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The book highlights some of the darker elements of the nursing profession, including workplace cliques, bullying, drug abuse, sex, poor working conditions and even cases of assault.

"The Nurses" by Alexandra Robbins dives into the world of healthcare services, bringing readers real-life stories from four different working nurses in the U.S.

In one passage of the book, nursing is described as being like "high school but with dying people."

Another element examined in the book is the constant threat of violence and abuse nurses face on a daily basis.

It is widely considered one of the most dangerous professions, as frustrated and emotional patients and visitors may verbally and physically assault an attending nurse at any given moment, Robbins said. "So they get bitten, punched, hit, scratched, and what's just as bad is that many workplaces make them feel like getting assaulted is just part of the job," she said. "Nobody in any other profession would have to tolerate that."

"Of course, there is no such thing as a perfect health system and it certainly doesn't reside in any one country," Mark Britnell, global chairman for health at the consulting giant KPMG, writes in his new book, In Search of the Perfect Health System. "But there are fantastic examples of great health and health care from around the world which can offer inspiration."

As a consultant who has worked in 60 countries - and who receives in-depth briefings on the health systems of each before meeting clients - Mr. Britnell has a unique perspective and, in the book, offers up a subjective and insightful list of the traits that are important to creating good health systems. If the world had a perfect health system, he writes, it would have the following qualities: the values and universal access of the U.K.; the primary care of Israel; the community services of Brazil; the mentalhealth system of Australia; the health promotion philosophy of the Nordic countries; the patient and community empowerment in parts of Africa; the research and development infrastructure of the United States; the innovation, flair and speed of India; the information, communications and technology of Singapore; the choice offered to patients in France; the funding model of Switzerland; and the care for the aged of Japan.

In the book, Mr. Britnell elaborates on each of these examples of excellence and, in addition, provides a great precis of the strengths and weaknesses of health systems in 25 countries. The chapter on Canada is appropriately damning, noting that this country's outmoded health system has long been ripe for revolution, but the "revolution has not happened."

Why? Because this country has a penchant for doing high-level, in-depth reviews of the health system's problems, but puts all its effort into producing recommendations and none into implementing them. Ouch. "Canada stands at a crossroads," Mr. Britnell writes, "and needs to find the political will and managerial and clinical skills to establish a progressive coalition of the willing."

The book's strength is that it does not offer up simplistic solutions. Rather, it stresses that there is no single best approach because all health systems are the products of their societies, norms and cultures. One of the best parts of the book - and quite relevant to Canada - is the analysis of funding models. "The debate about universal health care is frequently confused with the ability to pay," Mr. Britnell writes. He notes that the high co-payments in the highly praised health systems of Asia would simply not be tolerated in the West.

But ultimately what matters is finding an approach that works, not a perfect one: "This is the fundamental point. There is no such thing as free health care; it is only a matter of who pays for it. Politics is the imperfect art of deciding 'who gets what, how and when.' " The book stresses that the challenges are the same everywhere: providing high-quality care to all at an affordable price, finding the work force to deliver that care and empowering patients. To do so effectively, you need vision and you need systems. Above all, you need the political will to learn from others and put in place a system that works.

the consumer is naked in the screening market place. There's no one really protecting people from being exposed to screening that is neither recommended, didn't have scientific support, that had evidence of harm in terms of exposure to radiation and good evidence that kind of screening causes huge amounts of follow up in the average person

They're marketed as providing peace of mind, when they are statistically more likely to do the opposite, which is to give you a bunch of things you now have to worry about that you never knew you had to worry about before.

they may say prostate cancer screening improves survival time, as opposed to improving survival, meaning the time you survive after they've diagnosed you with the disease. If you're tied to the railway track, and the train's coming down the track and it's going to hit you at a particular time, you can see it maybe without binoculars at five miles, say a five year survival rate. Or, if you use the screening test, binoculars, you can see it at seven miles. Your survival time has improved. The date at which the train hits you does not change, but the statistics look like the survival time has improved by two years.

Cassels looks at tests that are commonly given to healthy people, including screens for prostate cancer, breast cancer, osteoporosis and high cholesterol.

the business model depends on overdiagnosis and over treatment

There's a huge gap in the pharmaceutical world between what the marketers or advertisers say and what the evidence says. In screening it's the same niche

It's a bigger tent. There's the patient advocates, the radiologists, the urologists, the specialists and the others who are pushing various types of screening. And the drug industry is there too.

You don't need to prove the benefits of a screening test before you launch it on the public.

many doctors feel they have lawyers looking over their shoulders as they consider whether or not to recommend a screen

I think that's a largely US thing, but I think it motivates physicians here as well.

That did little to quell critics who said the NDP has given up even the pretense of trying to rein in spending. Progressive Conservative Leader Brian Pallister said the government could have balanced the books this year if it had "just held the line on spending." "They are making promises with money they are taking from our children and grandchildren here," the Opposition leader said. "It took 109 years for us as a province to get about $18-billion into debt. It's taken six for the premier and the NDP to double that debt. Somebody's got to pay that back." Todd MacKay, prairie director of the Canadian Taxpayers Federation, said the "overwhelmingly irresponsible budget" shows the New Democrats have a spending problem. "They promised to have this budget balanced. Instead, the deficit is going up," he said.

