On the third frontier of medicine

Posted on February 18, 2008 in Health Debates

TheStar.com – comment – On the third frontier of medicine
February 18, 2008
Carol Goar

A black cat named Bailey with a theatrical flair and an impressive collection of feline furniture lives in the lobby of Bridgepoint Hospital, entertaining patients and visitors.

Sterility and speed matter less at this medical institution than knowledge and normality.

There’s time for an attention-seeking house pet. There’s a place for the kind of therapy no clinician can provide.

Bridgepoint is where people come when surgeons have done as much as they can; where they turn with a tangle of debilitating chronic diseases; where they learn to adapt to physical limitations.

They won’t be cured. But they’ll get better.

Chronic care is considered the third frontier of modern medicine.

The first frontier was basic sanitation. A century ago, people died in their 50s from impure water, mass infections and raw sewage.

The second frontier was human anatomy. It is still being explored, but doctors have made enormous progress in fixing the body when things go wrong. They can usually save the life of a patient who has suffered a heart attack or stroke or detected a malignancy in its early stages.

The third frontier, which is largely unexplored, is chronic care. It involves treating diseases that can’t be cured – diabetes, hypertension, asthma, arthritis, AIDS, many types of cancer – and equipping patients to manage their conditions.

That is what Bridgeport does – the only thing it does. Its aim is to become Ontario’s leading centre for the treatment of complex chronic disease.

Its 466 patients have an average of eight co-existing medical problems, which typically means they’re on a host of drugs, some of which work at cross-purposes. Their quality of life has been severely compromised. Some are in constant pain.

The majority, but not all, are seniors. Thirty- and 40-year-olds who have survived heart attacks come for rehabilitation and education. Young people recovering from cancer treatment come to Bridgepoint. Diabetes patients are getting younger and younger.

“As a geriatrician, I’m used to dealing with complex chronic diseases, but it’s not just the elderly any more,” says Heather MacDonald, Bridgepoint’s vice-president of medicine.

Half of Canadians have at least one chronic disease. One in seven has three or more.

Ontario approached the third frontier late and grudgingly. It is well behind Alberta and British Columbia in chronic disease management.

As recently as a decade ago, the province’s Health Services Restructuring Commission recommended that most of Ontario’s chronic care hospitals (including five in Toronto) be closed. Their patients could be sent to nursing homes or provided with home care, the government advisory body said.

It took a huge effort, led by Bridgepoint (formerly Riverdale Hospital) to convince Queen’s Park that keeping people alive is no longer enough.

It took a far-sighted health minister, Elizabeth Witmer, to commit public resources to improving the quality of life for those whose ailments are permanent.

Since 2002, Bridgepoint has staked out a mission to become Canada’s leading centre for the treatment of chronic disease and disability.

It will apply the best science available to develop medications that alleviate one condition without exacerbating another.

It will use the best technology available to help people regain as much independence and mobility as possible.

It will design programs to keep patients mentally active and socially engaged as they cope with their physical limitations.

And it will educate people to control their risk factors, manage their pain and handle life’s stresses.

One of the biggest challenges Bridgepoint faces is public outreach. Chronic diseases aren’t glamorous or well understood. They aren’t likely to be beaten anytime soon.

Most taxpayers would rather see their dollars used to save lives than treat symptoms. Most donors would rather see their money used to cure cancer, heart disease and multiple sclerosis than make them bearable.

“Getting rid of diseases is a worthy goal,” MacDonald says. “But in the meantime, we have a growing and significant part of the population that we don’t know how to care for.”

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