Solving Healthcare - Ottawas Department of Medicine

Solving Healthcare Podcast

Hosted by
Dr. Kwadwo Kyeremanteng (learn more)

Dr. Kwadwo Kyeremanteng cares for the sickest of the sick in the Intensive Care Unit (ICU) at the Ottawa Hospital. His research focuses on making the ICU more efficient and improving access to palliative care services. To achieve this, he founded the Resource Optimization Network, a multidisciplinary research group working to reduce health spending in this area without compromising care. Dr. K, as he is fondly called, is a leading contributor helping the department to achieve its vision of shaping the future of Medicine.

In association with the Ottawa Department of Medicine and the Resource Optimization Network, Solving Healthcare is a podcast series featuring interviews and discussions on topics related to improving healthcare delivery in Canada based on the values of cost-effectiveness, dignity and justice in healthcare. The podcasts will challenge the status quo and explore gaps, assumptions and different perspectives in the pursuit of finding solutions to the problems in Canada’s healthcare system.

Listen to the most recent episode:
COVID-19’s Impact on the Homeless, Safe Injection Sites & More, with Dr. Mark Tyndall

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05/19/2020

Episode Notes

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Listen More | Episode Archive

COVID-19’s Impact on the Homeless, Safe Injection Sites & More, with Dr. Mark Tyndall

COVID-19 Conversation with Kaveh & Lizzie From The House of Pod

COVID-19: Impact on Child Maltreatment, with Dr. Michelle Ward

Webinar 5: How to Manage Death & Grieving During COVID-19

Lessons From SARS, China, Approach to PPE & More with World PPE Expert, Dr. Laurie Mazurik

Staying Fit During a Pandemic, with Dan John

Jason Fung: Fasting Physiology, Why It Can Transform Healthcare, Impact on Immunity & More

Preparing Your ICU for COVID-19, with Dr. David Neilipovitz: Webinar 1

COVID-19: Impact on Nursing Homes, with Dr. Gianni D’Egidio & Dr. Celeste Fung

Webinar 2. “COVID-19: What You Need To Know About Personal Protective Equipment”

Minicast: Rapid COVID-19 Testing with CEO of Spartan BioScience, Dr. Paul Lem

COVID-19: Transmission, Masks, Treatments, Reintegration & More, with Pandemic Expert Dr. Amesh Adalja

Student Solidarity: Supporting the Front Line in COVID-19

Remembering What Really Matters In a World Turning Upside. Staying Connected, with Dr. Peter Brindley

Solving COVID-19, with Epidemiologist Dr. Raywat Deonandan

How to Talk to Your Kids About COVID-19, with Dr. Adrienne Matheson

Preparing for COVID-19. Innovative Solutions, with Dr. Bhaskar Gopalan ER Physician (Minicast)

Finding Balance in Our Response to COVID-19, with Dr. Paul Offit

COVID-19: Clinical Presentations of ICU Patients, with Dr. Nick Mark (Minicast)

COVID-19: Lessons from Seattle, with Dr. Nick Mark

COVID-19: LESSONS FROM ITALY & MORE, with Dr. Sumon Chakrabarti (Minicast)

Racism, Colonialism & Hope. The Realities of Indigenous Health, with Dr. Michael Kirlew

Healthy, Resilient & Engaged Communities. Solving Healthcare with Social Prescribing, with Dr. Kate Mulligan

Fasting: The Stall, Eating Disorders & Athletic Performance, with Megan Ramos

Benefits of Intermittent Fasting, with Megan Ramos

Coronavirus: What You Need To Know, with Dr. Sumon Chakrabarti (Minicast)

Privatization, Cannabis, Medical Assistance in Dying, Transgender Issues & More, with Andre Picard

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01/28/2020

Episode Notes

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Critical Levels:

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Transcript:

Kwadwo : 00:00 Yo, y’all wanted more of André Picard. We are delivering. We’re talking cannabis. We’re talking PharmaCare. We’re talking medical assistance in dying. We’re talking privatization of healthcare. Episode 14 with André Picard. Let’s go.

Kwadwo: 00:18 Welcome to Solving Healthcare. I’m Dr. Kwadwo Kyeremanteng. I’m an ICU and Palliative Care physician here in Ottawa and the founder of Resource Optimization Network. We are on a mission to transform healthcare in Canada. I’m going to talk with physicians, nurses, administrators, patients and their families, because inefficiencies, overwork and overcrowding affects us all. I believe it’s time for a better health care system that’s more cost effective, dignified and just for everyone involved.

Kwadwo : 00:53 Thanks for tuning in everybody. We are super excited about this episode with André Picard. We cover a lot. We cover some of the questions that we saw on social media, on Twitter and on Facebook, but what I want you guys to really take away from this episode is how a lack of clear objectives and goals within our healthcare system really can impair care, and impair resource utilization. I think that was a huge eye-opening point that André and I get to talk about here in this episode amongst the other things, but it’s a real eye-opener. Every other area within business, healthcare, your own health, your career goals, you, all of us have clear goals and objectives, but what are our goals in healthcare? Is it to reduce infant mortality? Is it to improve on mental health services? What are our objectives? These are the real questions we should be asking ourselves.

Kwadwo : 01:56 Okay. Before getting into the show, I want to tell you about our sponsors, Betterhelp.com As I said, I love these guys. They are online counseling service that provides accessible, affordable, and convenient counseling services that are readily available by a video chat, via telephone, via text messaging, and they cater to your needs, whether it’s teen counseling, whether it’s marriage counseling, whether it’s health care providers, addressing compassion fatigue. They’re fantastic. So if you guys are looking to sign up, use promo code Solving Healthcare, and you’ll get a 10% discount on their services. Our other sponsor today is The Podcast Critical Levels. This is hosted by my boy Zach Cantor and this show’s awesome. It’s about paramedicine and the issues around paramedicine, but they also dive into issues that involve us all. Specifically, he had a great episode with Dr. Zemek about childhood concussions, which as a father of three boys that are involved in hockey, I was completely engaged in. It was a great conversation.

Kwadwo : 03:08 This guy’s going to be a star, so you guys are game, listen to him on iTunes, Spotify, or Stitcher, anywhere you could listen to podcasts and, it’s a guaranteed gamer man. Good job Zach. Lastly, I want to give a shout out to the Department of Medicine at the Ottawa Hospital. These guys have supported this show tremendously. I want to give a shout out to Abhilash, Sandra, D D, Tracy, you guys are amazing. They’ve assisted with marketing, on updated website on the Department of Medicine page. I’ll leave links to that on the show notes. It is proper, but yeah, love you guys for all the support and uh, appreciate it. All right, let’s dive into it. André Picard, the author of “Matters of Life and Death.” And you heard him on Episode 13. Amazing journalist, 40 years of experience and he really delivers on this episode. We talk about it all and I can’t wait for you guys to listen to it. So we’re just going to dive into it. Enjoy Episode 14.

Kwadwo : 04:14 So I touched a bit on universal healthcare and in how, I’m not sure in Canada we can truly say that we have universal healthcare. I’m wondering if you had any thoughts in terms of privatization. You know this is coming up a lot in terms of ways of making healthcare more sustainable, dealing with wait times and so forth. What are your thoughts in terms of privatization?

André Picard: 04:40 Well let me start with the universality part of the puzzle. So we have, in Canada we have this notion that we have a universal system, but we have the least universal universal healthcare system in the world. I think once you put it in those terms, you go, “Oh hold on. Is that true?” Because we cover hospitals and we cover physicians a 100%, we cover very little of everything else. We cover about 45% of drugs publicly. Well, 30% of home care, uh, 30- 35% of long-term care, 6% of dental care. We’re all over the map and it’s irrational. So we don’t have a universal healthcare system. So that’s the first part of the puzzle. I always said, I like to use the analogy of a basket. So we have this Medicare basket of services. Right now we have a basket that’s very narrow and very deep. It’s hospitals and physicians.

André Picard: 05:29 We pay for all of it, even though some of it probably shouldn’t be paid for. And then the other stuff we don’t cover near enough. So I think we need to make this basket a lot wider and a bit shallower. So we cover a lot more, but we give some people some responsibility for the rest. So that brings us to the, the second part of the privatization talk. And I think a lot of the talk about privatization in Canada, the way to shut down any discussion about healthcare is to say, “Oh, you’re going to privatize, we’re going to be like the U. S.” Well, I think that’s it. I think that’s nonsense. I think it’s a false dichotomy. I think the reality is every, no health system can cover 100% of everything for everyone all the time. So we’re going to have some private healthcare,. We have to realize that from the outset.

André Picard: 06:18 So the question is not will we have private healthcare? The question is where do we have it, how do we regulate it, and how do we make sure that everyone gets the essential care that they need at an affordable price? So that’s, you have to have these philosophical parameters and then how we deliver the care. To me, it doesn’t really matter. I don’t care if it’s delivered by a privately, publicly a mixture. What matters is that people get the care and that it’s accessible and that it’s affordable. So that that’s my philosophy. I get some grief for that, but I think that’s how we have to have the discussion about privatization. It’s not black and white. It’s about how do we regulate it, how do we ensure that it’s delivered fairly and comprehensively, et cetera. I think in Canada, the problem we have is we have a badly administered public health care and badly regulated private health care. So we kind of have the worst of both worlds. A lot European countries have a lot of private health care, but it’s very strictly regulated. It’s not a free for all the way it is here. So there’s different ways to, to have get that balanced right. And again, you’ve got me on my pet topic.

Kwadwo : 07:27 That’s part of my game. It’s interesting because actually I’ve never heard it framed that way is that we’re the, how’d you put it, in terms of universal healthcare, we’re the…

André Picard: 07:36 …the least universal in healthcare.

Kwadwo : 07:39 Yeah, I like that. And I mean cause it’s often people forget that they’re like, oh we don’t have any private health care in Canada. But you know, if I go see a physiotherapist I’m paying out of pocket. And it’s true. It’s like where do we want to put our private resources? I mean, well some of the topics that come up or worries I hear people mention is like resource drain where like some of the best surgeons or physicians or whatever, allied health professionals, would just strictly go into the private sector. But it’s kind of like you mentioned if you regular, if you’re like anything that you’re going to do that’s semi new or complicated will take some nuance. And so yeah, you know, maybe you need to restrict how much time physicians could spend in the private sector. Maybe that’s a solution, but certainly to think that we can’t have any element of private healthcare in 2020 or beyond I think is a bit ignorant at this point.

