You're asking us to try to tell you in three minutes or less how we can fix the health care system. I won't pretend to try to do that, and I don't want to sound negative either, but certainly as a family doctor I observed an incredible increase in the complexity of the patients I looked after over a 30-year career. No longer did we see patients with one diagnosis. We'd often see people with two or three different illnesses going on at the same time, all requiring a range of services, and certainly a consequence of that complexity has been for me to say I cannot look after all this person's problems by myself. That has been one factor.
A second factor has been—and I may get tomatoes on this, not necessarily in this room—the mode of payment for physicians. In primarily a fee-for-service system, which I think over time has not favoured collaborative approaches, we're seeing some innovation in looking at alternate payments, capitation, enabling us to say the person we're seeing in front of us is important. But the population of this practice—my colleagues and I, the nurses, the social worker who comes in to help us, the pharmacist—we all have a responsibility to know who we are looking after and to look at what's happening from a population-based perspective.
The third factor has been a very slow introduction of the electronic medical record, and you cannot work effectively with other providers unless you have an electronic medical record. Paper works, but I can tell you that in this environment we need to have effective information systems that enable that practice to be connected with the hospital and other resources. That's not to say we're not responsible, but to try to explain why this is not happening at the pace you and I would like to see it happen.