Monthly Archives: February 2015

The lure of “integrative medicine”

It has been fascinatingly frustrating over the past couple of weeks to see faculty and students at the University of Toronto defending “alternative” and “integrative” and “holistic” medicine with all of their might. They are portraying this entire issue as an “us vs. them” debate, as if anyone opposed to the idea of integrative medicine is also blind to new ideas, opposed to non-prescription treatments, and has no interest in patient satisfaction. Nope, we actually care about all of those things. And we care about the patient’s pocketbook and about the scientific method.

I had an interesting patient encounter recently that brought this entire issue into focus. This is a patient with confirmed hypothyroidism on thyroid replacement, who came in feeling tired, moody, and feeling anxious. Pretty standard for most of her visits. She brought in a list of products that had been recommended by her naturopath. First I thanked her for trusting me enough to ask for my opinion, as I have learned that starting the encounter by scoffing won’t get me far. The list was a cornucopia of products which I know have not convincingly shown any benefit, which I informed her of in the gentlest of ways.

I paused and asked her “What exactly about how you feel do you wish were different?”. She said she wanted to have more energy and be less stressed and angry. I asked how she feels when she leaves the naturopath. Fantastic, she said. After a fascinating discussion with her and her husband, I learned that my patient is quite religious, and has been frustrated for the past decade that she hasn’t found anyone locally who shares her sense of spirituality. Until she met this naturopath, as they have very in-depth discussions about her faith. I explained to her that the benefit she is seeing from the naturopath is from a sense of camaraderie, and not any diets or supplements or treatments she is offering. I told her that she can feel free to continue seeing the naturopath, as long as she realizes she is essentially paying for companionship. The pricey supplements and herbs are just along for the ride, and are unproven in terms of safety and efficacy. An expensive placebo while the companionship provides all of the benefit.

Can you imagine if physicians used the same predatory techniques that these alternative practitioners do? A patient comes in with viral pharyngitis, and I tell them it will resolve on its own, not to worry. It resolves on its own within 48 hours. Or….I could offer them some special herbal concoction, and voila! The herbs cured the sore throat in just 48 hours! Amazing! Dr. Elia is the hero! Patients need to realize the humility that physicians show in allowing the concept of tincture of time to run its course without creating a false sense of a cure through bogus practices. I am bound by evidence and science, not by pricey cures and by the ego-boosting of “curing” illnesses. The public would truly be amazed at the proportion of my day spent simply ruling out serious disease and providing reassurance, allowing time to take its course. Not as sexy as being a hero, but it’s the only ethical way to practice.

We as physicians see an endless list of ailments for which we have few options available. That doesn’t simply mean we don’t have a pharmaceutical remedy for the ailment, but that our interpretation of the evidence does reliably point to a specific treatment for which we are confident in its efficacy, drug or non-drug.

Interestingly, most of these “incurable” ailments are exactly the same ones that many “alternative medicine” providers conveniently claim to have the solution for. Chronic pain, stress, obesity, menopause, fatigue, IBS, chronic headaches…I always chuckle when I visit the websites of these providers because they have not found a miracle cure, they have simply found a lucrative market.

“Integrative health practitioners” often point to patient satisfaction as a rationale for their existence and for funding, which is completely insufficient as a measuring stick for appropriateness in health care. We know that simply having an individual listen to your concerns and show empathy will improve outcomes, regardless of the form it takes. So take Reiki, and craniosacral, and therapeutic touch, and any mind-body energy life-force practices, and call them what they truly are. Relaxing companionship. Then let’s have a discussion about whether public funds should be directed towards that end.  And let’s tell private-paying patients that they are paying for companionship and relaxation. But don’t try and explain these techniques via unproven scientific principles as a means to give them legitimacy. Perhaps many of these practitioners can work to develop self-directed education programs for patients to help those improve their own stress. Less lucrative, but far more patient-centred.

So here’s my message to my patients, and to all patients out there. The terms holistic, and integrative, and alternative, and complementary, have become impressive marketing terms. But in terms of your treatment, they are meaningless. Medicine is only medicine if it works, and we don’t need these false-balance terms to muddy the situation. You want treatment that is effective, safe, and patient-centred. As your physician, I will offer you whatever treatments I believe will help you. That may include advice on exercise, nutrition, relaxation, relationship advice, and in some cases, pharmaceutical medications when appropriate. I will do it at the lowest possible cost, and I will always try to make you self-sufficient through self-directed treatments. For other practitioners to imply that “integrative medicine” is somehow distinct from what I provide as a physician is frankly insulting. If a patient chooses to seek the care of another practitioner in addition to my care, I will gently warn them to be as skeptical of the benefits of those therapies as they would be of pharmaceuticals. And I warn them that they may unwittingly end up paying for relaxing companionship.

