Brian Day: Day in Your Life
Brian Day moved to Vancouver thinking he’d only stay for a year. Thirty years later, the smart working-class kid from Liverpool has become the chief dissenter in Canadian medicine. It’s been a tough journey so far, and there are more fights ahead.
Brian Day chatters away as he works a probe through the triangular-shaped hole he has just cut in his patient’s knee. He’s talking about politics, he’s talking about Disney, he’s talking about advances in medicine. At any time, you expect him to ask the surgically masked posse around him if they know of any good recipes for barbecued salmon or vegetarian stir-fry. With a pencil-shaped surgical pick, Day, who becomes president of the Canadian Medical Association (CMA) this month, begins to strip away strands of tendon from the sedated patient’s hamstring. He pulls the tendon out through the half-inch portal he has created below the kneecap. It looks like an off-white ribbon of pasta.
Over the next hour, Day will use the tendon to build a new anterior cruciate ligament, commonly known as an ACL. The patient has torn his ACL badly and has come to the private Cambie Surgery Centre, founded by Day in 1996, to get it fixed.
Brian Day’s prescription for an overhaul of the Canadian public health system stems from his conviction that introducing sound business principles to health delivery would increase efficiency and reduce waiting lists. His specific recommendations include the following:
- Massively reduce the health-care bureaucracy, of which 80 per cent, Day estimates, is expendable.
- Water down the power of health-care unions. Day says they have fought against the innovation and change that could improve the system.
- Introduce user fees for doctor visits to reduce abuse of the system. Day estimates 50 per cent of visits to physicians are unnecessary.
- De-insure many services. Day believes 25 per cent of all services in most sections of the medical services guide could be eliminated. Examples include bunions, varicose veins, breast reduction and nose jobs. Under his plan, the public system could still pay for eliminated treatments with a doctor’s letter saying they were medically necessary.
Perils and profits
Voicing the mere notion of an expanded role for private health care in Canada is seen as fighting words by many. Tom Noseworthy, a physician and director of the Centre for Health and Policy Studies at the University of Calgary, says private clinics undermine the medicare system we have. Before long, he believes, people will be taking out private insurance to get a full range of treatment at private clinics and hospitals like Brian Day’s Cambie Surgery Centre. That would eat away at the foundation of medicare itself, he says.
Michael McBane, a physician and national coordinator of the Canadian Health Coalition, argues that Canada’s health-care system is not the inefficient, gas-guzzling beast portrayed by Day. In fact, he says that prior to Canada’s introduction of a single-payer system (where the government pays), health spending in Canada and the U.S. was escalating at the same rate.
“After 30 years of single-payer administration,” says McBane, “Canada now spends almost 50 per cent less than what Americans spend [9.9 per cent of GDP in Canada versus 15.2 per cent in the U.S.] while providing equal or better care.”
Day says Canada is missing the boat when it comes to the opportunities to generate hundreds of millions of dollars in revenue. Waiting lists, he says, are standing in the way of hospitals making buckets of money that would ultimately strengthen the health-care system in Canada.
He says many of the big hospitals around the world, such as the Mayo Clinic in Rochester, Minnesota, generate 25 per cent of their income by treating patients from other countries. Canada treats foreigners on an emergency basis but has to turn down requests from people from around the globe who want to come here for major surgeries.
“We get lots of requests to treat relatives of people here,” says Day. “We have a very large Asian population. That could be a major source of revenue. But we have to turn them down because politically and ethically it would be unacceptable to treat them ahead of Canadians on the wait list.
“Eliminating wait lists would give us access to the $2-trillion American health economy.”
By Day’s estimate, Canada could add $40 billion a year to its health-care coffers by charging foreigners to access our operating rooms and surgeons. It would also help retain many of the surgeons we are currently losing.
“Fifty per cent of our newly trained orthopedic surgeons and 50 per cent of newly trained neurosurgeons are leaving within five years of graduating because there isn’t enough work here,” says Day. “That makes no sense. We train them and then they take their expertise elsewhere.”
Most of Day’s recipe for improving the health-care system doesn’t have anything to do with private clinics. But he believes that one way of reducing waiting lists is to do what Britain is doing: contract out more procedures to private clinics. To his critics, this will eventually lead to the destruction of medicare and give us American-style medicine.
Day is said to be the best in the world at the operation. He has performed thousands of ACL reconstructions over the last 20 years and it shows. There isn’t a bead of sweat on his brow. He talks breezily with his medical team as he bores through bones, blood and saline solution occasionally gushing out from openings in the skin.
A monitor shows Day’s handiwork as he uses a scope to get rid of superfluous tissue around the area where the tendon will be grafted to the bone.
“Hammer, please,” he says.
“I’ll have a nine by 30. Actually I’ll have a 10 by 30, please.”
