, senior director of mental health and addictions, how they track outcomes of suicide management.Do they track what happens after completion of the suicide check list? Do they monitor whether the same person, then reappears in the "system" at the community mental health clinics? How many return to the emergency department, days, weeks, months later, with escalating or ongoing mental health needs?How many attempt suicide or complete suicide following the completion of the check list? How does she know that their process works for patients?She used "adminspeak" which makes it easy to explain away difficult issues—what I heard was there was no such mechanism to measure if their process of managing the highest risk patients with mental illness was actually working. I also heard that she personally believed that there was no problem with the way the system is functioning.About a month ago, Dr. Rick Gibson, senior medical director of primary health care, singled out and blamed Tony Kelly, from the Digby Area Health Coalition, for causing newly graduated family medicine doctors to ask critical questions of the NSHA. He also blamed media articles searchable on the internet, as a cause for doctors not wishing to relocate here. Two recent columns in the Herald, carefully point out the “positive" things that are happening within the health care system; while issues that are threatening to break it down are whitewashed out of the picture. Last week, the senior physician lead for mental health in the province, chillingly stated that it is unlikely Cape Breton can expect to be restored to their original complement of psychiatrists; which has dropped from 16 to 4.The service is being replaced with video-linkage with Central zone-based psychiatrists, who will offer the service, instead of taking a week of vacation.NSHA appears to be running out of fingers to plug the holes in the dam. Their solution to escalating problems is to hire more administrative staff and to drive the health care staff to work harder, to work more and have less down time; all of which push them towards burnout.The health care system, under NSHA management, with their ideas, implementation and operationalization is failing. Large cracks continue to appear, indicating the dam is going to break open. They continue not to change course, and address urgent issues that have now become emergent. Negativity, the media, individuals and communities that are speaking out are not to blame.It is imperative that doctors, who are looking to move here, be clearly apprised of the system in crisis. They should not be tempted or seduced with empty promises of work-life balance. Those that choose to come here must recognize they are desperately needed, and be ready to roll up their sleeves and apply their shoulders to the wheel.The reward is in knowing that they will serve the greater good in Nova Scotia, which continues to be a beautiful place that offers doctors a warm welcome.Dr. Ajantha Jayabarathan is a family physician in Halifax.Opinions expressed in this article are those of the writer, and do not necessarily reflect those of CanadianHealthcareNetwork.ca, or its parent company.

N.S. must inform potential physician recruits of the dire state of our healthcare system

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