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Don’t wait for the government, create your own Health Link

 

Health Quality Ontario hosted a conference today focused on Health Links, the Ontario Ministry of Health and Long-Term Care program that is intended to provided coordinated care to the 5% of patients who account for 2/3 of all health care costs. Health Links are designed to link the patient, family physician, hospital, long-term care home, and community organizations, in a coordinated effort to improve care.

I followed the conference closely today via social media, as I have followed the program from afar for the past few years. The underpinnings of Health Links make great intuitive sense for these vulnerable patients. Giving patients an individualized and coordinated plan, having care providers who ensure the plan is being followed, ensuring the patients are taking the right medications, and having a care provider they can call who is familiar with their situation. These are all incredibly attainable and important to successful care for these patients. Health Quality Ontario have developed fantastic documents available on their website, and many of their projects have been extremely thorough and well-done.

But here’s my concern. The Health Links program was initially piloted in 2012 in only selected practice areas, and has been described as a success by those involved. Let’s assume the anecdotes are correct and the program does improve outcomes.

Where does that leave the rest of us? Those who haven’t been deemed worthy of access to a Health Link. Those who are restricted from joining a FHO, let alone having access to the allied health professionals in a FHT with NPs, physiotherapy, psychology, social worker, pharmacists, etc. What do the rest of us do? Do we wait for Health Links to find us?

Quite frankly, physicians who aren’t in a Health Link, or a FHT, or one of these privileged groups, can’t wait for the province to find us. We can try to advocate politically for our patients and practices, but in the meantime, we have to make due with what we have.

So let’s create our own Health Links in our offices. We don’t need a rubber stamp from the government to take similar initiatives on our own. I’ll lay out a rough guide here for you to start taking steps to improve the quality and coordination of care for your patients.

This will be in a blog format, but I would recommend taking the aspects of these recommendations that you like, and create a standard custom form that you keep in each patient’s chart to track that they are receiving the necessary interventions.

And away we go…

1) Identify the target patients

The Health Links program identifies the 5% of top users in our system, so do the same for your practice. Identify your 5% of patients who you feel are the highest risk for admission to hospital, highest risk for deterioration, and/or in need of the highest need of resources (either health-related or related to social determinants of health).

2) Identify all relevant family and caregiver contacts for the patient

3) Tell the patient and their caregivers who should be contacted with any health concern

Ensure they have both the physician’s phone number, as well as any relevant home care emergency services. Make sure you are notified upon admission to hospital, discharge from hospital, and any ER visits. Tell them what your availability is for being contacted after hours to prevent ER visits.

4) Make medication reconciliation an ongoing priority

Typically these patients have multiple providers involved in their care, and medications are changing frequently. Medication lists are often out-of-date, leading to potential adverse outcomes. While we tell the majority of patients to bring all medications to all appointments, make it a MUST in your Health Links patients. Once you update their list, provide them a copy by doing a screen capture of your EMR medication list. Tell them that THIS is the list to show to health care providers (the list the pharmacy gives them is often a complete mess). Tell the patient to notify you of any medication change. If they end up in hospital, they are to notify you with any medication change. Document any medication discrepancies and how they came about. Offer compliance packaging whenever appropriate. Review Beer’s criteria. Create a culture where the accuracy of their medication list is seen a top priority, and patients understand its importance.

(knowledgeisthebestmedicine.org is a useful resource for capable patients to track their medications.)

5) Make it clear that you can offer same day appointments whenever needed

6) Be clear whether you offer house calls

7) Insist on follow-up with family physician within 48 hours of hospital visit.

Reconcile medications and review diagnostics and management plan. Ask the following questions: How or why do you think you became too sick to stay in your home? Did you see a doctor before coming to the hospital? If yes, who did you see and when? If not, why? Has anything stopped you from taking your medications? How do you set up and take your medicines every day?

