Thank you.
I'm really happy to speak on this, especially at the invitation of my friend and colleague, Dr. Ellis.
Look, I haven't been intervening a lot in today's clause-by-clause debate because my constituents are asking me to support pharmacare and get this critical legislation passed.
I do think, with all respect, that there's a little bit of a “Trust me—I'm a doctor” tone to what Dr. Ellis and colleagues have been saying. Of course physicians practise with patients' best interests in mind. That's a given. We're all trained to do the best we can, as do the vast majority of health professionals in general, whether we're talking about OTs, nurses, pharmacists, lab techs, all the providers in the system.
However, we all contribute to a system where errors and over-prescribing occur. I was thinking, when my colleague quoted a great Dr. Harvey, that there's another, Dr. William Harvey, who said:
As art is a habit with reference to things to be done, so is science a habit in respect to things to be known.
I think we just have to look at a little bit of what the science is telling us. For instance, nearly 70% of Canadians over 65 take five or more medications, and about 10% take 15 or more. That's a recipe for a higher risk of harm, hospitalizations, other reactions, injuries, potentially avoidable hospitalizations, and even deaths. There are many, many studies and much evidence to document polypharmacy, over-prescribing and inappropriate use. It doesn't mean that physicians aren't working hard or prescribing diligently, but mistakes do occur. I think of this as a kind of a system error or a way of errors, and we need system approaches.
For example, there was a U of T program to provide tools to practitioners to recognize inappropriate medication use as a result of prescribing cascades. In other words, you participate in a system where more and more medications potentially get added on to a patient's prescribing risk, and no one really has the tools, the time or maybe even the knowledge to really take a look at de-risking and having that holistic approach to reducing the risk of adverse effects by re-examining the whole list of medications.
Alberta even has an appropriate prescribing and medication use strategy for older Albertans. Most physicians in practice know—and I'm sure Dr Ellis knows very well—the Choosing Wisely program, with which the Canadian Medical Association is a strong partner. Really, it's looking at increasing physician knowledge in recognizing where there are common pitfalls, whether in the way we use diagnostic strategies or in prescribing.
Further to all that body of evidence, I just don't see where it says that the minister, the CDA or the government is going to tell physicians what to do. What I see are principles. Really, what the clause says is that “The Minister is to consider the following principles”. I won't read the whole thing—it's before all of you—but it specifically says that the minister will:
(c) support the appropriate use of pharmaceutical products — namely, in a manner that prioritizes patient safety, optimizes health outcomes and reinforces health system sustainability — in order to improve the physical and mental health and well-being of Canadians
I don't know a physician who is not going to support that principle and who does not want to participate in a system that helps improve patient safety through rational and appropriate prescribing. That's why I will not be supporting this amendment.
Thank you.