Words and Reality at the CMA Annual Meeting

What would it look like if the Canadian health care system actually produced “patient-centred care”?  I mean, what evidence would we see in front of our eyes? Given that patients are human, I would expect to see places that looked humane. These places would look humane because they demonstrated obvious understanding for what it means to be in a vulnerable state.

After decades of loose talk about patient-focused care by various agencies, Jennifer Graham reports from the Canadian Medical Association’s annual meeting that these words are still up for discussion: “Dr. Robert Ouellet, the current president of the CMA has said there’s a critical need to make Canada’s health-care system patient-centred. He will present details from his fact-finding trip to Europe in January, where he met with health groups in England, Denmark, Belgium Netherlands and France. His thoughts on the issue are already clear. Ouellet has been saying since his return that “a health-care revolution has passed us by.”

Incoming CMA president Dr. Anne Doig says “we all have to participate in discussions around how we do that and of course how do we pay for it.”   

What’s the solution? How can those well-intentioned words begin to match reality? Is it only about “efficient care” or “activity-based costing” or is it also about something deeply rooted in our view of the patient experience? 

The Finnish modern master architect, Alvar Aalto, in his Paimio tuberculosis sanatorium of 1933 demonstrated how a humanitarian approach to the architecture of hospitals could provide comfort to  patient at their weakest moment. His thoughts are summarized by Colin St John Wilson in Alvar Aalto: through the eyes of Shigeru Ban; a good read.

In Aalto’s extensive writing, including his 1940 piece The Humanizing of Architecture, he revealed the struggles he was facing in his professional practice between the emerging forms of modern architecture. His own work drew on the philosophies of naturalists John Ruskin and William Morris’s “democratic architecture.” This was in contrast to the prevailing trend of modern architects at the time toward, for example, Le Corbusier’s view of the house as a “machine for living.”

In response Aalto writes, “. . . the newest phase of modern architecture tries to project rational methods from the technical field out to human and psychological fields.” As Aalto points out, humans have a deep need for human responses that don’t conform to a rational mechanical method, and stated that “architecture is only authentic when Man is at the centre, grounded in human priorities.”

It seems to me that the incoming CMA president could benefit by looking at the evolution of modern architecture in terms of how it could truly put patients at the centre of care. As our aging hospital “infrastructure” is replaced, decisions must be made about humane physical environments. The delivery of care, as in the creating hospital architecture, is an equal mix of the science and art of healing.

– Tye Farrow

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