// Paste this code as high in the of the page as possible: // Additionally, paste this code immediately after the opening tag:

What You Don’t Count, Doesn’t Count: A Health Advocates Perspective

Light Bulb
Find Oakville's Cheapest Gas

About the Author

Gary J. Machan

Gary J. Machan

Gary Machan serves on the Community Advisory Research Committee for the Canadian Index of Wellbeing. Through the course of his career he has received several provincial awards including the 2nd Stage of Medicare, Ontario Tobacco Network Innovation Award for Excellence, and Food Champion Award. In addition, Mr. Machan is an associate with the Centre for Inner Freedom where his work was featured by Tom Harpur in his best selling book ‘Finding the Still Point’.

Latest posts (See all)


In his capacity as chief economic advisor to J.F Kennedy, the late, great Canadian John Kenneth Galbraith was reported as saying “what you count counts, and what you don’t count, doesn’t count.” My response is that one would be hard pressed to find a place where this maxim is truer than in health care.

Indeed, historians may very well look back at this time and describe it as the reign of the accountants. A time when such absurd things like PAP Smear Working Committees are established in health centres, involving multiple staff, funded by tax payer dollars. Why? Because this is one of a few numbers by which primary health care services are evaluated and CEO bonuses are calculated.

Don’t get me wrong, I have nothing against PAP smears. Plus, please note there are a few CEOs with integrity that refuse these cash grabs. Still, there is a huge downside to the way that the Ministry of Health has deemed certain procedures, illnesses and professions worth counting. Precisely, because of what isn’t being counted.

Lest this be too abstract, let me share with you the story of one young woman who was diagnosed with scoliosis at the age of twelve. For those who don’t know what scoliosis is, it involves severe curvature of the spine. As the first course of action, she was fitted with a back brace. However, after a year and half it became quite apparent this was not working.

Once her spine progressed to 40% off centre, the pediatric surgeon strongly recommended that she undergo surgery to straighten out her back by fusing a rod to her spine. Considering the adverse impact on her internal organs of not performing the surgery, the parents immediately consented.

The surgeon was optimistic that the surgery would take place within three months. However, after not hearing anything for several months, the parents called the doctor’s office only to find out that no date had been set. A week later the nurse called to say that a spot was available, only to hear a few days later the surgery was postponed.

During a consultation seven long months later, the surgeon was deeply concerned when he noted her spine had advanced to 55% off centre. Not just that, her spine started to wrap around itself. The parents learned that the issue was not his availability, but the fact that some ‘expert’ at Queen’s Park categorized major back surgery as ‘cosmetic’ in the same category as a breast implant.

It wasn’t until her spine reached 8o% – just think picture that in your mind for a moment – that she was able to undergo surgery. Ten long hours later, the surgeon emerged to say he was only able to get her spine back down to 40%. He explained the only way to bring the curvature down to a more acceptable range would be to remove her vertebrate and put her in traction.

Given the incredible agony associated with this procedure, the multiple operations that would ensue, and the increased odds for paralysis, the parents decided in consultation with the surgeon to not do the surgery.

Their education didn’t end here. Later, they discovered that another major factor contributing to the delay were the cuts made by hospital administration to nurses on the pediatric unit to bolster ‘high priority’ areas, such as knee and hip surgery. The offshoot of this was operations for children slowed to a trickle since nurses were assigned to other wards.

It strikes me that there is something inherently wrong – not to mention tragic – about a system that has the audacity to classify a ten hour surgery as ‘cosmetic’, especially when it involves a child. I should know because the child in this story is my daughter.



, , , , , , , , , , ,