Last week's show was all about medical hotspots.  The people who live in hotspots visit doctors and hospitals way more than the people who live just across the street.  On the show, I toured Saskatoon's core neighborhoods - a medical hotspot if there ever was one.  A study by Saskatchewan Health Region a few years back found this part of Saskatoon has much higher rates of diabetes, depression, addiction, sexually transmitted diseases and hepatitis C.  The infant mortality rate there is higher than war-torn Bosnia - much of that due to very low rates of immunization.  But this was not a bad news show.  I toured SWITCH - a clinic run by students that addresses not just the medical needs of local residents but all the other things that often play a bigger role in keeping them healthy - things like housing, good nutrition and a job.  I also toured Station 20 West, an innovative community center that opened in October that addresses many of the same needs.  We got a lot of positive comments from you.

Victor Van Buskirk, Victoria
"I just wanted to thank CBC and you, Brian Goldman, for an "out of the box" program. Very much appreciated."

Jessica Tichenor, Bowen island, British Columbia:
"I enjoyed this program which prompted me (as a former RN who worked in ERs) to ask why hospital ERs don't partner with walk in clinics so that non-emergent patients can be seen in a more appropriate setting for their needs.  An adjacent walk in clinic would better allow a patient to self select a provider or have a triage nurse do so.  If the clinic MD (or nurse practitioner) decides the ER is more appropriate, a referral there would be quick and easy.  Surely if private operators are now able to provide food and other services in Canada's hospitals, it should be possible to accommodate a privately owned walk in clinic either within or in close proximity to an ER. Keep up your great programming!"

Stephanie Sydiaha, Saskatoon:
"Thanks so much for profiling this story, we are very proud of it. I need to point out that the Community Clinics in Saskatchewan have been providing an integrated approach to health care since their birth during the Saskatchewan doctors strike in 1962. This is not to take away from the story about recent developments in the core of Saskatoon, but it's important to remember that these ideas were at the heart of the first universal health care system in Canada, first offered in Saskatchewan.  This model became a national model, which we are now fighting to save. I have a reaction to the guru highlighted in your program saying this is a new approach.  My point is it's not a new approach at all, and has been successfully carried out in Saskatchewan for 50 years.  Whenever I hear stories about health care professionals trying to figure out how to develop integrated approaches to health, I can never understand why Saskatchewan's experience is not highlighted.  The only reason I can come up with is that in Canada, the common perception is that nothing important happens in Saskatchewan, and we are simply lumped in with "the west" as a resource based economy that only values money.  It's simply not the case. Community Clinics continue to offer an integrated approach to its services, and work tirelessly to make the connections between the economic and social determinants of health.  Saskatchewan's contributions to Canada remain cutting edge, and we are very proud that helping our neighbours remains a core value. Saskatoon is also the first community in Canada where a co-housing unit has recently opened for seniors.  Our cooperative spirit is alive and well."

Many of you wrote in from other parts of Canada to say "me, too!"

Jack Rach, Winnipeg:
"I heard the piece on medical hotspots on Saturday and thought it was great. I thought I'd mention that Manitoba Centre for Health Policy research often focuses on this using anonymized data for all of Manitoba. Much, if not all, of the research done here finds that the poorest people in Manitoba often use the most healthcare services."

Colleen Kennelly, Forest, Ontario:
"I was very impressed with the episode on medical hotspots.  I am a nurse practitioner in a rural Community Health Centre in southwestern Ontario.  Our CHC has sites in two small towns, a First Nations Community as well as an area of a city which has many marginalized people.  As I listened to the program, I felt you were talking about the CHC model of care which is driven by trying to help meet our patients' needs in a way that recognizes the social determinants of health.  Our clinical team is interprofessional and very collaborative.  We have many partnerships with a variety of social service agencies and all work tirelessly to link our patients to these services. There are over 100 CHCs  as well as many Aboriginal Health Access Centres in Ontario as well as many across world. I heard some great ideas on your show that could help us move the bar higher. The model is here and growing and I was so pleased to hear your show to help know we are on the right track!  Thanks again for your awesome show."

Anne Guilar, Toronto:
"I listened to your episode on disruptive change and almost thought you were talking about my work place. Like the clinic in Saskatoon, Ontario too has interdisciplinary clinics to meet the needs of complex clients that often end up in ER., fall though  the cracks, and generally cost the healthcare system the most.  I am talking about the recently launched Centre for Complex Diabetes Care (CCDC). There are currently six such centres across Ontario at this time. I am working as a registered dietitian with an interdisciplinary team  at a CCDC that is hosted by North York General Hospital and sees clients from across the Central Local Health Integrative Network (LHIN). Our clients are people with diabetes with who have many barriers to care that can benefit from intensive support from an experienced team that has social workers, nurse practitioners, nurses, dietitians, pharmacist and others. Working together with our clients we have had tremendous success in meeting the complex needs of people with diabetes. We have many stories to tell of clients who, with the support a CCDC can give, have stayed out of the ER, brought their diabetes under control and improved their quality of life."

Carly Ptashnick, Montreal:
"Hot spots: no surprises there! I am amazed that people don't seem to get the link between overworked ERs and underfunded general practitioners. I don't have a family doctor, and I have lived in Montreal for almost a decade now. When people do not have a family doctor, where do they end up when they have a problem? They go to the ER. This is like calling 911 to complain about getting a speeding ticket. It is a waste of our public resources and tax dollars. We need to stop dismantling our public healthcare system from the bottom up- only when every citizen has a family doctor will the bottlenecks at the ER stop."

Dr. David Maxwell, Halifax:
"Your program on Saskatoon reminded me of our experience when my mother came to Canada, with two little children, in 1944. She came from a very proper Victorian background. We stopped in Saskatoon for several weeks on our way to B.C., and she sent back a letter to her mother. When this arrived it was postmarked:  "Saskatoon, Canada; Help Stamp out Syphilis"!  So Saskatoon has been at the forefront in health care for a long time."

Indeed it has, David. 

Thanks to all of you who commented on the show.