8) Perform a cognitive assessment

Mini-Cog, MOCA, MMSE, whatever your heart fancies…

9) Perform a falls risk assessment

Every office should have a standard falls assessment that you go through with these patients. In brief, do a complete physical exam (including Get up and Go test), optimize vision and hearing, avoid alcohol, remove any offending medications, encourage gait aids/handrails, take regular vitamin D and do home exercises. Remove unsafe conditions in their homes. Offer an OT assessment if the home environment is a concern.

10) Ensure adequate home care is in place, and communicate with case manager regularly

Regularly assess whether specific home care services are needed for patients. When care is deemed no longer necessary, reassure patient that it can be reintroduced if deemed appropriate. Here in my office, a representative from CCAC visits regularly and we “run the list” to make sure everyone’s home care is optimized.

11) Confirm your patient’s health literacy

Ask them to describe their understanding of their ailments to you. As them to describe medication administration to you. The Sixth Vital Sign Program assesses a patient’s health literacy by testing their ability to interpret an ice cream nutrition label. If you learn that their literacy is not adequate, this will certainly change your approach to delivering instructions to them.

12) Set attainable goals in consultation with patient and caregivers

Remember to set SMART goals (Specific, Measurable, Achievable, Realistic and Timely).

13) Review advance care directives on a regular basis

The patient should inform all relevant family and friends about their goals of care. If they wish to be deemed a DNR, offer to complete an official Do Not Resuscitate Form. These can be obtained in bulk by faxing a request to (416) 327-0329. Encourage patients and their families to visit advancecareplanning.ca.

14) Ensure adequate social and financial resources

15) Plan a full family meeting at least once a year (or more often if needed)

Use this meeting as an opportunity to inform all family members about the relevant info that you have reviewed through your Health Links template. This will serve to make them feel supported, and provide you valuable insight into their concerns about their family member.

16) Provide the patient and their family with a copy of your Health Links template

They should be encouraged to share this with other health care providers.

 

So there you have it. Try to review the above topics with your “5%” and their families and caregivers on a regular basis, and they will enjoy the majority of the benefits of a Health Link immediately, rather than on the government’s time.

CAM research in universities: Throwing good money down the well

Social media has been abuzz over the past few weeks with stories of academics at Canadian universities with lectures and research with a significant pseudoscientific slant. The question of academic independence has been raised, with the debate over whether our institutes of higher learning should be free to explore whatever ideas or theories they wish, regardless of the scientific consensus or merit.

In May 2014, Timothy Caulfield wrote this piece entitled Integrating Nonsense where he clearly outlines many of the potential dangers in allowing Complementary and Alternative Medicine (CAM) to play a major role in our academic institutions and hospitals.

In response, Sunita Vohra and Heather Boon (now Dean of Pharmacy at the University of Toronto) wrote this piece in September 2014 defending CAM research in universities. The essence of their argument is that CAM is widely used among the population, that we need to know as much as we can about CAM, and that universities are the best place for this research to take place.

They portray their views in this way:

“Advocates do not need evidence because they already believe, and detractors do not need evidence because they are already convinced all CAM is quackery. Neither position is evidence-based and neither invites thoughtful discourse and dialogue. We prefer a position in the middle: open-minded, yet skeptical; willing to listen and to investigate further.”

In reality though, those that are “opposed to CAM” are simply asserting their interpretation of the lack of evidence for the therapies that are widely described as CAM. As Paul Offit has famously said, “There’s only medicine that works and medicine that doesn’t”. Creating a false dichotomy between proponents and opponents allows opportunists to lump homeopathy and Reiki in with exercise, self-taught mindfulness and meditation. Describing CAM as an overarching concept to be defended is the equivalent of a physician blindly defending the merit in studying all proposed pharmaceuticals. Each pharmaceutical needs to stand on its own academic merit, with a grounding in basic science and scientific plausibility. Many in the CAM community seem to be lacking appropriate skepticism when it comes to scientific plausibility of CAM “therapies”.

Dr. Boon has done some great research in the past in studying natural and herbal products and patient behaviour, and has been widely applauded for her work. But crossing the line into actually doing an RCT on homeopathy in ADHD is a different ballgame altogether.