André Picard: 08:41 Well, you’re right. It’s about setting parameters. So if you look at a country like France, a many doctors practice in the public system and the private system, but there’s strict regulations. So if you want to work in the private for every hour you give to the private system, you have to give an hour to the public system. So that’s, that’s a way of getting some balance there. It’s not a, you know, it’s not an either or. In Canada you can opt in many provinces, not all, but in many provinces you can opt out of the public system and then you can charge whatever you want. There’s no limit. I’m not sure that’s a good system. Now very few doctors do because our Medicare system is actually very generous for doctors and it’s a good system, very little bureaucracy compared to systems like the U. S. So there’s the greatest beneficiaries of Medicare have been physicians. We shouldn’t forget that.

Kwadwo : 09:27 Yeah. I feel like it’s so taboo, but we need to go there and I, I don’t know what, will make us go there. What I’m getting at is what is our breaking point? Because baby boomers, are getting to prime time, health care, utilization, age, you know, we keep saying that we can’t keep this up in terms of healthcare delivery and spending. So what’s next? Like what do you see? What’s going to happen in Canada in your, in your humble opinion?

André Picard: 10:00 Well, you know, I think that we have to realize that healthcare is really important to us. Uh, we have to find a way of delivering it. And as I said before, we obsess a lot too much about the cost. Do we spend too much on healthcare? I am often asked that question and I always give the same glib response.

André Picard: 10:16 I always say, I have no idea because I don’t know what we’re trying to achieve. So we just spend, you know, we spend the way we spend, we don’t have any set public health goals in Canada. So unless you have goals, it’s hard to save for we’re getting, achieving what we’re trying to do. So I think that’s, we have to do some basic stuff.

Kwadwo : 10:34 What kind of goals would you have us, would you have in mind?

André Picard: 10:38 Yeah. So I look to many countries do this. So you look to a country like Sweden. So Sweden publicly publishes every year a list of its public health goals. So for example, I take one in Canada and Canada, we have an abysmally the high rate of child mortality compared to most of the world. So I would say in Canada, we want to bring our rate of child mortality from three per thousand to two per thousand.

André Picard: 11:05 That would be a public health goal for me. And then we find out a way to do that and we spend the money that’s necessary to do it. So that that’s how you have, goals and then you work to achieve them. People often get uncomfortable when I say, “You know, we have to treat it more like a business.” And that’s what a business does. A business says, here’s the goals for the year. Often those goals are related to profit, but we don’t have, that doesn’t have to be the goal in healthcare. The target, the goal can be, you know, we’re going to ensure that our child poverty rate falls by X percentage points or that, the cesarean delivery is going to be less disparate from one end of the country to the other. So there’s all kinds of goals you can set once you have goals. It’s easier, I think, to, to figure out how to spend appropriately.

Kwadwo : 11:48 You know where you’re trying to go. You have purpose.

Kwadwo : 11:53 Yeah. It’s funny cause you always hear on a lot of whatever endeavors that you, you, you go on that, you know, you need to set goals and, and write them down or discuss them, be clear on what your objectives are. And it’s funny if you asked me what, you know, what are the goals are Canadian healthcare system, that’s not an easy question. Yeah. To make Canadians healthier or whatever. But is that really specific enough? Is that like, what does that actually mean? You know? Yeah. No, that’s a, that’s a great point.

André Picard: 12:25 When I, when I do talk to, I often ask the audience, I say, what, what is the statement of purpose of Canadian Medicare? So we spend a quarter of a trillion dollars every year or $256 billion on healthcare. What is its purpose? So I often ask that to audiences and the question, the answer is always silence. So I tell them, you’re right, we don’t have any, you’re all right. You don’t just answer nothing. And when you put it in those terms, I think people go, “Wow, we spend all this money and we don’t, what’s the purpose of it?”

Kwadwo : 12:54 Yeah, wow.

Kwadwo : 12:56 I’m actually speechless because yeah, what really is our goals, you know? Yeah. I mean it’s, even if you think about it in, in specific niches, like you know, when I’m in ICU, I know my goals are clear. When I’m in the Palliative Care, my goals are clear. You know, when they, when we look at a system level, it’s not clear at all. You know, we might have a bunch of issues but we’re not prioritizing them. We’re just blanketly throwing money in and dealing with fires. Wow.

André Picard: 13:29 And Palliative Care is a really good example. You know, you have very specific goals once the patient is there, but whatever. What are our goals as society to ensure that the right patients get there? In Canada between 17 and 35% of people who should have palliative care get it. We do a terrible job of ensuring people are treated well at end of life. And you know, I can’t, it’s hard to imagine something that’s more important than alleviating people’s pain at the end of life to not see them die a horrible death. And we just haven’t, we don’t have goals. We don’t have, we haven’t made that a priority. You know, again, it’s the Canadian classic thing. Once you’re in power, you know, you’re in palliative care, we have fabulous Palliative Care. So many people are denied access to that, that it’s criminal.

Kwadwo : 14:16 Yeah, and the thing that people may or may not realize is even when it studied the benefits of early Palliative Care, like there’s a study out, it’s almost 10 years old now that it was stage four cancer patients got either early Palliative Care or just standard care up to the discretion of their team. And the patients that got early Palliative Care, not only were their symptoms improved, but they actually lived longer, ironically. And so, yeah, I mean you’re definitely preaching to the choir in terms of Palliative Care resources. I mean, you know, when you, when you look at trying to improve the experience for the family, for the patient, making sure that the, you know, they’re not suffering and you know, even from a resource point of view like the patients are less likely to occupy acute care beds as a result. It’s just a, it is a bit mind boggling that this is not emphasized more.

André Picard: 15:12 Yeah. And it’s a reminder. What you’re saying is reminder. I don’t, I don’t think we lack money. I don’t think there’s any lack of money in our system, we’re one of the biggest healthcare spenders in the world. But I think it’s how the money is allocated, is the problem. We don’t spend smartly. We don’t get value for money.

Kwadwo : 15:27 This is, this is my, I mean, this is like my mission, Andre. It’s like I see it day in, day out us putting in money into interventions that have no benefit. Even, there’s a simple, this is a very simple example, but you know, I think it clarifies things you could have if someone comes into the ICU when they’re, they need to be resuscitated with IV fluids. There’s normal saline that you’ve, we’ve all seen that costs maybe a $1 .30 and then there’s some more sophisticated fluids that cost about $50 to $60 for the same amount of volume.

Kwadwo : 16:03 So 60 times a price with no, like if you could study it through the union, there was no additional benefit for you getting that fluid. You know, and we, we spent thousands on it and if there’s no reason for it. You could have an oral antibiotic that’s just as effective as an IV antibiotic, but people will still order the IV one because it makes it feel better. Throwing away money just cause, you know, for lack of understanding or just because of a lack of lack of a will to change, it’s just, it’s all over the place. And then instead we could be putting it into places that matter. That’s a, this is, I don’t know if this is what drives me nuts. You know, I see my physio-therapist position gets cut , I see my social worker position get cut, things that actually are going to make a difference into the patient experience and improving care.

Kwadwo : 16:56 I’m going to have to cut these positions. Yeah. It’s crazy to me.

André Picard: 17:00 Yeah. And you remind me of, I remember visiting a unit for girls with eating disorders at a hospital and they had cut the psychological care so they were no longer getting psychological care. So what was the result is they ended up spending many more months in hospital. I had great, a tremendous cost, way more money than it costs to fund a psychologist. A different budget, et cetera. It’s just a lot of irrational stuff like that happens and it just, it actually costs more money, not less. I know people, 90 year olds with dementia and cancer are getting a hip transplant. What’s the good of that?

Kwadwo : 17:36 Absolutely. It’s and stuff that has been studied and we know are unlikely to benefit and we still offer it. And you know, I mean when you give that example of arguably who might be the most valuable person in an eating disorder ward, I would think it would be the psychologist. Wow.

Kwadwo : 17:56 That reminds me, we did get a bunch of questions on Twitter when we were doing this show and, and one of them, you’re a popular man. One question that like really stuck with me and, and I don’t think there’s an easy answer to this, is how do we break the cycle of these four year,

Kwadwo : 18:18 cycles where governments are in power. And so they, the budgets are reflective of that. So there’s so much sort short, shortsighted, you know, budget, budget, intervention cuts because we got to balance the budgets despite the fact that some of these cuts are gonna make things worse in the long run. Is there a solution to this problem?

André Picard: 18:38 Well, again, yeah, I think there is a solution and again, we can learn from looking at other jurisdictions. I think one of the things that distinguishes Canada is the level of political micromanagement. So there’s way too much interference from that. The Health Minister’s office reacts to what’s on the front page of a newspaper. That’s how our system runs. It’s like I always call our health ministers, firefighters instead of fire prevention officers, that’s what they should be doing. They should be setting the philosophical goals, as I talked about before. These are the goals that we want to achieve and we should have professional administrators running the system so that, that’s what I see when I go to countries in Europe, like the Netherlands and France, they’re professionally managed. They’re run like a business. And the government essentially keeps their nose out of it, and the public doesn’t want their noses in it. So I think it’s really to let the managers manage.

Kwadwo : 19:30 Mmm.

André Picard: 19:30 One of the worst jobs in Canada has to be a healthcare administrator because you have all this responsibility and you have no power and you’re constantly second guessed by politicians. It’s a terrible position to be in. So what do they do? They just cover their butts. They try and not make waves and we just go along, you know, try and keep quiet and nobody wants to catch the attention of the Ministry of Health because it’s always going to be bad news. So I think it’s this professionalization, that we have to aim for. And it’s weird cause we don’t do it in any other part of our government. You know, the Transport Minister doesn’t call and tell the airport what flight should be going out. And that’s, that’s how it works in healthcare. It’s absurd. So I think that problem is easily solvable, but it’s going to take some, some political guts for people to say, listen, hands off, I’m going to let the, you know, Ontario Health. So, you know, say take Ontario Health, this new system, theoretically you should be able to do that. That should be an independent entity. Government gives them their allocation of money, go for it, run it that it should be run that that’s how a system works in most countries and that’s how it should work here.

