The Sick Reality of Canadian Health Care
What does it take to get a clean bill of health in our two-tiered health-care system? Luc Bouchard found out first-hand why being a “patient” patient could be a life-threatening decision.
We have to operate, Mr. Bouchard. Your arteries are clogged in five different spots.”
The cardiologist is talking to me, but his eyes are fixed on a screen. “In some places, the blockage is up to 80 percent.”
A cold sweat comes over me. This can’t be happening, I think. I’m naked under a flimsy blue hospital gown. They’ve stuck electrodes to my body; a catheter in my arm. I didn’t sign up for any of this. All I wanted was to do my job.
The doctor turns away to confer with his staff. I’m overwhelmed by a fantasy of a scalpel slicing into my chest. “Please,” I cry out, my voice trembling. Everyone turns to stare at me. “Be careful,” I say. “As careful as you’d be with your wife or your child.”
“I’ll do better than that,” the doctor assures me, solemnly. “I’ll be as careful as I’d be with my own body.”
Three months ago, I was just a journalist setting out to answer a very simple question: How easy is it to get a medical checkup in our two-tiered health-care system? The idea for the article came to me after a friend of mine suffered a massive stroke and died. I am 45. He was just a few years older than me.
I like to think I’m relatively active for a guy of my age, although lately I have spent more time watching sports than playing them (and typically with beer and some chicken wings). At my last checkup, over two years ago, I learned that my triglyceride level was dangerously high and my blood-glucose level put me at risk for diabetes. My doctor also seemed concerned about my family history of diabetes, high cholesterol, hypertension and cancer. But to be honest, I wasn’t really paying attention.
Then my friend died.
Overnight, I became desperate to see my family physician. And, since journalism is in my blood, I started to wonder: What if I didn’t have a doctor? After all, that’s the case for more than 1.8 million people in Quebec, where I live – and 4.3 million in Canada overall. How long would it take to see a doctor? Would the wait times be shorter at a private clinic, and if so, at what extra cost? Would the quality of care be better?
I phone my family doctor’s office and set up an appointment for 43 days hence – the soonest slot available.
Next, I switch gears and pretend, for the purposes of my story, that I don’t have a family doctor. I call the government’s health-information hotline and explain to the woman on the phone that I want to make an appointment for a checkup.
“Do you have any symptoms?” she asks.
I falter. “Well, no. But I want to make sure everything’s okay.”
“If you have symptoms, go to a walk-in clinic,” she informs me curtly. “Otherwise, it’s going to be difficult.”
Bright and early the next day, I hit the emergency room of the nearest hospital: the Sherbrooke University Hospital Centre. After waiting for an hour, I’m seen by a kind woman who imparts her advice gently. “What you’re describing isn’t an emergency,” she says. “Don’t waste your time waiting here. It could be hours before you see a doctor.” She suggests that I head to a walk-in clinic downtown where certain doctors are accepting new patients.
At the walk-in clinic, the front room is packed with a mix of impatient and resigned faces. I take a number and wait my turn to register. After two hours, I approach the receptionist’s counter to ask how much longer it will be. She snaps back that it’s not her job to manage the wait time. I give it one more hour, then leave. I have another appointment: with my dentist!
I return to the same clinic the next day. It takes only thirty minutes for the receptionist to call my number.
“It’s for a checkup,” I tell her, brightly.
She stares at me. “This is an emergency clinic,” she says.
“Please,” I beg. I explain about my triglyceride levels and my family history. I tell her that my friend died recently, without any warning, and that I’m scared. “I just want to make sure everything’s okay,” I plead.
The receptionist sighs. Eventually, she makes an appointment for me. “The doctor may agree to see you today,” she says, “but this doesn’t make him your regular family doctor, understand?”
After another hour of waiting-room hell, finally my name is called and I am led into an examining room. Sitting at the desk is a real live doctor.
And he refuses to help me.
“I can’t do it,” he explains. “If I give you these tests, then I’ll have to take you on as my patient, and that’s just not my specialty; I work in emergency medicine.”
“However,” he continues, closing the door, “I do know a place where they could see you right away.”
I perk up. “Where’s that?”
“The third window at the front counter. Right next to reception.”
“You’re suggesting a private clinic?” I ask.
“It might be worth paying, this one time,” he shrugs. “You’d get the reassurance you need while you’re waiting to find a permanent doctor.”
I hesitate. I’ve never been keen on the idea of a two-tiered health-care system, but then again, this is research for an article. I set my principles aside and, for just $295, I “purchase” a family doctor.
Five days later, I return to the two-tiered clinic for my appointment. The waiting room is just as full of pale faces and persistent coughs as it was before. Without taking a number, I go straight to the third window. A few minutes later, I’m led to a well-appointed office and seen by a former ER doctor who explains that he gave up on the public health system because it prevented him from practising family medicine the way he saw fit.
He listens to me attentively, asking questions about everything from my hygiene and lifestyle to my emotional well-being, to my family history of illness.
“Genetics can tell you a lot about a person’s specific health risks,” he tells me during my head-to-toe physical exam.
Sixty-six minutes later, I leave with a request for a full blood workup. Ironically, I must take these tests within the public system – the university hospital, to be specific – at the taxpayer’s expense. The doctor promises to call as soon as he gets my test results.
The last step in my research involves delving into the world of private medicine. I call three high-end Montreal clinics, each of which guarantees fast, efficient, personalized service.