Most of all, my concern with research into CAM comes down to a finite amount of research funding to go around. In an era where austerity is hitting both private and public sector research, every research dollar should be considered precious. The public deserves for academic leaders like Dr. Boon to use those dollars wisely, towards pursuits that will have the greatest impact on public health. The U.S. has already done Canada an enormous favour by willingly throwing over $20 billion over 20 years towards The National Center for Complementary and Alternative Medicine, which has been criticized broadly by many in the scientific community, and quite eloquently by both Science and the Skeptical Inquirer. Even the UK has spent millions of dollars doing a review on lack of value in homeopathy. We don’t need to re-invent the CAM research wheel here in Canada simply out of morbid curiosity.

Let’s learn from their mistakes and only fund and support university research with an ounce or two of scientific plausibility.

Take The Supplement-ectomy Challenge!

(Note: None of this blog should replace the advice of your physician. Do what they tell you to do.)

I am continually astounded at the number of dietary supplements, herbal products, and vitamins that my patients are on. Either through recommendations from friends, advertisements or endorsements from alternative health providers, well-meaning patients can quickly end up on a cornucopia of products. They often believe that they are making sound investments in their health, hoping to buy longevity. Little do they know that the overwhelming majority of these products have minimal or no evidence to support their use.

I won’t spend an entire post recapping the evidence against supplements, but here are a few good summaries about multivitamins, omega-3 supplements, and child supplements, Bottom line is, most of what our patients are taking are completely useless, and will do nothing except separate them from their money.

Frustratingly, despite my repeated advice to stop their supplements, patients are still sometimes reluctant to do so. Pleas to evidence often do not work, so let’s make a plea to their social conscience.

We all have social causes that are important to us, yet we have a limited amount of money to support these causes. What better way to find additional money to donate to these projects than to give them the money we would’ve otherwise spent on useless supplements.

Here’s my challenge to anyone who buys any of these products. At your next visit with your physician, bring all of your over the counter products and ask whether there is good evidence to support their use. (Note: You should definitely continue anything that a physician has instructed you to take, including vitamin D, prenatal vitamins, ASA, calcium, and any other specific instructions you have been given.) Take all of the products that you no longer need to take, and figure out how much they cost you per month. Multiply that by the number of months between now and the end of December. Pick your favourite LOCAL charity. Make a commitment to donate that amount in mid-December to that charity in time for the holidays.

Here’s what I can guarantee. You will feel much better about yourself donating that money than any improvement you would have seen from the unnecessary supplements.

Supplements make up a $32 billion industry every year. Feel free to share this with friends, and let’s see how much of that money we can redirect to worthy causes. Share any planned donations to charities in the comments!

Why I recommend physiotherapy to my patients

Let me start off by stating that I have no financial stake in the success of physiotherapy as a profession.

Last week, a patient came in with uncomplicated mechanical back pain of one week’s duration, with no red flags, and asked about seeing someone for “therapy”. I’m going to share with you exactly what I told her.

When I refer a patient to a specialist of any kind, I am asking their help with a very specific question. When that issue is resolved or stabilized, the patient’s care is returned back to me. This is the basic model of primary care that works well, given our skill sets. Everyone within the circle of care is evidence-based, which creates a sense of trust among the providers.

When I refer a patient to physiotherapy, for the most part I know exactly what my patients are getting into. They will focus on evidence-based strengthening, stretching, sport or activity-specific rehabilitation, and will give the patient home exercises to work on where possible. The patient is never asked for a pre-payment for a large block of treatments. The therapy proposed is for the minimum duration, and its continuation is largely determined by patient preference. If the treatment is not improving things as expected, there will often be communication with the primary care physician to ask for suggestions.

This is the physical therapy model that works for my patients, and improves patient outcomes while still being evidence-based. I know that when I send my patients to physiotherapy, they will not be sold supplements, herbal remedies, fad diets, or be encouraged to sign up for expensive “wellness programs”. I know that they will not be signed up for long-term commitments, detoxes, and full-body x-rays. I know that the physiotherapist will not encourage them to bring their whole family to them for regular “adjustments”. I know that the physiotherapist will not try to use physiotherapy to treat ear infections, asthma, and improve their immune system.

And most importantly, I know that the physiotherapist will not spend the majority of their visit disparaging vaccines, medications, and “Western Medicine”.

It’s fairly clear that I’m making not-so-subtle references to some of the practices of some chiropractors in North America. But before I get bombarded with hate mail, please hear me out.