Kwadwo : 20:42 Have you seen a province, the healthcare system that works better than others?

André Picard: 20:47 That’s when I traveled around the country. I always know that’s going to be the first question when I do a talk. I’m obsessed in Canada. Are we the worst or are we just sort of in the middle? That’s everybody wants to be in a major of Canadians. So I think, I think the answer to it is we don’t know cause we don’t measure things very well. I think anecdotally we know that every province does some stuff really well. So we all have areas of excellence. I often describe Canadian Medicare as “islands of excellence in a sea of mediocrity”. We have a lot of mediocrity. We have that but have a lot of great stuff. So New Brunswick has tremendous paramedicine. Manitoba has really good homecare. Quebec has really good primary care with CLSC’s.BC has a really good handle on its drug program. So there’s all of these provinces that do things well.

André Picard: 21:37 And the frustrating things for me is we don’t learn from each other and copy each other. We do quite the opposite. We always try to reinvent the wheel. But to get back to your initial question, who does it best overall? I’ll just go with my gut feeling cause again, there’s no measures, but I think these days, I think it varies. I think Alberta used to have by far the best health system, sort of a pioneered the regionalization model, and it does it really well. It allowed the regions to, to run in the way we talked about, you know, you’re the boss and you run it and the government keeps its hands out and until the government started meddling again, that worked really, really well. So I think Alberta was a leader for a long time. I think now probably Saskatchewan. Saskatchewan is a really good size, but a million really good size too to run a system.

André Picard: 22:26 Ontario is kind of a dog’s breakfast. They’re trying to fix this with a reorganization, but it’s really the most disorganized system as a result. I think one of the ones with the, with the worst outcomes, unfortunately. I don’t think there’s a best and I don’t think there’s a worst, but there’s a lot of good and there’s a lot of bad overall. Unfortunately.

Kwadwo : 22:45 No, I can appreciate your answer. I’m originally from Alberta and one of the things that was taking place before I left was single electronic medical health record. You know, they had this, I’m forgetting the name off the top of my head, but you know, taking the bull by the horns and saying, you know, this is ridiculous. We should all be under one system and oh it should, all hospital charts should be able to speak to each other to a certain extent.

Kwadwo : 23:15 And this was, I mean this was in 2005 when I left, so yeah, I do. I could, I could see where you’re coming from. And yeah, at the time they still had the like a health authorities is what they would call them. Like which pretty much had as you described, a free reign. Relatively speaking to, to work in the way that was most effective for their community. It’s a really good point you bring up though. It’s, you know, a little bit more independence for some of these administrators to, you know, to try and do the right thing for their, for the community and to be able to get to their needs. Yeah, I mean that’s a, that’s a fair point and that you don’t hear about every day, but yeah, certainly in Ontario this is what we’re attempting. All right. I’m going to ask you a bit of a controversial one too.

Kwadwo : 24:02 Is there a party that you feel like since you’ve been doing this for 40 plus years, it seems to do a better job of this than others?

André Picard: 24:11 Well, you know, the, I think one of the biggest problems in Canadian politics is that there’s very little difference between the parties, violent agreement on, you know, essentially the status quo. And that’s, to me, it’s always frustrating to me during election campaigns, there’s very little discussion of healthcare because there’s no disagreement. Everybody sort of has this, well, Medicare is great and we don’t want to talk about it attitude. NDP, Conservative, Liberal, all the same approach. And I think a lot of it goes back to there’s a famous quote to attributed to Joey Smallwood, who is the premier of Newfoundland, one of the Fathers of Confederation. He once said that, “I’ve never had a discussion about healthcare that didn’t lose me votes.” To this day, politicians feel like that…

André Picard: 24:56 You start talking about healthcare and it becomes a losing proposition because you can never satisfy everyone. So the parties kind of agreed to to say nothing. We have these little discussions around the edges occasionally because there’s never any serious talk of performing healthcare regardless of the party. So short answer, no, there’s not one that’s better than the other. What we do know is that the lesser a party’s chances of being elected, the more bold their promises are for healthcare. So that, that’s the sad reality.

Kwadwo : 25:24 Fair enough. Okay. I’m going to touch on a few more questions that some of the our friends were, were asking. So in terms of new cannabis legislation, what’s your, your overall opinion on our approach?

André Picard: 25:43 Yeah, so I’ve been long a proponent of, I, don’t believe that, you know, drugs should be regulated the way they are now.

André Picard: 25:51 I’m a big believer in, legalization of all drugs because I believe people are going to use them and we have to make it safe for them to use, and educate them, et cetera. So that’s my premise that I operate from. Lots of people don’t like that view, but I have a very libertarian view about drugs and I think it’s viewed from a public health perspective, that that’s the most rational approach. Now when we take cannabis, I think that legalization of cannabis was long overdue. We started discussing this in the 1970s with the Lyddane Report and finally two years ago we got around to legalization. Now what’s happened since then? I think it’s been kind of a bust in a bust economically, socially, medically because we’ve replaced this criminalization with a whole bunch of stupid regulations. There’s way more laws about cannabis use now than there were before it was legalized.

André Picard: 26:45 So it’s kind of a, we’ve undermined what we were trying to do. From the business perspective, that’s the story that gets the most attention in Canada is our cannabis companies are all going bust, because they’re, the sales are not what they expected. We could have built an industry here that export it, its knowledge around the world, but, there’s so much red tape and regulation that we’ve denied ourselves that, right. So, and I think we’ve kind of messed up this good idea. We’ve get it done it very, very badly unfortunately. So the reality is what the reality is, a lot of people still buy on the black market. The government stores have a product, but they have long wait lines. You know, there’s the Canadian way. We wait for everything. We even wait for in line outside to buy our pot. So I think it’s kind of been a huge disappointment, unfortunately.

Kwadwo : 27:35 Yeah. It’s, um, I do hear you about the, from a like a public help perspective on legalization cause certainly, you know, putting somebody in jail or putting them in a spot where they can’t have a job based on a substance that people are going to use anyway. It seems, you know, um, not right. But my concern personally is the use, especially amongst the youth. Like I think there’s some detrimental affects that maybe we’re not appreciating. Like I know we see a little bit more psychosis in lead adolescence, early adult age. I just kind of wish it was studied a bit more before we’re like, hey, you know, let’s just throw it out to the world, but you know, I, do hear from the public health side for sure.

André Picard: 28:27 You know the youth, the youth issue, whether it’s cannabis, whether it’s vaping, whether it’s tobacco, that’s a particularly challenging one.

André Picard: 28:34 And those things are all illegal. It’s always been illegal for young people. Probably always will be. And that’s not the issue. That’s not the way we’re going to deal with that demographic. We have to, we have to teach them. Uh, we have to recognize that they’re young people, so they’re going to be risk taking. They’re going to be experimenting and we have to deal with that reality instead of being moralistic about it and saying, “Oh, we’ve got to ban, vaping, we’ve got to ban cannabis.” They’re going to use it. So let’s make sure that when they do they do it safely, uh, they do it rationally as much as possible for a teenager to do anything rationally. I think we just have to be much more pragmatic about this stuff. I think that’s, to me, that’s the big lesson I’ve learned about writing about public health for a long time is. ..

André Picard: 29:15 You really have to put your opinions aside and be very pragmatic about this stuff and realize it’s going to happen. So how do we make it as safe as possible? How do we reduce harm? Harm reduction has to be the driving force of our, our public policies. And the worst thing for harm reduction is, is prohibition. Prohibition is always failed regardless of the substance.

Kwadwo : 29:37 Yeah. Fair enough. I guess it’s always the question, which I guess we don’t know. It’s just, you know, what is that safe level? What is a, what is the amount or the approach that, you know, is truly reducing harm. But yeah, a lot of questions in terms of, you know, the approach. How about, another question that came up was regarding PharmaCare. I think you’ve, you’ve written a bit about PharmaCare and Canada. Oh, any thoughts on that?

André Picard: 30:07 Yeah, so an issue we’ve written a lot about because it, it actually did get debated politically.

André Picard: 30:12 Again, I think PharmaCare is necessary. We need to, you know, we’re the only developed country aside from the U.S. that doesn’t include drug coverage and our, and our universal health plan. So that’s something that’s needed to be fixed for 50 years. So we have to do that. So we’ve done it to a certain extent, but we’ve done it in a very haphazard way. So we have 102 public drug programs in Canada. We have to make some sense of that. We need some, some more centralization, more logic. But I think the really important thing that’s lost in the PharmaCare debate is we have to define what we mean by PharmaCare. So we have a lot of people talking about, you know, we need this single universal system. Sure. That’s one way of doing it to be, it’s not necessarily that way, but the most important thing is what are we going to cover for who and why?

André Picard: 31:02 So how are we going to get value for money, uh, for our drugs? And I think the way to do it is not to copy what we’ve done with, with the physicians and hospitals, we’ve covered those 100% and it doesn’t work. We’ve had a lot of waste. We have a lot of, stuff that’s not done because we spend too much in those areas. I think we have to be careful not to repeat the mistakes we’ve made earlier. I think we have to be a little smarter to decide what we’re going to cover and that, that to me is the essence of the debate. There’s no question that we should cover. Drugs are really important. If we’re going to have universal healthcare, but universality doesn’t mean covering every product for every person all the time. Ensuring that everyone has the essentials in an affordable way and those are different things .

Kwadwo : 31:49 That certainly was one of the few healthcare related topics that came up during this past election.

Kwadwo : 31:57 And that was a, it’s funny, those are my exact thoughts when it came up, I’m like, what is, what does that actually, what does formal care actually mean? Like what are we actually debating here?

André Picard: 32:09 Yeah, there was no, there was no real debate. There were a bunch of platitudes that were uttered, but that wasn’t debate because they, the parties never defined what they meant. You know, they said, we’re going to bring in, in this program, but what exactly is the program going to be? And then, the fact that the Federal parties were debating this, neglecting the fact that ultimately it’s up to the provinces, that that was a big problem as well.

Kwadwo : 32:32 Excellent. Excellent. So, okay, André, what are your thoughts on medical assistance in dying?

André Picard: 32:38 Yeah. So another issue that we took a long time to deal with. So I started covering that issue in the early eighties.

