Building on local strengths key to cooling medical hot spotsAn intriguing idea was recently put forward by the Government of Saskatchewan, that of addressing medical hot spots. It has been reported that just five people were responsible for visiting Saskatchewan emergency rooms over 500 times in the last year.  One patient alone is said to have required over one million dollars in health services.A report earlier this summer showed that just 20 individuals in Saskatoon were costing a total of two million dollars per year in health and social services. With a third of Saskatchewan's health expenditures going to serve just one percent of patients, it's no wonder the government is wanting to explore a different approach to health services.Saskatchewan is not alone in this concern.  Provinces and regions across the country are sitting up and taking notice too.  Tightening health budgets across the country are leading people to take a different look at just where health care dollars are flowing.The term, health care 'super utilizers' or 'super users,' was first coined by Dr. Jeff Brenner of Camden, New Jersey to describe individuals who, despite very high levels of health intervention and expense, are still suffering from very ill health.  His work also outlines the existence of 'medical hot spots' -- specific areas in a community that often incur the highest health bills.The proposal from the Saskatchewan government to focus on medical hot spots and health care super-utilizers opens a fascinating dialogue about how we could re-imagine health care to be more effective, more equitable, and cost less, both in the province and across the country.Surely there must be a way to help those most in need that is more effective and less expensive.Some of the answers may come from innovative models developed elsewhere. Dr. Brenner and others have used regular interdisciplinary team huddles, community-engaged outreach workers, and other creative means of adjusting the rigid world of health care delivery to meet the complex and chaotic needs of patients. There is indeed much we can learn from these successes, but before we import too much from afar, we have some success stories of our own too, including from my neighbourhood on the West Side of Saskatoon.In an interview on medical hot spots on an episode of CBC's Black Coat White Art that described this area of Saskatoon as exactly such a hot spot, Dr. Brenner referred to two local initiatives – Station 20 West and SWITCH –