
             TAKE TWO MINUTES AND DON'T CALL ME IN THE MORNING

                            By SUZANNE MORRISON
                             Hamilton Spectator

     HAMILTON - Get lots of rest and drink plenty of fluids.

     Canadians hear advice like that every time they get a cold or the
     flu. If more of them followed it - and stayed away from the doctor
     - they'd be doing Canada's ailing health care system a world of
     good.

     Across the country, people are seeking medical treatment more
     frequently than ever before. Federal figures show that between 1971
     and 1985, Canadians increased their use of doctors and hospitals by
     a whopping 68 per cent.

     In the last decade, the population grew by 10.5 per cent while
     growth in the use of medical services increased 42 per cent.

     Granted, rapid scientific advances mean medicine has a lot more to
     offer: In 1950, there were about 100 lab tests to chose from, a
     number that has since jumped to 600. There are also more doctors to
     provide them.

     But health experts are increasingly blaming patients for at least
     some of the fat in the $60-billion system.

     Treating colds and the flu in Ontario alone cost $200 million in
     1989. As well, 34 per cent of cold and flu patients in Ontario
     received a prescription that may not have been necessary, says a
     provincial task force on medical services.

     A trip to the doctor may not seem like an abuse of universal health
     care when it's your cold. And if you are given an unnecessary
     prescription, isn't it the doctor's fault not yours?

     ``I cannot accept that it is one or the other 100 per cent,'' Dr.
     Dennis Psutka, a member of the Ontario task force on medical
     services, says when asked whether it is patients or doctors who are
     driving health care costs. ``It's obviously a mutual thing.''

     But regardless of who is to blame, the situation is serious.

     ``The consumers of Canada have to realize that if they continue
     with willy nilly use of the system, and if the government of Canada
     is unable, or unwilling to change, then we are going to become a
     very unhealthy society,'' Psutka warns.

     When researchers at McMaster University's health policy centre
     studied the issue in 1982, doctors complained about such things as
     patients requesting unnecessary care and services, visiting a
     doctor after symptoms have disappeared, and many ``third party''
     requests by patients, such as notes for work.

     Many factors are influencing this rush to the doctor: compelling
     advertising by drug companies; news stories about technological
     advances; even health campaigns that warn your cholesterol level
     might be too high.

     Good health has become a national shrine; medical miracles recall
     fables about the fountain of youth; the latest bad news about what
     causes cancer stirs unpleasant fears.

     Overwhelmed by demands and information, ``the consumer is so
     freaked he goes to see the doctor,'' says Dr. Psutka.

        See also <26health> for people who turn to holistic medicine

     Influenced by many of these same factors, Canadians may also be
     making bad choices once they get to the doctor.

     Health economist Jane Fulton of the University of Ottawa says
     studies show that about one-third of all surgical procedures in
     Canada are not necessary, including many coronary bypass operations
     referred to the United States.

     ``Patients are being misled by their own physicians,'' she says,
     adding that the administrator of a U.S. clinic confirmed this to
     her during a visit last year.

     ``The administrator said `Dr. Fulton, please don't interfere with
     the flow of Canadian patients, they're not really sick and we make
     a lot of money from doing their heart bypass operations.'''

     Evidence shows educated patients make better health care choices
     and fewer demands on the system.

     And it's not difficult to become an educated patient, says Dr. Andy
     Oxman, an assistant professor in the department of family medicine
     in McMaster University's faculty of health sciences.

     When a doctor proposes treatment, a patient needs simply to ask:

      - How are you sure this works?

      - What are the expected benefits, risks, side effects, and
     costs?

      - Is the advice I am receiving really applicable to my case?

     Once a patient begins to challenge a doctor's advice, they start to
     challenge all kinds of things, Dr. Oxman says.

     An interactive video being tested at Toronto General Hospital, and
     sites across the U.S., is another tool that may make help patients
     make more intelligent decisions.

     Produced by the non-profit Foundation For Informed Medical Decision
     Making at Dartmouth Medical School in New Hampshire, the video
     deals with benign prostatic hypertrophy, a non-cancerous
     enlargement of the prostate.

     A patient feeds his age, sex, symptoms and medical history into a
     computer, which calculates probable outcomes for different
     treatments. A video fills in the human dimension in the form of
     interviews with patients who have previously undergone treatment.

     The foundation is planning other videos on subjects such as low
     back pain and breast cancer.

     But unless individual consumers of health care learn to curb their
     expectations voluntarily, stress on the system will dictate more
     drastic action.

     When health care is free, British politician Enoch Powell once
     said, there is virtually no limit to what people will absorb.

     So in a situation of finite resources, one option is to legislate
     choices _ as is happening in Oregon.

     Faced with a health care crisis, the northwestern U.S. state
     decided in 1987 not to cover most organ transplants for patients
     covered by Medicaid, the U.S. government insurance plan for the
     poor.

        See also <01health -Band-Aid> for discussion of this issue

     The $1.1 million Oregon had been spending on a dozen or so
     transplants a year was instead spent on prenatal care for thousands
     of low-income women.

     It didn't stop there. Drawing on input from thousands of its
     citizens, the state went on to rank the whole gamut of health
     services on a scale that could be used for rationing.

     Pneumonia, tuberculosis, peritonitis, treatment for an object stuck
     in the throat and appendicitis top the list of medical priorities
     produced by the people of Oregon in what state officials are
     portraying as health care by democracy.

     Items that ended up at the bottom of the list because of their high
     cost and  poor outlook include treatment for advanced cases of AIDS
     and care for exceedingly premature babies.

     If the U.S. government approves, the state will use Medicaid
     dollars only to finance treatment for procedures in the top part of
     the list.

        See also <13health> for discussion of U.S. health care system

     Dr. John Kitzhaber, president of the Oregon Senate and the
     rationing plan's leading supporter, says Oregon will spend the
     savings to extend medical coverage to the 40 per cent of the
     population now without it.

     ``Where was the equity in giving sophisticated and costly services
     to a few Oregonians covered under Medicaid before providing basic
     health care services to other equally needy citizens, including
     many of the `working poor,' who lacked any public or private
     coverage?'' he argues.

     Health professionals in Canada are among those closely watching
     Oregon's efforts.