André Picard: 32:45 Then it got a lot of steam with the, in the early nineties with Sue Rodriguez kind of died off for awhile and then came back. So that again, we finally brought in this legislation to give people more choice at the end of life to minimize their suffering. So I think that was a really big important piece of legislation. Now the problem was that the legislation was, was flawed and it was inadequate and we, we’ve got to fix it. So we’re at that point now. In fact, a new public consultations have just started about expanding the MAID legislation. So that’s going to happen. The court has ordered it, but it’s always frustrating with these issues, how slowly we go, how cautious the politicians are. Thank God we have an activist court in Canada. Or we, we’d have much worse health care. Of course, it forced us to do stuff that we know we should do, but politicians are too, too wimpy to do on their own.

André Picard: 33:37 So I read the important issue. I think we have to recognize it. Very few people are ever going to get an assisted death. That’s going to be one, 2% very tiny percentage. But I think it’s a really important philosophical point, a theoretical point that people have choice that end of life. I think that’s what’s most important about this debate is giving patients more control. And I think that we’re going to see that now we’re going to see the really tough ones. Does that apply to people with dementia? Does it apply to people with mental illness? Does it apply to children? There’s some really, really tough debates coming. But again, I, I stay in my bubble about being pragmatic. I think we have to give people options and then we have to ensure at the same time that there are protections. So that these things aren’t abused.

Kwadwo : 34:22 So basically what I’m hearing is we can’t use this slippery slope argument as a reason not to implement this. People deserve to have that choice in terms of, how they want to end their life.

André Picard: 34:37 I don’t know how many times I’ve said in my columns that not every slope is slippery, but I think we actually remember that, that that’s kind of a banal argument. Not every slope is slippery there is, we have to have buffers in place to ensure there aren’t abuses, but that doesn’t mean denying people rights to want them. No one should be forced to take, to have an assisted death when they don’t want to. No one should be choosing assisted death for lack of alternatives like lack of Palliative Care, lack of long-term care. That’s unacceptable. Not no one should be denied and assisted death who wants it?

André Picard: 35:11 Who’s making a rational choice? We can do all those three things at once. They are not mutually exclusive.

Kwadwo : 35:19 Exactly. In your book “Matters of Life and Death” you touch on transgender issues. Where do you see some of these issues in 2020?

André Picard: 35:30 Well, I think it’s just an example of what we talked about at the outset, it’s an evolution. You know, it’s a new patient group, a new demographic that’s standing up and being heard, and that the health system has to adjust. This notion of treating gay men was unthinkable in the 70s and 80s, no, they’re a bunch of perverts, and we hear a lot of that same when you’re around a long time, you start to hear these echoes and we hear that now about transgender, Oh, we can’t possibly do that. We can’t use different pronouns. Oh, the language has always been the same, but the things evolve.

André Picard: 36:03 Language evolves. Medicine has to evolve and I think this is these developments are good. They challenge us, they force us to think differently. Unfortunately, there are abuses or wrongs that happen along the way that forces us to deal with this, but I think it’s, it’s a very positive development that we’re talking about. Like gender fluidity, that the gender is a social construct. I think these are really important things for physicians and few for future physicians to think about and to talk about. And how do they treat their patients well regardless of their gender or how they identify.

Kwadwo : 36:38 Super important topic and definitely one for a future episode. André, what about the wait times we’re seeing overall whether in emerge or if you’re waiting for a hip. Do you see any solutions in the near future?

André Picard: 36:55 Yes. So again, I think wait times is the systemic issue.

André Picard: 36:58 So it’s about creating more flow in the system. It’s about breaking the bottlenecks. You know, as we talked about earlier, at the long rates in our emergency rooms have very little to do with emergency care, right? They’re all about bottlenecks. It’s about inability to admit people, inability to, to get people out of hospital. We have this perversity in Canada called the ALC patients, (alternate level of care) patients who live in hospitals. I’ve done stories about this. I met a patient who’s been living in a hospital for 10 years because there’s no alternative for them. This makes no sense. It makes no sense from a business perspective and makes no sense from a patient care perspective. Ethically, all these things are wrong and we have to fix them. But you know, in some provinces, one third of all hospital beds, are ALC patients. They are people who have been discharged but have nowhere to go.

André Picard: 37:51 So these are, this is how you deal with wait times is you deal with things across the spectrum. No easy solution. It can’t be overnight, but we have to correct the errors we’ve made of of bad planning. You know, we all, we hear often and over and over again, Oh well,it’s the aging boomers. You know, that’s what’s overwhelming our system. We’ve known about the boomers for 60 years. No surprise here. It’s just a bad planning, lack of foresight. And we have to fix it.

Kwadwo: 38:20 Agreed. But what can we do now? Like if I’m, you know, the Minister of Health or I’m a lead for a health authority and I got these tons of ALC patients, what can we do?

André Picard: 38:33 Well, I think, again, if look at it and say from a business perspective, what do you do in a business if you have this problem? You have a mixture of carrots and sticks.

André Picard: 38:42 So you start punishing hospitals that have ALC patients. Why did patients, you know, that perversity is that hospitals actually like having ALC patients because they require less nursing care. They’re understaffed on nursing. They get paid the same amount of money, require less care. So it’s actually a good thing for them, which is wrong. It shouldn’t be a good thing. So you have to punish them financially. And that will solve the problem pretty quickly. They’ll get them elsewhere. We have to incentivize people to have more long-term care homes. Most of our long-term care homes are private businesses and we have to ask ourselves why people don’t go into this business. That’s because the rates suck , it’s because there’s way too much regulations. We have to make it easier for people to provide spaces for people who need it. And then we have to deal with the other pieces of the puzzle, which is home care.

André Picard: 39:30 I think we’ve, put far too many resources into people getting home care just to get them out of hospital quicker from short-term surgery and we haven’t invested enough in the chronic part of the puzzle. So again, from a business point of view, way cheaper to care for those ALC patients in their homes costs a fraction of the cost. So take that money and use it differently. And if you don’t do that, then you’re going to be punished. So the carrot and stick approach, all this stuff is solvable. And I know it’s solvable because I see, I don’t see these problems in other countries around the world.

Kwadwo: 40:05 Interesting. We kind of talked a bit about how to create change in healthcare and you do bring up the carrot and the stick. And I mean money talks. One of my main incentives to do research around costs is because that’s the language that that’s a change language.

Kwadwo : 40:24 That’s the language of administrators, of politicians. So if you could show a financial benefit for any intervention, like that’s when things actually start to move. And so withholding funds so that change can occur. You know, I think it can go a long way, but certainly just sticking with the status quo is not good enough.

André Picard: 40:48 But I would add the proviso that if you’re going to have carrots and you’re going to have sticks. People have to have accountability and they also have to have power. So you can’t punish a hospital for having ALC patients, but not giving them the power to resolve it. I think, again, when you have a regionalization is supposed to be the solution to this, right? So the way a regionalization is supposed to work is that they should say, here’s our overall budget. We’re not spending it well by having these people living in hospitals, we should spend it on home care or we should spend it on long-term care facilities. So you have to have the power to move that money around and that that’s how the issue will get resolved. Ultimately give people, accountability and power to fix things.

Kwadwo: 41:29 I love it. You know, trusting in the people that you’ve invested into, trying to make the healthcare system better.

André Picard: 41:36 We pay healthcare administrators a lot of money, let them administer.

Kwadwo : 41:40 Mmm, no, that’s, that’s a great point, André. One thing I like to do is always end on a positive note and allow our guests to talk about a story or a time where they’ve felt that your job has had a big impact in general. And you did give this story earlier

Kwadwo : 42:00 about, um, you know, the AIDS patient in Toronto, but is there an any other time where you felt that you covering health care and being as engaged as you have been, that you’ve really made a difference?

André Picard: 42:16 I think there’s all those little stories like we talked about, you know, the one patient who, who got better care because of your story, little policy changes. Those are always moving. But to me there, to me, there are two big things in my career that stand out. I wrote for a long time about the tainted blood tragedy. So this came out of my coverage of AIDS. I started covering, you know, there were four groups who were infected with AIDS and one of them was always forgotten. This little group of hemophiliac and transfusion patients. So we started focusing on them and this became, this became a huge story. It became an exposure of one of the worst, probably the worst public health scandal in Canadian history. About 30,000 people were infected with HIV and hepatitis, not because of mismanagement of the blood system, because of lying to people because et cetera.

André Picard: 43:06 I have a whole book length version of this rant, but, that issue that the tainted blood issue I think is one of my proudest moments because it really did bring relief to a lot of people. There was more than $5 billion in compensation paid out. Ultimately, our drug regulation system changed profoundly as a result of that. And I’m not taking credit for that solely, but we did get the ball rolling. So I think that’s really important story in my, my legacy, if I could put it that way. And there’s another one very similar, but on a smaller scale that a very touching one was a work that I did with my colleague on the, thalidomide survivors. So there’s a group of five people who are affected by thalidomide in the 1950s, sixties, left with, you know, missing limbs, et cetera.

André Picard: 43:54 Those folks live the long time suffering in poverty. And we came back to that a few years ago and wrote about these forgotten survivors. And again, the result was a quite a large compensation package. People getting their lives back, people who are forgotten, you know, we got to tell their story. And there’s a lot of, a lot of touching, touching stories as a journalist to hear from that and when you actually change people’s lives. So those are two of the biggies for me. But all the little ones day to day, you know, they, they keep you going.

Kwadwo : 44:27 Yeah, no, I got to tell you, André, it’s truly is a privilege to be able to have this conversation with you. And I could truly echo the amazing, inspiring work that you’ve done over the years that has impacted Canadians and people worldwide and given people a voice, increasing awareness on many health care related issues. And I got to tell you, I learned a ton today. You know, I got no political, no policy, game. I’m not educated from that front, but the things we talked about today was super eye-opening, especially like the silo stuff and the regionalization aspect of, of things like the way you framed it. And it’s just, I don’t know, there’s a lot to digest and a lot to think about, but, you know, I’m hoping my listeners are feeling similar to me and feeling pretty inspired and I’m truly grateful that you took some time to do this and I hope to have you on again.

André Picard: 45:30 A pleasure. And you know, I always remind people, you know, I, my job is to sort of summarize and to translate all this. I meet all these brilliant people and my job is sort of steal their ideas and make them pithy and accessible to the public. So I can’t forget that I know nothing. I learned all this stuff from other people and I think my only skill is really being able to boil stuff down and simplify it and hopefully communicate it in a way that people can understand and act on.

