Friends and colleagues have often asked me over the years why I decided to come to Canada. particularly those who know of my close family relationships in the U.S. The answer is relatively simple. I felt that Canadian medicine represented the best of the British and of the American system, while avoiding the worst of both. Alas my opinion has changed over the years as I have seen the steady deterioration brought about by the politicization of health care. We have gone from being one of the best systems in the developed world to becoming one of the most poorly rated. The Canada Health Act has condemned Canadians to mediocre medicine at best, to shameful neglect at worst. Furthermore the hubris of elected officials has assured that Canadians have been prohibited from seeking health care privately as is available in most of the developed countries in the world. For the most part that has forced patients who are dissatisfied with the public system to go outside the country or to seek one of the low-profile sources that manage to exist because the prohibitions imposed by government are being challenged in the courts. Unfortunately, the administridiots now control medical care and have turned it into a political game in which votes come first and patient care comes last.
All of which is the introduction to one simple example I am going to share with you. Because, even in this age of pseudo-respect for confidentiality, nothing is private, I will avoid identifying persons in this story that a friend of mine shared with me very recently. The following account does not presume to record the actual clinical events in detail, but rather to give an overview of my interpretation of what Rose told me took place.
It was approaching midnight when Rose heard a loud clatter coming from the bedroom. It was unusual for Tom to still be clattering around at this time of night, so she went into the bedroom to see what might be going on. She was not a person who panicked easily, but when she saw her husband spasming on the bedroom floor, she panicked. Even under those circumstances she reacted quickly and efficiently. She called 911 and ran to his side to help in any way she could. By then, he had stopped seizing. The emergency response was timely and appropriate and Tom was taken to the nearest ER for management. Rose was not allowed to accompany him in the ambulance, so despite being thoroughly shaken up, prepared herself to drive to Emergency to be at her husband's side.
Fortunately her neighhbour had been disturbed by the ambulance and came rushing over to help.
"I think Tom has had a stroke and they are taking him to the Emergency Room. They won't let me ride in the ambulance so I am going to drive right over there now." said Rose.
"You can't drive anywhere in the state you're in. Let me grab my coat and I'll drive you to the emergency room."
She dropped Rose off by the entrance. Rose went in and introduced herself . The Doctor had seen Tom and had arranged an emergency CT scan as well as X-Rays and blood work. Many hours later, when the tests had been completed and interpreted, the doctor came over to talk to Rose.
"Your husband has two tumours," he said, "one in the brain, the other in his lung."
" Oh my God, what do we do now?" she asked, deeply distressed.
"He needs to be evaluated by a neuro-surgeon and we are going to set up an appointment. Meanwhile you can take him home now and we'll be in touch with you regarding the appointment."
"Will someone be seeing him tonight?" she asked.
"Oh no," said the doctor. "We will have to arrange an appointment. You can take him home now and we'll be in touch with you."
Rose felt a surge of panic welling up inside her."What if he has another seizure when I take him home?"
"We have started him on anti-convulsants and I will write you a prescription to keep him on, so that will probably keep things under control for the moment. If he did have anything further in the meantime just bring him back here."
Shaken badly Rose called a taxi and took her husband home so she could worry herself sick about him.
A week went by and Rose had heard nothing. She had to phone the Emergency Department and her family doctor who knew nothing about the event.
When I talked to Rose a few days later she finally had a date for the appointment which had not yet taken place. Her stress level remained as high as one would expect.
Now let me tell you how this would have been managed in the 'bad old days' when I was a family doctor:
The patient would have phoned the clinic her family doctor worked in, where a member of the group was on call on a twenty-four hour roster. The patient would have been patched through to the on- call doctor who would have met the patient in Emergency, examined him and prescribed what was necessary. This patient would undoubtedly have been ADMITTED to the hospital for observation and management and would have been seen as an emergency consultation by the neuro-surgeon in the morning, Meanwhile, the family knew the patient (yes, I still call them patients!) was at least in a setting where immediate attention would be available if necessary. Thus the patient was in a safe place where he would be appropriately monitored and the family/caregiver was relieved of some of the stress in a high stress situation.
These changes have come about because the administridiots that the Government put in charge of health care are more concerned with votes and appearances than with patients and they know it is easy to download the blame to the doctors and nurses and other health care workers on whose shoulders the whole system is carried.
Many people share stories like this one with me. If you have one you'd like to share, contact me. Obviously no identifying data would be published.