"Future generations are going to pay for this budget. It's completely irresponsible." The infrastructure spending wasn't enough to win over others. Winnipeg Mayor Brian Bowman said it will do little to help the province's largest city. "We need new money. The model is ... fundamentally broken in terms of how we fund our cities," he said. "We have an obligation to fix it." The NDP tries to leave behind internal turmoil that led to a leadership race in March which Mr. Selinger won by 33 votes. The Premier's top five cabinet ministers resigned last year after calling for him to step down in light of plummeting opinion polls following the provincial sales-tax increase. "The government has obviously been preoccupied with something else over the past eight months and has not been focused on governing," said Chuck Davidson, president of the Manitoba Chamber of Commerce. "This was a great opportunity to at least get us on a path ... to getting our economic house in order. They missed the mark."

In a prebudget letter to Mr. Oliver, the NDP urges the Finance Minister not to delay the budget and to instead scrap the recent tax cut that allows parents with children under 18 to split their income for tax purposes. The NDP says Ottawa should cut spending on advertising, the Senate and corporate subsidies. The letter calls for more spending on health care, child care and pensions and the creation of a credit for small businesses that make new hires.

The government says it is taking a few extra weeks to release a budget in order to get a better understanding of the current changes in the economy. The price of oil has dropped by more than half since June, a development that will mean billions less in tax revenue for Ottawa than had been previously expected.

Federal Employment Minister Jason Kenney is also pledging that Ottawa can hit its target without dipping into a $3-billion contingency fund, a comment that is at odds with recent statements from Finance Minister Joe Oliver, as well as analysis from several private-sector economists. The messaging from the government is shifting quickly in the face of growing signs that current, dramatically lower oil prices will be around for some time. The Bank of Canada will release its quarterly Monetary Policy Report on Wednesday, which is expected to expand on recent warnings that prices could go lower, or remain low, "for a significant period." In a series of interviews broadcast over the weekend, Mr. Kenney said balancing the books has important symbolic value and that "it may take some additional spending restraint" in order for the government to deliver on its promise.

The 2014 federal budget reintroduced a two-year freeze on departmental operating budgets that runs through the 2015-16 fiscal year, which is when the Conservatives are promising a return to balance. The 2014 budget said this freeze would save the government $550-million in 2014-15 and $1.1-billion in 2015-16. Mr. Kenney did not explain how extending the freeze might help the government achieve its balanced-budget promise. "They spent the surplus before they had it and now they're scrambling to figure out how to make one plus one equal three," said NDP finance critic Nathan Cullen.

Economists say it makes no practical difference whether Ottawa posts a small surplus or a small deficit, given that federal finances are sound overall in terms of debt levels and longterm spending trends. But Mr. Kenney said balancing the books remains an important goal. "It's a commitment we made to Canadians in the last election," he told CTV. "It's important that, when possible, we no longer go back and borrow money to pay for government spending."

“It seems to be preferential access for well people while the sick suffer,” says Wendy Armstrong, a researcher with the Consumer Association of Alberta, which has intervenor status at the public hearings.

In his book Seeking Sickness, Alan Cassels of the University of Victoria points out that colon cancer screening by stool sample or colonoscopy only reduces deaths from 8.83 per thousand to 5.88 per thousand, or about 3 per thousand.

The clinic was established after two wealthy Calgarians — John Forzani and Keith MacPhail — donated $2.7 million for pricey technology, the U of C donated some space in a brand-new building, and the health region (medicare in other words) committed to $70 million worth of funding.

Billed as the largest colonoscopy clinic in Canada, it boasts six pre-assessment rooms, six endoscopy rooms, 24 recovery beds and is staffed by 55 health professionals.

Alberta Health Services now covers the entire cost of the Forzani-Macphail Colon Cancer Screening Centre

The United Kingdom and Australia consider an 85% acute care bed occupancy rate to be the safe upper limit, according to the OECD. But Campbell, who says the OECD’s figures on Canadian occupancy rates are probably accurate, is not interested in debating appropriate overall rates.

It may come as a surprise that despite these statistics, Ontario Hospital Association president Pat Campbell is not advocating for more hospital beds.

Between 1998 and 2011, the number of all types of hospital beds in Ontario remained “virtually constant at approximately 31,000” while the population increased by 16%, according to a 2011 Ontario Hospital Association document.

Rose says, for example, that occupancy rates in surgical critical care units, characterized by rapid turnover and short stays, should be about 75% to be efficient.

This kind of cooperation could also work when hospital crowding becomes excessive, for example when flu season hits, says Mike Tierney, vice-president for clinical programs at The Ottawa Hospital and one of the editors of Healthy Debate. What is needed is “an ability to look at hospital occupancy

Still, Schull does not advocate for more hospital beds. “It would be a mistake to add beds to a dysfunctional system,” he says.