“Probe, please.”
An hour after scrubbing up, Day is stripping off his mask and hat to visit his next patient, an 87-year-old woman with a bad knee who was going to have to wait a year to get it fixed at a public hospital.
“Imagine that,” he says. “Telling a woman who’s 87 she’s going to have to wait a year. What kind of health-care system is that?”
Certainly not one that Day supports – at least not entirely. As he begins his one-year term as president of the CMA, the controversial Vancouver surgeon will use his new national platform to talk about his vision for Canada’s health-care program. It’s one he believes could be more efficient and deliver better service if it incorporated sound business principles.
Some see Day as the potential saviour of medicare, and many think he’s out to destroy it. So how did this British schoolboy arrive at the pivotal position in which he now finds himself? In many ways it’s an improbable story, replete with heartbreak and tragedy.
Brian Day grew up with the Beatles. Literally.
Day was born in Toxteth, the deprived working-class neighbourhood of Liverpool, England, on January 29, 1947.
His father, Moss, was a pharmacist, or chemist as they are called in Britain. His mother Florence, known to family and friends as Flo, opened a booth at St. John’s market selling nylon stockings and cheap jewellery.
When the couple realized that Flo often made as much in a day as Moss did in an entire month as a pharmacist, Moss quit and joined his wife in her business venture. (Years later he would return to pharmacy and do quite well.) In the early days, the family was quite poor.
Brian Day was a smart kid and after elementary school attended the Liverpool Institute, the city’s best high school for boys. He remembers two rather famous schoolmates who were a few grades ahead of him – Paul McCartney and George Harrison. He also remembers a kid who delivered firewood throughout Toxteth, a chap who would later become known as Ringo Starr. John Lennon lived in a flat in Toxteth in the early 1960s.
“It was an exciting time to be living in that area,” says Day, sitting in his medical-centre office. “There were about 10 or 12 bands that were really good when I was in high school. There were two or three that might have been as good as the Beatles at the time.”
One was Gerry and the Pacemakers. The Merseybeats and the Undertakers were two others from Liverpool that were also big back then. They all performed at the Cavern Club, made famous by the Beatles. In his teenage years, Day was a regular visitor to the musical hotspot and saw the Beatles perform there many times. The band often performed at lunchtime.
“They were terrific,” Day recalls. “McCartney and Harrison certainly had an aura about them, even in high school. They were already starting to become famous even then.”
Toxteth was a tough place to live. If you didn’t learn how to handle yourself at an early age, life could be miserable for a young boy. So Day learned to get pretty good with his dukes.
He was developing into a fine little boxer until he stopped growing at about five feet four inches tall. Along with the sur-vival techniques he learned as a kid, Day was imbued with a competitiveness that courses through his veins to this day.
Day had early dreams of becoming a pharmacist like his father. His father wanted him to be a doctor instead. Day honoured his father’s wish and entered medical school at the age of 17. He was interning a couple of years later and soon had to choose which kind of doctor he was going to be. After an initial interest in pediatrics, he eventually settled on orthopedics.
The University of Manchester, where Day studied, boasted some of the top orthopedic surgeons in the world at the time, including John Charnley, later to become Sir John, one of the pioneers of hip replacement.
Another city that was making a name for itself in the area of orthopedics was Vancouver. Leafing through a magazine one day, Day saw an advertisement for the Canadian city and was immediately drawn to the shots of snow-capped mountains, since he loved to ski. He thought it wouldn’t be a bad place to work for a year. Through connections some of his professors at Manchester had with orthopedic specialists in Vancouver, it was arranged.
Day arrived in the spring of 1973 and would never permanently return to his homeland.
There are many events that shape a person’s life – some profoundly. There have been three such profound events in Brian Day’s life.
When he was a 19-year-old intern at a London hospital, Day was working in the emergency ward. There was a terrible car accident that resulted in the deaths of two 17-year-old twins. It fell to Day to tell the parents.
“I was a 19-year-old kid who was a quasi-doctor,” recalls Day. “I had to tell this couple who were in their late 30s that they’d just lost their children. It was an awful thing to have to do. Medical training desensitizes you a bit. You see terrible things. I had to do terrible things that most 19-year-olds don’t have to do. Having to tell those parents about their kids had a lasting impact on me.”
Day was in Vancouver in 1981 when he received a phone call from his sister, Yasmin, who lives in Washington state. Riots were underway back home in Toxteth. It was bad. More than 140 buildings were destroyed, mostly by fire.
Amid the chaos, Day’s father, Moss, carried on at his pharmacy. On July 13, 1981, while walking home from work, Moss Day was followed by two drug addicts, a father and son. They waited until Moss got inside his house. Flo wasn’t yet home.
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