Kwadwo : 45:55 Yeah. Well I’ll tell you it’s working. Awesome. André, thank you so much. There’s going to be links to all your books, your Twitter handle, everything in the show notes and, thanks again for doing this.

André Picard: 46:07 Thank you. I look forward to it.

Kwadwo: 46:09 Thank you. Thank you so much for listening to Episode 14 with André Picard. I hope you all enjoyed it. If you guys want to follow him on Twitter, it’s @picardonhealth. If you want to follow or support this show on Facebook, on Twitter, on Instagram at Kwadcast, you could send comments to Kwadcast99@gmail.com and please let us know how we’re doing. We were looking to always improve on the show, the five star rating on iTunes. If you’re up for it, leave a review. Thanks again guys. We’ll talk soon.

Please send your comments/feedback to kwadcast99@gmail.com

Andre Picard: A Pragmatic Approach to Solving Healthcare

Minicast: Out Of The Cold Program. Supporting Vulnerable Inner City Patients with Dr. Mariah Hughes

Transition from Doctor to Patient. The Value of Patient Partnerships, with Dr. Lynn Ashdown

A Call to Action & Christmas Love: Minicast

Unwanted Lessons From Having a Child with Cancer. How Dr. Jennifer McCombe is Solving Healthcare.

Minicast: How Likely Are You to Survive In-Hospital CPR, with Dr. Shannon Fernando

Surviving Pancreatic Cancer & Living Your Best Life, with Sindy Hooper

Minicast: Lessons From The Ottawa Patient Safety Conference 2019

The Opioid Crisis, Humanizing the Homeless & More, with Dr. Jeffrey Turnbull

0:00

…

11/19/2019

Episode Notes

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TRANSCRIPT:

Kwadwo: 00:43 welcome back everybody. Super excited about episode nine year with Jeffrey Turnbull. But first I want to tell you about our sponsor. Better help. This is a group of amazing online online counselors that provide online counseling via audio calls, via, via chat, via messaging, and it’s affordable. It is timely, it’s on your schedule. And these guys are great. They reach out after hearing episodes with dr Adrienne Matheson and dr Tamina Eapen. And um, I think they do amazing work. So if you want to sign up, you get a 10% discount using discount code solving healthcare. There are better help.com and uh, I highly recommend these guys. Okay. A couple of housekeeping things. We’ve been busting out episodes every week. And for the sake of my marriage, we’re going to be extending that to every two weeks. Now that we’ve have a few episodes out. Now we’re also going to explore different format.

Kwadwo: 01:51 We’ll call them mini casts, where you get 10 to 15 minute episodes of, of innovative things that are happening within healthcare that, you know, there might be quite niche, but the idea is that it could be scalable, it reduces spending and provides better care. And so, um, that’s another format we’re going to explore. Okay. I’m going to tell you about our next guest, dr Jeffrey Turnbull. This guy is a walking angel and as far as I’m concerned is a hero. He works with the homeless population. Okay? He’s done this throughout his career and his whole motivation is to give them a voice, humanize them, provide them with care that they should be receiving in a setting that is optimal for them. So he is the medical director of the Ottawa inner city health program, which provides full range of care to the hump homeless population, including safe injection sites, um, manage alcohol program.

Kwadwo: 03:01 And even palliative care and I got to work with him about 10 years ago in that environment. And it was truly, I don’t even know what to what the word is. It was just eyeopening. It was humbling. It was, it was fantastic. The work that they’re providing and it was a real, a true honor to have him on the show. And this guy, let me tell you, he’s a baller. Okay. Like when I tell, let me list off some of his accolades. Order of Canada, order of Ontario queen Elizabeth, the second diamond Jubilee medal. I don’t know exactly what that means, but that sounds proper. He’s been the president of the CPSO, which is a college of physicians and surgeons of Ontario, president of the Canadian medical association, president of the medical council of Canada. And honestly, the other thing that’s amazing about Jeff is he’s truly a nice guy and he’s held all these leadership positions. And I’ve always thought to be, you know, up there, you need to be, you know, you need to be a hard ass. You gotta be that militant leadership approach. And he is the opposite. He’s been a true inspiration in terms of leadership styles and I it, he’s amazing. So without further ado, Jeffrey Turnbull,

Kwadwo: 04:24 Jeffrey Turnbull, I got to tell you, it’s a privilege man. A privilege is all mine. Oh, thanks for doing this. This is amazing. We are in, where are we actually?

Jeff : 04:35 So this is our office facility. So we’re in the basement of that. Right beside you. Over there is a nursing station where we draw up injectable hydromorphone for the opioid substitution program. And above all, the next two floors are administrative and where our nurses work and set a, when they’re not out in the shelters.

Kwadwo: 04:58 Wow. I mean we’re going to get into this, but I know say right out of the gate, this stuff that you’re doing is stuff that angels do. And I, it really is an honor to be here and it’s, uh, it’s been an honor to work with you in the past. Um, I want to ask you the day in the life of Jeffrey Turnbull in 2019 cause you, I mean if you look at your resume, it’s pretty ridiculous. Uh, what is like not like for you?

Jeff : 05:28 So a very, very different, so it’s not involved in the hospital and it’s not involved in Toronto. So I’m not flying back and forth commuting. Um, I’m here and I’ve devoted my, my week now to the homeless. Um, today began with picking up eggs and at the farm and, uh, doing some farm work and then bringing Charlie to my youngest son to school. And then from there I

Jeff : 05:58 came down for our meeting, which is, I was actually in this boardroom where we go through the list of clients that we have at any one time. It’s about 280 to 300. And they’re in all of the facilities around us and we discuss each case and we have the care providers, but we also have housing people and social workers and addiction specialists, uh, that join us and mental health specialists. Wow. And we all go through each one of those cases about how we’re handling them and what are the challenges that we’re facing.

Kwadwo: 06:33 And I, I can’t imagine that these challenges aren’t, uh, many. So maybe give us a sense of if you had this magic wand to, to, to fix some of the issues that you see, like some, what are some of the major concerns that you come across dealing with the homeless population?

Jeff : 06:54 Well, the, the homeless, like many other vulnerable or disadvantaged populations, um, because of their circumstances, the poverty that they live in, the mental health or addictions, lack of education, concept of health, all of those things bring them to this environment, but it’s this environment that prevents them from getting meaningful, reasonable care and moving away from homelessness. So, um, if I had a magic wand, as you said, what would I do? Uh, um, the, I think we really have to address all of those factors that bring people into a world of homelessness, addictions, mental health, and those are the upstream factors. So those are the things like, um, early childhood development, poverty reduction strategies, education, employment, um, uh, intact family structures, um, not having residential school systems, et cetera, et cetera. However, the, my life now is drinking from a fire hose and I just can look at only the complications of that. And so the 300 people that I’m looking after today, um, what’s the best thing for them? It’s improved public health policies. It’s, um, better addictions management. It’s better mental health treatment. Um, and it’s bringing care that is traditionally hospital focused or primary care, uh, in a residential setting into their world on their terms, which is very, very different than what you and I’ve ever experienced before.

Kwadwo: 08:39 Can you, can you, can you paint that picture? Like what, what is it like to be taken care of such patients?

Jeff : 08:49 Well, um, can I tell you about a patient from this morning discussion? So he is, um, a guy who came to us yesterdays overdosed three times and the last two weeks, um, had to be resuscitated on two of those three times. The third time just woke up somewhere. Um, and his, when you talk to him, you know, you begin by saying, you know, how much, what’s your addiction like? Well, he’s taking, um, um, not only does he take a Dick, he’s addicted to benzodiazepines. He’s also addicted to, um, Nissan, a gram of Kadian every day, his thousand milligrams. He takes, uh, about two grams of what we call purple, which is, um, fentanyl mostly or all other stuff. So two grams. If you think about that, that’s fentanyl’s a hundred times more potent than morphine. So you can do the math. This is massive doses. And he has this history of mental health.

Jeff : 09:57 Uh, he’s been institutionalized. He was, um, a product to the child welfare system. He was orphaned at a very young age. He’s had a history of abuse and trauma. He has behavior management problems, um, violence and aggression has been in jail. And um, he’s 38 and probably will not see 40, um, probably won’t see three, four more months. And so the challenge for him is how do you actually, you know, turn the clock back for him? How do you start to treat his mental health? Well, he doesn’t have a place to stay. He squats, um, and winter’s coming. How do you treat his addiction? It’s massive. You couldn’t give him enough opioids to control that. And his impulses are such that whenever he has something, he takes it. And so he’s at very high risk of overdose death. And so we were trying to think about could we put him in a housed environment, start treating as mental health, then make inroads on his addiction. Um, and all of these things are, you know, a constellation of impediments for him that will likely lead to his desk.