Occupancy rates matter if you accept the premise that high rates lead to poor access for patients who need to be admitted from emergency departments, notes Michael Schull, an emergency room doctor at Sunnybrook who has published on wait times in emergency and overcrowding risks.

and bed availability across a region in real time, rather than each hospital trying their best to manage on their own

The sobering reality is that Ontario hospitals are tight for capacity largely because of the number of beds occupied by patients, most of them elderly, waiting for admission to another facility (such as rehabilitation or long-term care) or for support to return home.

Administrators at Health Sciences North in Ontario have discovered the benefit of very active cooperation between the 459 bed Ramsey Lake Health Centre (formerly the Sudbury Regional Hospital) and the local Community Care Access Centre (CCAC).

Working together, the result has been a reduction of ALC patients at the health centre from 133 to 78 in the period between September and December 2012, says David McNeil, vice president of clinical services and chief of nursing.

The challenge for the CCAC was to expand its capacity for community-based care, and some funding was received from the province for new programs including behavioural support and mobility programs. For its part, the hospital recruited a new geriatrician, gradually closed beds at the former Memorial Hospital site that had been used for ALC patients, and redirected money towards chronic disease management.

As well, community groups have been engaged “to help them understand that the hospital is no longer the centre of the universe,” McNeil says

Brock University history professor Maureen Lux has documented a part of this recent past in her new book, Separate Beds: A History of Indian Hospitals in Canada, which describes a period from the 1920s to 1980s, when the nation effectively had two health-care systems - one for aboriginals and one for everyone else.

In these hospitals, First Nations patients often received substandard care in facilities that were, in Lux's words, underfunded by design. Some patients were experimented on by surgeons using outdated and ineffective treatments for illness like tuberculosis, leaving them disfigured. "It was all part of an attempt, frankly, to prevent white Canadians from having to share hospital space with aboriginals," she said. Although there were so-called Indian hospitals prior to the mid-1940s, they didn't really take off until after the Second World War ended. This was the period where Canada began to move toward universal health care. While the politicians argued over what that might look like, federal funding was made available to build hospitals. Lux said that by 1948, that money created more than 46,000 new hospital beds in Canada. At the same time, the federal Indian Health Service was responsible for a separate, segregated hospital system for First Nations communities.

Unlike the facilities for non-aboriginal Canadians, these hospitals were not new buildings, but established in army bases Ottawa no longer needed. The pay for medical staffin these hospitals was low, attracting doctors and nurses who, Lux said, "could not get a job anywhere else." Lux tracked how tuberculosis patients were treated in these Indian hospitals compared to the rest of the nation, and the results are chilling. Prior to the 1950s there were few effective treatments for tuberculosis. Beyond bed rest, there were some surgical attempts, including deflating lungs and removing ribs, to halt the disease.

"But that was never very effective, but at the time there were no other options," Lux said. "But by the 1950s, you have effective antibiotics and instead of staying at the hospital, most times you were given your meds and sent home." Unless you were an aboriginal person. The prevailing attitude was that First Nations people could not be trusted to take their medications, so they were kept in hospital and, instead of using antibiotics, doctors continued to use ineffective, invasive treatments. In fact, First Nations people could not even use Canada's proper hospitals. Prior to national health care, Canadians still needed private health insurance. So if an aboriginal person came to a hospital, they were asked how they would pay. Usually the answer was the Indian Health Service, which only paid for treatment in Indian hospitals. Patients often died. If an aboriginal person was in a facility far from home, the federal government would only pay for them to be buried at the nearest grave yard, rather than be sent home for a funeral. Lux said many First Nations people were buried in unmarked graves in the back of graveyards as a result.

The decommissioning of this segregated system didn't start until 1968 with the arrival of universal health care, but some facilities continued to operate until the 1980s. Lux said in a few remote communities, a few of the hospitals still exist, although they operate more as medical clinics than hospitals. The point is there are First Nations Canadians alive today who were treated in those hospitals, and would have been subjected to poor, even dangerous, care simply because they were aboriginals. So when someone asks why, when it comes to First Nations issues, the past cannot be left in the past, you can tell them it's because that history is very much alive for many people. And until we learn to deal with the reality of that, nothing is going to change. Lux's book is available from the University of Toronto Press and on Amazon.

In Canada, it’s estimated between 56,000 and 63,000 people die as a result of medical errors and hospital-acquired infections – the second leading cause of death.

preventable medical errors are going to get worse if the Ontario government cuts hospital budgets and thousands more beds

To find out more about the June 4 conference go to: http://www.ochu.on.ca/conferences_conventions.html

If your finances permit, you can jump the queue for publicly funded nursing care and, in some cases, pay upwards of $5,000 per month to stay at a private facility.

And the public health authority Capital Health pays more than $1 million each year to a private clinic, Scotia Surgery, to perform hundreds of orthopedic operations.

The author and professor arrived armed with reports, information graphs and a copy of her book, Health Care in Canada: A Citizen’s Guide to Policy and Politics.