What’s the Plan?

Ms. Gurmeet Sohiby Gurmeet Kaur Sohi, University of Manitoba, Class of 2018

I’m sitting on an airplane, flying somewhere over Calgary and Vancouver and my heart is heavy. This isn’t a leisure trip, a hurrah for finishing exams or a typical visit back home. I’m going home to say my final goodbye to someone who meant the absolute world to me. I’m saying my final goodbye to someone who taught me so much about strength and kindness and perseverance. I’m saying my final goodbye to someone who I’ve been losing slowly for the last seven years. I’m saying my final goodbye to a body whose mind left us a while ago. I’m saying my final goodbye because it finally feels okay to do so. I’m saying my final goodbye to my grandmother.

Looking back at these last few years, I can’t help but think of the small victories and the bigger losses. She remembered my name – victory. She thinks we’re in a different time period – loss. She spoke a coherent half sentence – victory. She can’t speak at all – loss. She ate a whole cup of pudding – victory. She’s lost her ability to swallow – loss, the ultimate loss. And with these victories and losses, I think of how her journey may be over, but it continues for so many other families. How many families are going through their own victories and losses, counting the tiniest of blessings?

My personal reflection lead me to think of the system we’re in – a system that is not ready. A system with a culture of reactivity instead of proactivity. A system focused at solving problems and less so preventing them. When we approach a medical problem, our thought pattern has been conditioned. What is the presenting problem? What is the history of the problem? Is the problem urgent or can it wait? And the cornerstone – given this information, what is the plan? What investigations do we need to do to confirm exactly what the problem is? What can we do to solve the problem?

Where am I going with this?
We have a problem in Canada that needs solving.

And what is this presenting problem?

Our population is aging. Our population is getting older and with the population getting older, that means our population is getting sicker. The problem is we don’t have the resources in place to address this problem. Not from a medical standpoint, not from a societal standpoint, and not from an economic standpoint.

What is the history of the problem?

Over the last couple of decades, life expectancy has increased given our successes in medicine and technology. We no longer die in our teens of infections. We live until our 80s and 90s and we die not from a single condition but likely from a myriad of chronic health problems. There are currently 261 geriatricians in the country. The average number of geriatricians per 100,000 population sits at 0.7 – that’s not even one whole geriatrician for 100,000 people (1).

Is the problem urgent or can it wait?

Over the next 25 years, the number of people 65 years and older is projected to double (2). You decide if it’s urgent.

And our favourite question, what is the plan?

What is the plan? There is none.

The Canadian Medical Association started a DemandAPlan campaign before the 2015 federal election. Over 30,000 people signed the petition. I’d be curious to know the demographics of the people that signed the petition. How many were physicians? How many were allied health care providers? How many were seniors? How many from the general population? And what really piques my curiosity, how many were medical students? The Canadian Geriatrics Society estimates that during medical school, students receive approximately 80 hours of geriatric exposure compared to over 300 in for example pediatrics.

We are told from our first day in medical school how special we are for being here. We are told how we are the future of medicine. We are told of the extreme responsibility we will have to our patients. We are told of the expectations that society has of us. We are told about the power and privilege our career in medicine will bestow on us.

Do we not have a responsibility to use that voice?

But you’ll say, oh you’re passionate about geriatrics so of course you’d want to use your voice for that. There are so many important issues we need to be advocates for. We can’t do everything.

I am not asking for everyone to become geriatricians. I’m not asking people to write letters to their Members of Parliament requesting increased resources for the elderly (although that would be nice). Recognizing that there is a problem is a start. Changing the culture of medicine is a start. Not referring to the elderly patient with Alzheimer’s disease as the “old demented guy” is a start. Trying to discharge an elderly person to their home for better quality of life and to not just free up a bed is a start. And we can work from there. Crowding of personal care homes, the lack of effective and minimal home care, polypharmacy – these are just skimming the surface of the medical side of the problem we’re facing. We need to address these issues as part of a national, provincial, and municipal plan. But in order for there to be enough interest and enough commitment to demand that these issues be addressed, we need to form a culture where we recognize the problem. We need to form a culture where we respect and dignify the population enough to show that we’re interested in making a plan. That population will be our parents one day; that population will be us one day.

Many of us who have any interest in geriatrics do so because we had an older person in our life who inspired us to want to do better. Someone who may not have been treated as well as they should have by the system because of their age. Someone who drove us to make sure no one has to go through what they had to.

People say geriatrics isn’t ‘sexy’ enough. There’s no ‘saving of lives’ or any validation from helping the old – they’re going to die anyways. Is it not our responsibility to ensure those latter years of life are at least not void of the supports that allow for some dignity? We need to come together and ask, what is the plan?