Kwadwo: 11:16 That’s, that’s it. That’s incredible. Like the thing that breaks my heart is, you know, we, the general public, you know, we, we see people in these circumstances, they’re on the street, they’re asking for money and we’re like, Aw man, get a job. Get that gate, get yourself cleaned up. You know what I’m saying? And just as you alluded to at the beginning, it’s like, think about the factors that got them there. You know, it’s like we say like, you know, getting like, get control of your life and do these things. But you got a question when you go through such trauma as you just described, this gentleman going through, is it like how much of his fate is in his hands? You know, like,

Jeff : 12:08 yeah, so, so very little at this point. If there was inroads earlier on when he was six, when he was not abused in foster care or when he was, um, uh, early on developing signs of, um, disordered mental state and, uh, struggling with his trauma. Um, if we had to intervene then in a more supportive environment, wrap services around it, it might’ve been different. But now I have a 38 year old and I have a 38 year old that’s on massive doses of opioids who’s overdosing, who can’t control behaviors, is unemployed and lives in a world of poverty and doesn’t have a place to stay tonight. I can’t even find this guy, you know, like, it’s not as if he’s got a, an address. He can’t get the usual entitlements. He doesn’t have a health card, you know, all of that. So there’s so many other built in obstacles for him to get care that it makes it almost impossible for him to get care. And yeah. You know, what happened to those people that, you know, we, we see, we attend many memorials obviously because of so many people dying. Um, in this context. And almost always there is a young seven year old in a cowboy outfit, a pitcher, you know, that their parents have brought and something happened between that seven year old in keloid pads and a couple of hat to that person who is 25 who just overdosed and died on King Edward and Marie,

Kwadwo: 13:45 you know, and this is something that I try and remind our healthcare team is, you know, that patient that we’re seeing that got themselves in this situation, I’m doing this and they’re doing air quotes. That’s somebody’s son. That’s somebody’s brother. Yeah. And you know, I almost wondered if Jeff didn’t like the work you guys are doing is, is, is truly amazing. I wonder how much, like are there stories that you’ve come across or have seen where this has made a difference? Are they too far gone because of all the stuff that has happened? You know,

Jeff : 14:26 so no, there are, they are never too far gone. You can, you can always have an impact on their lives. So are there circumstances where we’ve taken, we’ve seen somebody who’s on the streets, um, and return them to lives that you and I would think are normal employment, paying taxes, you know, um, they’re not many stories like that, but there are, and so in fact that’s, you know, keeps us going a lot. But on the other hand, those people who you see on King handwritten Murray that are in veteran alcoholics are injection drug users. Um, you know, who’ve been doing this for many years, you can improve the quality of their life very dramatically just by simple support, housing care, treat their HIV, treat their Hep C, um, treat their underlying mental health issues, support them, build trust, and do it in a, uh, in a, an environment that allows them to have control of their health outcomes. You know, the, that you may say, well that’s palliative care, but that is in fact we’re taking people and making their lives better, even though they have an underlying problem that probably they will never recover from.

Kwadwo: 15:49 Yeah. And the one thing, I mean, I got a chance to work with you over a decade ago and one thing that really stuck to me was how appreciative they are of the care. And I that it’s always stuck with me when I, when I, you know, when you’re, and when we were working, it was in the palliative setting, but when you’re there to, uh, support their medications or that they hear, hear their story, it’s, there was always a thank you. There was a genuine look in the eye and saying how appreciative they were.

Jeff : 16:29 And they are, they’re enormously appreciative. And when you bring care to them on their terms, suddenly there’s a new trust that’s built. Um, you don’t see them in a hospital environment. This is foreign for them. Where authority has always been a challenge for them. You say, Oh, you got a quote, can’t go out for a smoke. Um, you know, and, and that, that bad series of behaviors that we see in a hospital environment are so predictable, but they disappear when you deliver care here. And they are charming, nice collegial people. I mean, they have their moments. There’s no question about it. And they make terrible decisions sometimes, but frankly, nobody ever taught them how to make good decisions. And that’s the world that they live in. And uh, um, it’s not for me to judge what’s right or for wrong. Um, my job is to pry and try and improve the quality of their life as best I can.

Kwadwo: 17:31 And I, the one thing I think that must be amazing for them too, and I don’t want to put words in their mouth, but that non judgemental environment in here, like they are treated like human beings, like the way they should be treated, which unfortunately I don’t think it’s all, there’s always the case everywhere. They’re everywhere they go, you know?

Jeff : 17:55 No, and they’re not. And you know, it’s probably the first time in their lives to be honest with you there, where somebody sat down said, Nope, what do you want? Not me. What do you want with your addiction, your mental health, you know, and you know, they’re your future. And sometimes it’s just simple stuff. I want to connect with my family. Once again, I wanted to have a, a room that I can call my own. I want to continue to inject, but I wanted to be safe. Um, I don’t want to die, you know, uh, these are, you know, things that we can achieve.

Kwadwo: 18:35 That’s crazy. I, I mean, it’s one thing I’ve been appreciating doing this, the show a bit. Like I just finished a show with a child psychologist and we did, we talked a lot about child like me increasing anxiety and depression we’re seeing in kids. And what really stuck with me was early intervention. How much of an impact if we were to invest more early on in, in prevention, in sewing to her world, if we could have more resources to be able to either treat the kids or to have set up them in an environment for them to thrive. You know what I’m saying? And once again, this is the theme here too. You know, kids that are getting abused, kids that are in foster homes, it’s, you know, it’s, it’s just so sad to hear that this is something that we could be doing better.

Jeff : 19:34 Yeah. And you have to ask yourself, why don’t we do that? Or on those things, because we know financially the return on investment is enormous. Right? So it makes good financial sense if nothing more, you know, to invest into early childhood development, poverty reduction strategies for children, those types of education, you know, community building, stuff like that. Enormous return on investment. So it’s not a financial issue. It’s not, it’s the right thing to do for communities.

Kwadwo: 20:06 Absolutely. But I mean this is a bit in your world, like you’ve been in some big wicked men positions. Like I know you’re not like political, but what, what do you think it is? Like why, why aren’t we going there? Like it’s our kids, you know what I’m saying?

Jeff : 20:22 This is our future. These are our children. And so I, on the one hand, you know, there’s an argument to do this for because as good for communities is the right thing to do financially, it’s the right thing to do from a human rights perspective. Children, like any other citizen of this province deserves safety, education, housing, nutrition, you know, that’s what we would expect of our for our children, all those entitlements. So why doesn’t that happen? Um, as there, I think that we are paralyzed in that sense of, um, we can’t move ahead. Um, because of the way our govern is structured and the, um, the lack of vision that some of our leaders have about doing what’s the right thing. I sometimes in my darker moments, wonder about is there a sense of I don’t want to help them because, you know, why do I want to be, have so much equity within our community when I’m a, an influential leader who’s on the upper side of things? Um, but I do believe by and large, Canadians want to live in a more equitable society and they don’t want to see people begging, um, on their streets or children dying of,

Kwadwo: 21:44 I don’t know what the answer is too, but I just, I pray and I hope that it’s not because they feel like their, their feed is already written on the wall, whatever the expression is. I hope that’s not the, the, the, the concern cause it’s clear from research, from, from experts that this is not the, this doesn’t have to be, their faith

Jeff : 22:09 does not have to be their fate. However, I can tell you there is certainty that if you do not deal with this, their fate will be addiction, mental health in and out of the hospital, in and out of prisons, uh, on a regular basis. And the cost of that is something that we just cannot afford.

Kwadwo: 22:30 Yeah. And it’s true. Like we talked a little bit about this yesterday in preparation. It’s like even the fact that we put a lot of these, uh, I w I don’t want to call them patients with these poor people in an environment where they’re not gonna thrive. Like in prison, we’ve talked about this. You go to prison at a vulnerable age. In, you’re in an environment where there are drugs that are violence. The, the idea of reforming their on papers, ridiculous.

Jeff : 23:03 We know that it’s not very effective. But think of what we do in society. What we do is we take our most vulnerable populations, those populations that are in the greatest need. Um, in my circumstance it says the homeless, but it may not necessarily be the homeless, maybe our indigenous colleagues, whatever. But we, we as a society, we tend to isolate those individuals. We tend to put them into circumstances, out of sight, out of mind. For me, it’s lower town. It might be the lower East side of Vancouver. It may be, you know, region park in Toronto or other places. Um, we put those people in. Those are particularly vulnerable. Um, there’s high risk around them of drugs and violence, et cetera. So we take vulnerable people, put them in circumstances of higher risk. We deprive them of access to reasonable entitlements to help them get out of that circumstance. And then we’re surprised that HIV rates, hepatitis C rates, mental health rates, addiction rates, trauma, suicide, all of that exceeds that of the developing world. And we’re thinking that’s odd. Well, our public health colleagues would say that’s exactly what you would anticipate.

Kwadwo: 24:21 Absolutely. You know, I think, um, I want to ask you a bit about the opiate crisis, but just to that point too about, you know, um, the added resources and strain to a system related. Mostly I think to the opioid crisis. I work at more for hospitals, so close to venue and the amount of overdoses, complications from injections, uh, whether that’s endocarditis or infection of the valve or bloodstream infections, cellulitis or infection of the skin has been like, I don’t want the numbers in front of me, but they’re crazy. Like if I even look in the last eight years. And so I wanted to get a sense from you. Are you feeling this? Like what are your, like today you were saying, you know, you’re, you were going over about 300, just under 300 cases. If you were to compare this say to six years ago or whatnot, is there, has it been a dramatic change?

Jeff : 25:21 So our whole world changed in 2016, you know, when the opioid crisis hit, I used to say, you know, we were dealing with alcohol and non beverage alcohol, you know, from mouthwash and stuff like that. So this is pretty tough, you know, and then crack cocaine happened to us and I said, Oh, can never get worse than this. And then we had, you know, I would have a couple of people who are heroin addicts in a month, um, and maybe three overdoses, um, in a month, maybe longer. Well, uh, however, in 2016 in August we had a, we knew it was coming and we had 35 overdoses in August. Wow. We had 70 overdoses in September and we leveled off at five overdoses a day. And so what you’re seeing in the emergency department, uh, the ma for the ICU, we don’t send our people anymore by ambulance when they overdose.

Jeff : 26:33 Wow. We deal with them the last time. Often the ambulance is bring them to us for resuscitation, not to the hospital. So we have a modus, we have, you know, we, I can’t think of the last time we asked an ambulance to come and pick up an overdose. Our staff are skilled at looking after it. Um, and we, um, we deal with all of that. We have a program called targeted engagement and diversion where we divert ambulances to us away from hospitals for addiction. You’re drunk and disorderly. You’ve got other problems. The ambulances would pick that up, the person up normally and go to the hospital. But you know what would happen, we both know what would happen in the hospital. You would wait for offload. The person would slowly recover. Uh, they would probably never be seen. They would leave AMA and do it again and do it again. Um, sometimes hundreds of times in a, you know, six months, uh, that would happen. And so we divert those people to us now. And so we, at any one time in the evening, you’ll see about three ambulances in a squad car outside of our unit. And those are people dropping off, not picking up. We divert 3,400 emergency visits to us every year away from the emergency department.

Kwadwo: 28:02 That is absolutely insane. Like, think about this, huh?

Jeff : 28:07 The hook and you go there. That is crazy. 11 or one in the morning. It is off the hook. Like we have 45 beds and they are all full every night.