For acute musculoskeletal injuries, there is fairly broad consensus that manual therapy does improve pain, whether it be from physiotherapy, massage therapy or chiropractic care. And patients are adamant about this. The therapy for the most part does work to decrease pain. But the means by which it improves pain is where the disagreement lies. It is not through adjustments of so-called subluxations, or by improving energy flow, or any other fanciful non-evidence-based explanation. Manual therapy improves pain largely through a neurophysiologic model that is achieved through any form of manual therapy, both through central and peripheral mechanisms. No magic, and no need for lifelong treatment for maintenance. Home stretching and strengthening programs for “maintenance” should be the standard after acute treatment.

I like to think I’m a fairly reasonable family physician. I am deeply passionate about nutrition and exercise, and discuss this with patients at almost every visit. I promote yoga, meditation, and mindfulness….not because they possess any magical powers above placebo, but because they get my patients to relax. I suggest free resources for all of these things wherever possible. It is my responsibility to ensure a patient’s treatment course is safe, effective, and cheap. I understand the financial motivation behind the messaging that physicians are evil and anything “holistic” is good, but it’s a false dichotomy and not rooted in any truth.

I know that many chiropractors do limit their practice to short-term musculoskeletal treatment and evidence-based health promotion, and I want to give them an opportunity to set themselves apart from the rest of the herd. Chirobase.org provides an excellent guide to some of the issues surrounding chiropractic care, and where there is and isn’t evidence to support it.   They also provide these guidelines for what patients should ensure their chiropractor practices:

My practice is limited to the care of musculoskeletal problems. I may also counsel patients about lifestyle improvements and give practical science-based tips about the management of common ailments. My approach to back pain parallels the AHCPR Clinical Practice Guidelines that lie within the scope of chiropractic. For medical problems outside my scope, I refer patients to appropriate physicians.

I publicly endorse immunization, fluoridation, and other standard public health measures. I reject biotheistic notions that “subluxations” and/or “nerve interference” are the cause or underlying cause of disease. I do not make claims about curing earaches or any other diseases. I do not (a) use free screening examinations as a patient-recruiting tactic, (b) try get patients to sign contracts for lengthy treatment, (c) promote regular “preventive” adjustments,(d) use scare tactics, or (e) disparage scientific medical treatment. I do not routinely perform or order x-ray examinations because most patients do not need them. I do not utilize 14″ x 36″ full-spine x-ray examinations.

I do not offer or advocate the use of Biological Terrain Assessment, computerized “nutrient deficiency” testing, contact reflex analysiscontour analysis (also called moire contourography), cytotoxic testingother improper allergy testingblind spot mappingelectro interstitial scanning,electrodermal screening, Functional Intracellular Analysis (FIA), hair analysisherbal crystallization analysisiridologyleg-length testing (to check for “subluxations”), live blood cell analysis (also called nutritional blood analysis or Hemaview), testing with a Nervo-ScopeNutrabalanceNUTRI-SPEC, pendulum divination, provoked testing for toxic metalsreflexology, saliva testing, spinal ultrasound testing to “measure progress,” surface electromyography (SEMG)thermography, testing with a Toftness device, weighing on a twin-scale device (Spinal Analysis Machine), or any other diagnostic procedure that is unsubstantiated and lacks a scientifically plausible rationale.

I do not utilize or promote acupuncture to “balance meridians” or treat disease. I do not use or advocate the use of Activator Methodsapplied kinesiologyauriculotherapyBio Energetic Synchronization Technique (B.E.S.T.)chelation therapyChiropractic Biophysics® (CBP®), colonic irrigationcranial or craniosacral therapy, laser acupuncture, magnetic or biomagnetic therapy, Neuro Emotional Technique (NET)Neural Organization Technique (NOT)NeuroCranial Restructuring (NCR), NeuroModulation technique (NMT), or any other treatment modality that is unsubstantiated and lacks a scientifically plausible rationale. I do not advertise or offer expensive courses of treatment with spinal decompression machines. I do not “prescribe” homeopathic products. I do not sell or promote the use of unproven dietary supplements or herbal products for the treatment of disease.

I invite any chiropractors to check out this page, and add their name to that directory if they agree with the above guidelines.

Currently, I refer to physiotherapists because I know what my patients are getting with them. Health care decisions should be based on evidence, not anecdotes of benefit.

