Convocation Address - Dr. C.R.F. Elliot

First let me immediately express my sincere thanks for the great honour you have bestowed upon me this morning - it will always be cherished and I am very proud. I would also say how happy it makes my wife Kay and my daughter and son-in-law, who are all UBC graduates. I am a graduate from Queen's and Toronto and the three of them go around stating ad nauseum, "It's nice to know, dad, that you finally have a degree from a good university." I ignore those remarks but being a native British Columbian I secretly agree.

I am also honoured in being asked to say a few words to the graduates this morning. I would like to reminisce a bit about the good old days, and then perhaps be mildly critical about the current situation in health care in Canada, and look into the future.

My father was a GP from western Ontario, arriving in B.C. in 1899. He opened a practice in the Columbia Valley, later practiced in Harrison Hot Springs and Hedley, and in 1919 we lived in the East Kootenays in Corbin, a coal mining town near Fernie - interesting to me there was a health insurance program there which was operated by the local union - medical care including drugs and hospital cost $2.50 per family per month. I remember my mother helping my father make cough medicine - a year’s supply - on a 6-ring kitchen coal stove. My brother and sister in the meantime scrounged for bottles for the cough medicine and got 10 cents a dozen from my father. He also kept a family of leeches since a good number of the miners were from Europe and leeches were a well-known treatment aid.

In those days of the early twenties, explosions from methane gas were not uncommon in the mines. Those miners still alive were brought to our home where there was a 6-bed ward attached. My brother and I would frequently see these miners severely burnt on all skin areas not covered by tight clothing. The odour was intense and permeated our home - the majority died. I had worked underground in the mines in the summer holidays at age 16 and during holidays at medical school. This was a scary time and I am sure these experiences of seeing the miners brought in following explosions convinced me that when I wen to medical school I would work hard.

When I interned at the Vancouver General Hospital in 1935, the pay was $25 a month with board room. In addition the hospital held back $15 a month for any damage we did or if we left the hospital before our year was up. You could generally count on losing this compulsory deposit.

Naturally, as interns we never had any money, so we sold our blood (no Red Cross Transfusion Services then). The going price was $15 — quite often as we went up to a patient’s room with the blood to finalize the transfusion, the patient was deceased. With no hesitation at all we would return the unused blood into the donor’s veins and he would remain at the top of the priority list for donors and had his $15. I did a locum in the Cariboo for $125 a month and a room plus a car. Often, on house calls into the country on the way home I would have eggs, poultry (often alive), sometimes a pig, as payment which I would turn over to the doctor’s wife. Perhaps the Health Ministry should look into this as an alternative method of payment!

Yes, there were nurses in those days, but not the many other disciplines we have today assisting in our medical programs. The student nurses got about $5 a month, I believe, and resided in old buildings adjacent to the Vancouver General Hospital. These buildings were the "shacks" that UBC was first housed in until 1923 when the "Great Trek" occurred. To complete the story, one of these buildings was later the Provincial Division of VD control.

Things have sure moved since the good old days in our mutual medical world. We now have a complete team caring for our health. This team includes nurses, physicians, dentists, pharmacists, social workers, nutritionists, physiotherapists and occupational therapists and others in the field of rehabilitation, speech therapists, psychologists, technologists in many fields, and likely others I should have mentioned.

When I joined the Health Ministry in 1946, the budget was about $2 million. In 1985-86 the health budget was $3 billion. Sixty percent or $1.8 billion went to hospital programs; 28% or $830 million went for medical care; only 7% or $208 million went to preventive programs, and a mere 2% went to alternative methods of care. These figures continue to increase, especially in hospital and physician fields, and everyone wants more. The 7% for preventive care and the 2% for alternative care must be increased somehow. There must be more research and investigation into these two areas if Canada is to continue to have the best health care system in the world.

At the moment millions are spent on research searching for cures in a multitude of diseases, some of which are extremely rare. This policy must continue I am sure; however, it is time we all became concerned that if the cost of health care continues to increase it will either collapse or soon have to be rationed. Let us hope this does not become necessary.

It is paramount in my opinion that new research funds must be allocated to explore newer methods of delivery of health, and this must be a joint effort of governments, university, and all the professions involved in health care delivery.

The co-ordinator of Health Sciences at UBC and a group at McMaster University are hopeful that such an undertaking will become a reality in the not too distant future. The Health Ministry and two local foundations are supporting the co-ordinator’s office in this plan.

Dr. Jack McCreary, the former Dean of Medicine and coordinator of Health Sciences, was a person with a vision and had an international reputation; he was the founder of the health team concept. It was his concept that if all those responsible for health care delivery were trained in the same environment as far as possible, it would encourage them to retain a close relationship in actual practice. Dr. McCreary’s concept was adopted in principle by many universities in the Western world. However, it has not been adopted in the delivery of health care to any large extent at this moment, which is most unfortunate.

Some of the blame for this lack of action must be placed on the shoulders of the professionals associations representing their own members; it seems they are just looking after the demands and requests of members, rather than accepting the social responsibility they have in health programs.

I was a member of the Glasco Royal Commission on government organization and served on Dr. McCreary’s committee dealing with health care. In the Northwest Territories, we found that the majority of health care at the primary care level was carried out by nurses, and this was carried out with great success. One wonders why nurses and other professionals in the health field are not encouraged or allowed to enter into the primary care field. It is quite apparent to me that our professional associations give only token attention to an interest and study into other and maybe better methods of health care delivery.

I also believe my own profession has been a little negligent in not giving more leadership in the methods of delivery of health care; certainly if all those professions involved in this matter could speak with one voice it would be great. The medical profession should be the natural leader in such a development.

One cannot but not how few professionals in the medical field get involved deeply in community problems. I can remember when we had as many as 4 doctors in our provincial legislature. Today we have none. Our Premier, on Good Friday, stated: "If you don't like what we are doing, run for office."

I have covered the good old times, the present, and now for a bit on the future.

I would guess that the exciting field of genetics would make many more valuable contributions to health care in the future. I would hop all of you have seen the most recent Quarterly Report of the UBC Health Sciences Centre Hospital. It is excellent.

In no particular order, I mention rehabilitation medicine as one that will contribute a lot and I quote from a recent article in the Canadian Medical Journal:

"After years of trailing in the wake of acute-care medicine and picking up the pieces, rehabilitation medicine is finally coming into its own. In fact, a number of health care experts are predicting that rehabilitation medicine will be the speciality of the next decade, attracting more funding dollars, personnel and interest than ever before."

Thank you, Rick Hansen.

I would also hope that preventive medicine and alternative methods of care would receive more support. In Vol XX, No. 2 of Forum, (publication of the Association of Medical Colleges), the following statement is made:

"As we move towards a society in which age and disability become more prominent features, there is an increasing need to emphasize prevention, extending from primary through to tertiary prevention with its relevance to the adjustment of the patient and the community to irremediable conditions.

"There is a need in every medical school to recognise that prevention is a responsibility of virtually every clinical department. Every dean should make this a policy for undergraduate and graduate education.

"There is a need to promote a broader concept of medicine that includes reference to public policies, and that recognises health services and policy related research to be just as fundamental to the future of physicians and medical care, and that of traditional biomedical research."

I have rambled a bit about the good old days, today and the future. A quote I read somewhere says: "Today’s lamented modern days will become tomorrow’s good old day."

I thank you all. I congratulate all the new graduates and please do not lose touch with our great university. To paraphrase president Jack Kennedy, "Do not ask what your university can do for you. Ask what you can do for your university."

God Bless.