Kwadwo: 28:18 So let me just summarize this and make sure I got this right. So as of three years ago plus the uh, because of the opioid epidemic, the volume of cases that you were seeing puts you in a situation where you are now having to or encouraging ambulance ambulances to, to see, to come to, to hear it for you guys to manage these patients and diverting. That meant you said 3,400

Jeff : 28:50 yeah. Ambulance visits per a year.

Kwadwo: 28:52 And, and y’all, you, you guys like your, what your wait times in the merchant long. Now imagine if these guys were coming in. That’s a lot. That’s like what is that 3,400 divided three so like 10 a day, almost 10 a day.

Jeff : 29:05 Oh, at least, remember we have 45 beds and so those are just ambulances. Then there’s the walking wounded who come in and the police, um, OSSI transport. Now it’s not all book. The opioid crisis is people who are dictated to alcohol, mental health crisis, et cetera. But it’s been made worse by the opioid crisis. And so I think the, our world has changed dramatically with the opioid crisis. We have seen, you know, deaths and you know, complications you’ve described of heart infections, of skin infections and bone infections. And we deal with that every day. Uh, we probably have at any one time three people on intravenous six weeks of intravenous therapy for complicated infections as a result of injection drug use. Um, so the, the opioid, it’s just turned a whole world upside down.

Kwadwo: 30:06 Yeah. I got to tell you to like, just to put a bit of context in this too, like we would see like you obviously got appreciation of the numbers, but in ICU, you know, we would see maybe one or two patients we would lose or would pass away, like opioid related or overdose related. You know, from knowing IB drug use or from complications thereof. And I can think of at least two cases in the last two months where people under the age of 41 was in the late, late twenties, early thirties. Once again, a mum, a parent, a brother, a sister, a loved one that is now deceased. It’s, it’s crazy and it’s, and it’s so sad and I, I just, I just can’t believe the work yet. You guys do and I mean I might be ignorant cause I didn’t know about these numbers and I F I don’t know if this is well known throughout, you know, the city, but if not you, this needs to be praised because this is amazing work y’all are doing.

Jeff : 31:18 I always like to think of it as a, the problem is one that profoundly affects our community, where we come from and the solutions will come from our community and yes, we’ll draw upon them. Our four hospital, the Ottawa hospital for support. Um, but by and large, they want their care as much as it can be done for them. [inaudible] to their intravenous therapy, whatever, to be provided to them on their terms, in their location. They don’t do well in hospitals or in other institutional settings. They, so if we can do our best to provide that care, it’s cheaper, it’s better for them. We get better outcomes and our community is the better for it.

Kwadwo: 32:10 [inaudible] what I love about this is like you guys took it in your own hands, you took it in your own hands. This is a problem. You want the solution. And I think this is a model for a lot of people too, by the way, because we’re in a town where a lot of people bitch and complain about and there’s no action. You know what I’m saying? It’s a lot of dah, dah, dah, dah, dah, dah, dah. And the thing that I, I will always be proud to associate with y’all. It is the fact that you saw the problem. You come up with a solution that works with the patient, with the, with, with the people, not something that you think is best. Not the model that you read them some textbook that says that or this model, this is the way we should approach this problem without booking the P the patient or the people in the eye and saying, what will work for you? You know what I’m saying?

Jeff : 33:03 Yeah. Then, but to do that, you know, our healthcare system and you know, to be given as credit is very good for the majority of people who use it services. You know, these are people like you and I. um, and I’m very proud of that. Very proud of our tertiary hospitals and our primary care. But for visit these people, the vulnerable, the disenfranchised, they just, it has to be on their terms and it won’t be successful if we just say, you know, look, here’s what’s offered to you. Take it or leave it cause it’ll be leave it. And we know the consequences of that. So if you actually sit in and listen to them and say, what would be the care that you need, how would that be delivered? On the one hand that is liberating because now you can start to think of ways that really are successful. You engage them, they start to trust you. Um, but on the other hand, it’s very intimidating and very challenging. So what is appropriate for them? Um, you know, is it right for me to be doing chest taps, um, and giving Ivy therapy to somebody in a shelter environment? You know, and,

Kwadwo: 34:23 but you know, it’s a shared decision. It’s a shared decision. That’s what’s beautiful about it. Like, yeah, there’s risk maybe of, you know, it’s not the ideal environment, but you’re two grown ass people saying like, these are what, this is the situation, these are the risks, this is how, you know, this is what our options are. Is this okay?

Jeff : 34:47 Yeah. And they invariably will accept the option of saying, I want you to provide the care that you think is the best for me on my terms. And you know, and you know, frankly, that’s patient centered care. That’s what, um, that’s probably what we should be doing. And that’s why we got trained as physicians to serve that community serve and to serve all, yeah. Not just the people. We kind of like who look like us, but more so to serve people who you know, just are so, you know, they’re, they struggle so much.

Kwadwo: 35:26 You know, I, I want to get into a bit of some of these stories as well cause like you’re talking to me yesterday about a lot about their, a lot of these, these uh, the patients you see because on the surface, you know, when you see some of these patients in hospital, because it’s not an environment where they thrive, there’s a lot of attitude, there’s a lot of conflict. And so I think a lot of people get there. Whatever the expression is, guns up or backs up, the humanization is in the waste there. You know what I’m saying? And so can you think like what are some of the mindset that you find when once you make that connection, once you have that rapport, like where their head’s at?

Jeff : 36:13 So I can only give you examples. And so just recently I was chatting with a young lady who would be in her twenties, early twenties, and, um, there was a lot of behavioral challenges that we had encountered with her. And, um, and we, she was a very profound opioid addict, defendable addict. And those behaviors were related to her addiction, either out there searching for the money to feed $150 a day habit, um, or the consequences of injecting and, um, being a fentanyl addict recovering from your injection. Um, and she just, I S chatting with her about, so opioid substitution and how we get better manage this and you know, this person who is at first standoffish and kind of hostile a little bit then just suddenly disintegrated. She was in her young 20s, early twenties, and she said, you know, I never thought this would be what my life was like.

Jeff : 37:25 I squat in housing, you know, out in a parking lot. Um, I’m assaulted on a regular daily basis. Um, I have no belongings. I don’t connect with my family anymore. Um, four years ago I was in school and now I’m a street prostitute. Addicted to fentanyl, this is my life, you know, and you know, it’s hard for me to sort of think about how terrible that would be. You know, I couldn’t conceive of that for any of my children. And it’s very hard to walk away from that and saying, you know, that’s your problem. You made that decision. You know, her mental health, uh, she three or four years ago started to hear voices. That’s what our mental health deteriorated and that’s where it’s led her. Um, so I think we have an obligation not to walk away from that person.

Kwadwo: 38:24 I’m really glad to hear this story because once again, you know, a lot of the people listening to this is our healthcare providers and you know, I’ve said it a couple times now, but they are human beings. Yeah. This poor girl did not want to be sleeping with people to make money so that she could pay for her addiction. Right. And, and like, and Jeff like maybe even illustrate like once you’re addicted, what satellite? Like, you know, like we, we judge and say, Oh, they’re just seeking more drugs or whatever. What’s it like not to get that fentanyl.

Jeff : 39:05 So they will say, um, that they can’t conceive of anything worse in their life, um, than to go without, um, one person just recently said, you know, if you gave me the choice of being hit by a car today and dying as a result of a motor vehicle accident or coming into hospital and withdrawing from fentanyl, I would choose any second the motor vehicle accident and death. Rather than that. That’s how powerful and how terrifying withdrawal is for these people. You know, and you know, you’d say, Oh, well why do they inject? Well, they inject because of this terror of withdrawing. They inject because of the high. And when you talk to them about, you know, well, you just can’t keep getting high all the time. Um, they look at you and they say, you know, you think I’m doing this to get high. I do this to get numb.

Jeff : 40:11 I just want one hour out of 24 when I don’t have to be me. A person who is living on the streets, who has no family, poor, um, mental health, committing crime, things that, you know, they thought as they grew up, they would never ever do that would be somebody else. And now that’s who they are. And for 23 hours a day, they have to be that person. But for one hour they get to be known and they have so much history of trauma, uh, throughout their life, um, that they’re just trying to forget that for a very short period of time. So it’s really not up to me to judge when they inject or not inject or it’s only really up to me to better understand the circumstances.

Kwadwo: 41:06 Yeah. Even as a health professional, like I don’t know if I fully appreciate how difficult withdrawing can be on, on our patients and like, cause I mean, like most of most things that we see, we’ve all had a family member of broken leg go through, have a deliver baby bursa or appendix or whatever. You know, not everyone’s had a family member withdrawing fentanyl,

Kwadwo: 41:33 salt or hopefully not a clinician doing the same thing. But, uh, it’s less, um, what’s the word? Relatable maybe. And so like to hear stories like that I think can go a very long way. I got to ask you, because the work that you guys are doing once again to incredible is this unique to Ottawa, is this, uh, other places doing similar, similar activity.

Jeff : 42:04 So the like we provide sort of comprehensive health promotion, primary care, secondary care, some tertiary care, uh, even end of life care, um, for the homeless community. So, and we have shamelessly borrowed and stole from some of our colleagues when they have good ideas throughout the country and internationally. However, now we’ve sort of moved beyond that and some of the work that we’re doing is almost every week we have somebody from another city, United States, Europe, um, um, Australasia just recently. So it is unique in terms of the overarching comprehensiveness of what we do, uh, that no other city does that. Um, however, um, some aspects of it have been reproduced in other jurisdictions for our managed alcohol program, um, is a program that has now been reproduced in all of the Netherlands. Wow. Um, yeah, we went to the Netherlands and looked at how they deal with opioid addiction, you know, so, um, it’s a, it’s a process of sharing internationally.

Kwadwo: 43:17 Yeah. Cause you know, one of the themes of our show is just promoting anything that’s innovative that provides better care, that allows healthcare to be more sustainable. And just hearing this and, and, and hearing the work that you do, hearing the 45 beds and diverting all this, these cases from emerge, like it really, it really needs to be championed that I, I mean, I know every city’s different and, and just like we talked about what each kind of clinical scenario you want to tailor it to the, to the city. But the bare bones of it I think is incredible.

