MSPEI supports recommendation based on evidence in the best interests of Islanders
Guest Opinion by David Bannon
Another question about health care in P.E.I. has been taken to the court of public opinion. This paper’s editorial board added to the discussion in a recent piece about vascular surgery on the Island. This was followed by two editorials which appeared like the prosecution and defense arguing their cases. How can the public judge which approach is in their best interest?
As MSPEI president, a surgeon and taxpayer, I want our system to continually ask the broader question of what services are appropriate to provide to a small population and what needs to be referred to off Island centers.
The Medical Society advocates for our physician members and their patients to ensure access to high quality health care. To deliver that care government has to sustain a system with the greatest value for patients with declining dollars. This means that as we decide to invest in a service we will have to reduce another to pay for it.
Your physician and health care leaders constantly wrestle with these issues as we engage in efforts to shape a sustainable and quality health system for Islanders.
Since we have a small population of approximately 140,000, cost is not the only important issue. Health system thinkers have to recognize that there is a critical relationship between volume and the ability to provide a quality outcome. Decades of research about the relationship between volume and outcome have produced results that are scientifically credible and compelling:
For complex procedures, hospitals that do higher volumes produce on average better outcomes for patients than those that do low volume. This extends beyond surgical procedures. Hospitals that treat a low number of certain procedures related to medical and emergency conditions compared to higher volume centers have on average longer lengths of stay, more complications and poorer outcomes. Emergency departments that see low volumes of critical conditions cannot replicate the quality of care you would receive at higher volume emergency departments. As residents of a province with a small population, we need to understand that in many medical services, bigger is indeed better.
Therefore, we must accurately and objectively measure what the volume is given our population and whether this volume is sufficient to support the service based on evidenced based professional standards. The statements in recent commentaries make it appear that there is significant difference of opinion on this subject with respect to vascular services.
The government, through Health P.E.I. has invested heavily to build a structure to ensure we make the best possible decisions based on the best possible evidence.
The Physician Resource Planning Committee and the Provincial Medical Advisory Committee, constituted largely by physicians, have made a recommendation that is based on evidence collected and tested which they believe to be in the best interests of Islanders. We should respect it.
MSPEI supports that evidence should inform our decisions, rather than opinion. We should work to ensure we know the difference.
I believe it is the time to start engaging the public in a constructive conversation about issues like the relationship between volume and outcome and how it impacts our system design, educating the public on evidence based care, and building our capacity to present facts not impressions.
Determining which services to support resides in finding a proper balance between needs, capacity, cost and quality. As a surgeon, I want to provide the widest range of services for the convenience of my patients. As a professional, I am committed to ensuring that I don’t compromise quality outcomes. Working together we need to find that balance.
David Bannon, MD,
President, Medical Society of P.E.I.