The View from Dromore

Recently, I was visited by an old friend from Dromore, Ontario, Canada. During his visit I had occasion to see my doctor because of an infection on my left ankle that was not responding to home treatment. Because it resulted from a quite minor scrape, I expected it to heal in a few days. A month later it was getting worse, so I called my Doc around 11AM Wednesday and was given an appointment at 10AM Thursday. I had a followup a week later, and he was quite pleased with the progress of the treatment (antibiotics and hydrogen peroxide soaks).

Following is the impression this made on my visitor:

Duane,

During my recent visit to Michigan, I was totally shocked by your ability to get a doctor’s appointment on short notice. If the American health care system is “broken”, I didn’t see it. It may be expensive, but it would appear to work the way most people would want it to work. It doesn’t matter what your problem was (not immediately life-threatening – apparently easily resolvable with antibiotics), what struck me was the speed with which you got a doctor’s appointment. I think you said you called on Wednesday and had an appointment on Thursday – unheard of in Canada in my experience. You also lost very little time from work. The appointment was at 10:00 and you were probably back at your desk by 10:30. It would appear that when you make an appointment for 10:00, the doctor actually sees you at 10:00. Interesting concept.

It made me reflect upon what would have happened to me in a similar situation under the Canadian government-run single-payer system.

First off, I have a “family” doctor and have had for over 30 years. That immediately puts me in a rather unique position. Neither he, nor any of the other doctors in my area are accepting new patients unless a current patient dies or moves away – the wait-list is years long. My doctor, who used to have his own office, is now part of a government-mandated Local Healthcare Integrated Network (LHIN) – i.e. a clinic, composed of local docs and supported by a number of nurses and nurse practitioners (a relatively new breed – registered nurses who have taken additional training and are allowed to do certain things normally done only by doctors) as well as a common administrative staff.

So, let us assume that I had a relatively minor problem similar to yours. What would my options be under the Canadian system?

There are four: 1) Ignore the problem, cross your fingers and hope it goes away on its own – an option I have taken in many cases; 2) Ask for an appointment with “my” doctor – and be prepared to wait a couple of months (not that dissimilar to option 1); 3) Ask for an appointment with any doctor at the clinic and be prepared to wait for a couple of weeks; and 4) Go to the emergency at the local hospital and bring a copy of Tolstoy’s War and Peace with you as you are likely to be able to get most of the way through it while you sit in the crowded waiting room for several hours.

At the emergency, there is a one-in-six (we have six local docs) chance that I will actually see my own doctor because they are mandated to supply emergency room service on a rotating basis (I am in a rural area – this may not be true in an urban area).

In defense of the system, the common administrative staff and records at the clinic means that any doctor has complete access to my medical history. How much time they may have to review that information before seeing me is open to question. Nonetheless, it seems mildly efficient.

Also in defense of the system, if I was exhibiting symptoms of a truly serious nature (arriving at the emergency carrying a severed limb, bleeding from the ears, chest pains, etc.), I would move to the express line and would probably be seen fairly quickly.

The vagaries of our Canadian system means that I normally take option 1 (ignore the problem) or option 4 (go to the emergency). Options 2 and 3 are not really viable options.

Having said all that, no matter what my situation may be, I only need to present a health card, not a credit card. It’s “free” in the sense that I’ve already paid for it through my taxes. I will never be bankrupted or even majorly affected in financial terms by my health situation.

Again, I was impressed by your ability to get quick medical attention from your own doctor. If Americans want to experience my situation, go ahead, but I’m not sure you’ll be all that happy with the resulting process.

Rationing of services and extended wait-times are the real prices you will pay for a government-run system. Cheaper? – probably (although I question the government’s (either yours or mine) ability to run anything either efficiently or effectively). Better? – you decide.

As to the expense, it was paid for by insurance and, having given my insurance particulars many years ago, I did not need to present any card. This does not mean that I like the idea of employer-based health care, or that I had not been paying (tax exempt) premiums. Still, the visit was simple and easy, including scheduling the followup appointment.

Finally, it turns out that options 1 through 3, above, would have been pretty bad choices. The Doc explained that if the infection spread to my Achilles tendon I would have been in for significant difficulty and the insurance company in for significantly greater expense.

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