Jeff : 44:00 The principle is one that I think people who are interested in health policy should really adhere to. The principle is moving care to where it’s best applied based on the needs of that unique community and whether you’re indigenous or frail, elderly or homeless. Um, the, the principle is the same. You know, your day is filled with looking after people who probably at the Ottawa hospital could be cared for just as well in another cheaper setting, 100% and so shouldn’t we try and embrace that principle wherever we are now, I happen to have practiced that in a homeless setting and frankly, if you can do it in the shelters over here, and if you can give [inaudible] and oxygen and treat HIV and Hep C and seizures as well as addictions and mental health, and you can do that in a, an an environment of a shelter, you can probably do that anywhere. Wow.

Kwadwo: 45:06 That’s a, that’s a frigging powerful statement right there, man. Um, so many lessons there. What would you need to thrive even more than your thriving now?

Jeff : 45:20 So when we started this process, we started with what I’ll call the front end. That’s the stabilization initial treatment, et cetera. Um, so somebody’s out of control because of their addiction, their mental health, living in a world of chaos. Um, it was, our hope is to be able to stabilize that person and get them frontline care for their HIV, their Hep C, their addiction and their mental health. And we did that and we continue to do that on a regular basis. But we never thought much about, you know, because we just weren’t thinking, um, about the back end. Like after that they’d turned to us and said, so what? Now you’ve got me stable, now I want a garden and reconnecting with my kids and I want to, you know, cook for myself. And you know, that led us then to say, okay, well we now have to have a lot of what I’ll call backend services.

Jeff : 46:24 So we’ve got residential housing programs, we have four sites or hotels now that we’ve taken over with individuals. But as we continue to stabilize people and move people out of this environment, which is toxic to them and dangerous and inappropriate for anybody, and we just need 40 hotels, not for, you know, we need to have supportive, subsidized housing where we can take these people and say, here’s a place for yourself. Go and thrive. But we’re onsite, we will continue to help you with your mental health. We will continue to look after addiction. We will continue to look after your HIV and Hep C and endocarditis, whatever it might be.

Kwadwo: 47:13 Wow. They have that support there. You know, the thing I think is so beautiful, and I think I might’ve said this already, but it’s the nonjudgmental approach to treating these patients like the, you know, I still remember the days where somebody comes in with alcohol withdrawal. Okay. And you know, they’re usually at rounds and they’re, someone’s talking about giving them more sedatives to try and keep them more calm and all that stuff. And I’ll be, I’ll be like, just give them some alcohol, give them a Labatt blue on ice. Okay. Uh, and this will fix everything. The withdraw stops. We don’t have to give them an increasing level of sedation. So let me just walk you through what normally happens in real life. So if someone comes in with alcohol withdrawal, you treat them with normally a benzodiazepine, more like, uh, uh, Adavan for example, to try and manage their symptoms. Sometimes you need more. Sometimes their level of consciousness goes down. Sometimes they can’t maintain their airway, so now they need to be intubated sometimes that they, uh, they might develop a pneumonia because of the deck, decreased level of consciousness. They’re in ICU for four days. They cost the system probably about $15,000 at that point of ICU costs. And this solution could have been, they get their beer, they get their Brandy, get their alcoholic choice, and they’ll be home in a day.

Jeff : 48:45 And often the solution was they came to you because of a pneumonia, which now because of the sedation that you give them is much worse. And they’re going to stay for a longer period of time with complications. And now they’ve got a seizure as well because of the alcohol withdrawal. In fact, if you just gave the person antibiotics out in the community, they would never have come to you in the first place. I’m willing to have gotten better care. Exactly. And that’s what you and I would have expected for a simple pneumonia. But for some reason we’re going to put those people at huge, risked their lives, withdraw them, and you know, they’re going to, it’s enormously expensive to them, their own personal health and to us as a system

Kwadwo: 49:32 cause of it. It all comes down from judgment, from not having that patient centered focus. Get put your ego away. See, look at Charlie or what, or Chuck and say, what do you need now to get yourself out of this? Yeah.

Jeff : 49:50 Wow, man. And you know, when you sit down with Charlie or a Chuck, if I know this guy’s an architect or this guy was the guy who designed the Welland canal, or this guy is an artist,

Kwadwo: 50:03 I got to tell you, that was the most mind-boggling thing, Eila. Call me an ignorant a screwball. But that month, that week I spent with you, that was the most touching humbling thing is that you would talk to the 65 year old guy that’s dying, you know, and, and, and dying comfortably, thankfully because of the care that, uh, y’all were providing. But he lived a life. He had, he accomplished some things and he was, uh, uh, you know, a chartered accountant or, or work for the government and how to divorce, got to the bottle and, and that God, the better side of them got homeless, lost his money and had complications there of after, uh, related to that. And you just realize like, yes, these are, I keep saying it, they’re human beings

Jeff : 51:02 and they, you know, frankly could be any one of us maybe of us a step away from those series of events, you know, that brought that person to that seat could be any of us or our families.

Kwadwo: 51:15 Absolutely. So just in summary, Jeff, where, how, how can we fix some of these, these major issues that could practically,

Jeff : 51:27 so I think there is something that everyone can do in this. It’s not for healthcare providers or housing people or social workers. This is for our whole community and there’s something that we can all do to contribute. Yes. If you want to fix it, um, work on some of those upstream social determinants. Um, but they’re gonna take time. We’ve still got so many people who need care. Um, but communities can embrace these individuals. We can start to think of better ways of moving care out of the hospital environments, into the communities where we can do it much more effectively. We can listen to this community much more. Yes, we can invest in subsidized housing and we can do better with more addiction counseling and mental health services. All of those things are things we can certainly do. But at the same time, I would argue that we should be starting to seriously think about policy decisions.

Jeff : 52:34 Um, you know, how do we think it’s right to fill our prisons with people with mental health and addictions? It shouldn’t we be trying to deal with that as a, um, uh, an illness rather than, uh, some social aberration. Um, so couldn’t we be thinking of more informed, um, drug policy, more informed, uh, social policy as we look to support these populations? Certainly our indigenous communities, certainly, uh, others who find themselves so disadvantaged, you know, shouldn’t we be reaching out with, you know, or advocating for, you know, evidence informed policy decisions rather than, uh, what seems to be, you know, palatable to a population such as warm, you know, there’s a war on drugs, which does not work.

Kwadwo: 53:33 I always liked to, you know, when we get to the end here, a story where you were proud of what you do. You, you got the sense that, you know, this is why I’m here.

Jeff : 53:46 You know. Um, I’ve always thought we spend the first half of our life trying to live up to the expectations of our parents and the second half of our lives living up to the expectation of our children. And I think that time that I feel the proudest of what I’m doing is when, um, my kids see what I’m doing and they just say, you know, what you’re doing is a good thing and I just want you to keep doing it. And I think that makes all the, you know, the late nights, the on call, uh, you know, you know, times when I don’t sleep, that makes it worthwhile. And so I think that that’s probably the times when they’re with them and they say with the homeless and they just say, you know, your dad’s doing a good thing. Wow. That’s what probably makes me the most proud.

Kwadwo: 54:44 I mean, I, I, I always, I got to tell you, the life has changed since bringing in some offspring in the world. But I where you’re, where you’re seeing reigns. True. Like I always say all myself, like in general, in life in general, how would the kids react when they’re, if they saw dad in this situation, how would, how would dad want to react if dad was, what,

Jeff : 55:07 how would you like to be viewed by your children? What would they say about you when you know, you’re 70, 80 or gone, but would they say, you know, yeah, you made it a whole bunch of money, you know, or he did the right thing.

Kwadwo: 55:26 Okay. And you know what, and that’s what it comes down to. And this is another theme of this show is like, let’s all try and do the right thing. Let’s all be able to look at ourselves in the mirror at the end of the day and say, I did something good here. Yeah, I did something that my kids will be proud of. And, um, I just, I do feel like sometimes we need to say that more, you know?

Jeff : 55:53 Yeah. We have to think that our job, why we were here while we were put on this earth, while we were educated, why we were, you know, society put money into us was to serve. That’s why we’re here. And to serve a community no matter who they are, but those people in need and independent of their income and what they look like. So that’s our job.

Kwadwo: 56:20 And, and to be honest with you, like not to get too philosophical on, on

Kwadwo: 56:24 your cats, but like in this era where we’re a little bit where we’re seeing more depression and mood disorders and everything, you want to be happier, surf. Yeah. You know, help others and I promise you, you will, you’ll be more content. You’ll find more fulfillment and um, you know, it’s easier. I know for a lot of people it’s easier said than done, but you know, I, I do truly believe you’re moving towards that direction leads to a more fulfilled life.

Jeff : 56:58 How’d you too, I honestly agree that this concept of bringing meaning into your life, we do it many different ways. We can, you know, through children, through relationships. Um, but some of us have this great opportunity to bring meaning to our work and we’re blessed and we shouldn’t squander that.

Kwadwo: 57:22 Amen brother. I, I can’t, I mean this was truly special for me, man. Like I, I’ve looked up to you for awhile. I, we didn’t totally get into all the work that Jeff does cause we would be here for three hours and 47 minutes, but you know, how, how many hours do you sleep in a day? I’m not a big sleep. Last time I asked you that you said about four hours and uh, and uh, the amount of work you do, the amount of meaningful work you do, the impact you’re having on so many lives. I am proud to know you already been a great fan of yours too. Thank you. Appreciate it. Thanks so much.

Kwadwo: 58:08 How amazing was that? Oh my God, I love Jeff. Um, so in terms of lessons from this episode, from an administrative level, we really need programs to support programs like Jeff’s where we provide care in a setting where the homeless and the vulnerable patient population can thrive. Uh, I think it’s, I think it’s scalable. I think it’s too important and um, we need to, we need more of that from a clinician point of view. Remember, these are human beings. Whatever we could do to support them in an environment that is optimal for them, I think we got to do our best to do that. So let’s work with our homeless population. Let’s work with, our drug addicts and, and, and provide them with care that will allow them to thrive. And then from a general population point of view, honestly, if you have time, volunteer your time, connect with these guys, provide some support. It truly is amazing. You will, you will get as much out of it as you are providing for them a promise you that. Okay. That’s it for episode. So if you want to connect with us, we’re on Twitter @kwadcast, we’re on Facebook at kwadcast. If you have any comments at kwadcast99@gmail.com and thanks again everybody for tuning in and we’ll see you in a week or two.

Over Parenting: Pushing our Kids into Mental Illness, with Dr. Adrienne Matheson. Part 2

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