I’ll close with this passage from Harriet Hall from Science-Based Medicine:

What if chiropractic had policed its own ranks, limited itself to providing only short-term treatment for certain types of musculoskeletal pain, worked hard to determine which manipulation techniques were most effective, abandoned techniques that it found ineffective, and denounced vaccine rejection, applied kinesiology, and other forms of quackery? Manipulation might have been more widely accepted as a therapeutic tool if it had not been so tainted by the company it kept. Chiropractors could have become “physical therapists for the back,” experts in manipulation that MDs could refer patients to with confidence.  Chiropractic might have been integrated into the medical mainstream just like osteopathy and optometry, but it didn’t even try.

Political priorities…health care isn’t one of them right now.

As a physician, the decision-making of the provincial government has become of particular interest to me over the past few weeks. The Ministry of Health and Long-Term Care (MOHLTC) announced they are imposing unilateral cuts to physician fees for the 2nd time since 2012. In addition to the additional cuts across the board to all specialties, they are imposing a ceiling of total physician compensation over a 3-year period. If an aging population and an increasing number of users causes utilization of services to increase above the artificial ceiling, the government will clawback that amount from all physicians after the 3rd year. Let that sink in. A public sector group being forced to compensate for increased public demand.

So why now? Well it’s no mystery the province’s finances are in tatters, and they are looking for easy cuts wherever possible. Physicians are a convenient target right now. Public opinion is generally that physicians are well-compensated, and the government feels they can cut physician compensation without affecting voter confidence. I’ll get to why this is a huge miscalculation later on.

What drives government behaviour? It sounds crass, but quite simply it’s the next election. We are mere months into the term the new Liberal majority government, and all parties are already strategizing for October 2018. This is no secret to anyone with any experience in politics at any level. The goal is to be able to maximize voter confidence and approval come the next election. This is why cuts are made early in a government’s term. Get them over with now, and by the time the next election rolls around, no one will remember they even happened.

This brings me to health care in Ontario. Interestingly, polling numbers show that health care is at a 10-year low in terms of its importance to voters. Which may surprise many, given the general state of angst many have about our health care system. ER wait times, inadequate access to mental health services, underfunding of long-term care and home care, lack of access to family doctors, etc. Anyone working in the system knows that we are on the brink of collapse in many crucial areas. It won’t be pretty. The fact the public is largely unaware of this is a testament to health care workers who work tirelessly to fill system-created gaps.

From the government’s perspective, they know that the two main issues for voters are jobs and the economy. Health care is a distant 3rd, and the government is taking advantage of this. In addition to the cuts across the board to physicians, they have removed financial incentives for physicians to take on new patients. Regardless of the rationale for this decision, the projected result is obvious. Fewer physicians will set up practices in Ontario (as was seen through the 90s and early 2000s), and the number of patients without a family physician will increase. This will push more patients to walk-in clinics and ERs, which the government is fully aware of, hence why they reduced the amount paid for walk-in visits on evenings and weekends. They know demand will be higher there with fewer family physicians accessible. Wait times for specialists will also steadily grow with fewer specialists being attracted to the province.

My prediction is that the quality of our health care system will continue to decline because of underfunding until the middle-to-end of the 3rd year of the Liberals’ 4-year term. By then, strategic spending will be well publicized in a few key areas, the majority of the public will be under the impression that health care is on the rise, and the voter seduction will begin. Without any urgency demanded by the public in the interim, this path will be quite predictable. If there is no political risk to continuing along their current trajectory, the government has no incentive to deviate from their plan. Silence from the public is music to their ears.

But what of the next three years? Is the public really content to sit back and be manipulated like this? Millions of Ontarians will struggle in the health care system for the next three years, simply because the government knows that average Joe Voter isn’t outraged enough about the health care system to do anything.

I’m not asking for sympathy for cuts to physician fees. But what I want the public to understand is that sometime in the next three years, someone close to you will likely feel the impact of these cuts, either through limited access to a family doctor or a specialist. The ONLY way that you can have any impact on this is to let your MPP know how you feel. Let them know that your memory is better than they give you credit for. Any impact on the health care you receive as a tax payer, you will remember in four years.  Tell them to get back to the table with doctors and other health professionals, and come up with actual solutions to our health care woes, not just short-term band-Aid proposals. (Here’s an article from former OMA president Dr. Scott Wooder that explains the type of “interest-based, mutual gains bargaining” that the public should be demanding government participate in).

Health care is merely an accounting item to politicians right now. Let them know that it needs to be far more than that. Email, call, or write your MPP and tell them your personal story of why health care is a priority for you. Otherwise we know exactly where we’ll be in four years.