I choose an establishment that promises a complete checkup with results in five hours. I’m impressed by the list of investigations: biochemical profiling, blood work, lipid tests, abdominal ultrasound, electrocardiogram (ECG), nutritional analysis, physical exam and tests of my vision, lung capacity, hearing and stress level. I’m less impressed with the price tag: $1,250. For that kind of money, I could fly to Buenos Aires and back, buy groceries for the next three months or spend a week at an all-inclusive resort in Cuba.
When I return to the private clinic for my appointment, I’m greeted like a VIP. A slim, energetic young woman has been assigned to my case. She spends the entire morning guiding me through the clinic’s medical departments: cardiology, audiometry, radiology, spirometry… It’s almost noon by the time I’m led into the doctor’s office to hear the results. The doctor sits silent, reading the chart.
“What is it?” I ask.
She hesitates a moment. My triglyceride levels are very high, she tells me. And I may be starting to suffer from diabetes. And…
“And?” I prompt.
“Your electrocardiogram indicates that you have a left bundle branch block,” she says slowly, pronouncing each word carefully.
“A what block?”
“It’s an anomaly of the heart’s electrical conduction system and it prevents us from interpreting your ECG reliably. We need to run a few more tests, including a MIBI.”
I want to ask if I should be afraid, but I’m too afraid to ask.
I leave feeling completely drained, loaded down with recommendations and directives, including one for a nuclear-medicine exam for my “left bundle branch block.” What on Earth is that, anyway? An evening surfing the Web provides only fragmented answers: “A left bundle branch block may indicate the presence of a severe heart condition.”
And a MIBI? “A nuclear-medicine test, the purpose of which is to detect and evaluate myocardial ischemia.” Ischemia? “An interruption or decrease in blood flow to an organ.”
I sit straight up. That sounds suspiciously like a heart attack. Am I a ticking time bomb? I immediately start calling different hospitals for an appointment and manage to get one at the university hospital. The wait time is 12 days.
Twelve long worry-filled days later, I’m injected with a radioactive substance. A gigantic camera is inserted into my mouth. Shots of my heart are taken. The next day, they do it all again but this time I’m asked to walk on a treadmill for a few moments first, to see how my heart deals with the exertion.
Generally, the hospital is supposed to send my test results to the private clinic in Montreal and I’m supposed to wait patiently at home for the clinic to call. But the worry is killing me. I go to the hospital and pick up a copy of my test results in person.
What I read makes the hair on the back of my neck stand on end: “Ischemia, reversible ventricular dilatation, signs of severity.” I don’t understand most of the medical jargon, but I know something is wrong with my heart.
To hell with my article about our health-care system, I decide – I could die of a heart attack at any moment. In a panic, I phone a friend who is a doctor. She confirms my fears about the seriousness of my condition and promises to put me in touch with a cardiologist she knows.
Some days later, my doctor friend still hasn’t heard from the cardiologist she knows and she’s getting nervous. “Do you have any chest pain?” she asks.
I’m about to say no, but then I realize that yes, I do have some pain in my chest. I actually get it all the time; I just always figured it was my asthma, or stress or indigestion. Suddenly, because of the test results and my anxiety-inducing Internet research, I decide to stop self-diagnosing.
“Go to the emergency room,” she orders. Diabetics, my friend would later tell me, often have “silent” heart attacks because their diabetes renders them insensitive to chest pain.
I race to my car, MIBI scan and blood-test results in hand. When I get to the university hospital, it occurs to me that it’s been 37 days since I started researching my article; 37 days since that nice lady gently suggested I go elsewhere. This time, I have everyone’s attention. Funny how something as simple as chest pain can unleash such a flurry of activity in an emergency room.
I am plastered with electrodes and placed under observation. A nurse asks me to evaluate the intensity of the pain in my chest on a scale of one to ten, and I give it somewhere between three and four. When she sprays nitroglycerine under my tongue, the pain drops away to one. “That’s not a good sign,” the nurse says grimly.
Hospitalized, I spend the next four days undergoing a battery of tests. Everyone remarks that I don’t look the least bit sick. Even as I’m being wheeled into the operating theatre, one of the cardiologists speculates that they won’t find anything. “You don’t have angina and all your ECGs are clear,” he states. “I wouldn’t be surprised if your coronary angiography is negative.”
He couldn’t have been more wrong.
A few hours later, I emerge with three stents in my arteries. “Consider yourself lucky,” says the same cardiologist. “You could have been two years, two months or two hours away from a major heart attack.”
Ironically, I’m released from hospital the day before I’m due to see my family physician – the very first appointment I made, before this whole ordeal started. The past 42 days have changed my life. My outlook on our medical system and my view of myself will never be the same. Like a lot of men, I more or less consciously chose to ignore the signs that I needed to make significant lifestyle changes. Not anymore.
As for our health-care system: It is clearly capable of the best and the worst. It can save a life with remarkable efficiency, or allow people who are dangerously sick to fall through the cracks. Canadians are constantly being promised improvements in family medicine and reductions in wait times, but as things stand, even if I had been “lucky” enough to have a family doctor, I would have had to wait a month and a half before my health assessment could even begin.
The crazy part is that I can’t even sing the praises of private care. Remember the first private doctor I saw, at a cost of $295? For all his sensitive questions and holistic care, he did not order a stress test on a treadmill. As for the fancy private clinic whose VIP treatment helped me uncover my left bundle branch block, believe it or not, they never received the results of my hospital exams, thanks to a spectacular administrative mix-up. And no one seemed remotely concerned about it until I reminded them, five months later (as I was finalizing this article), that I was still waiting to hear from them.
Journalists like me undertake assignments like this in order to bring you answers. But all I have now is a slew of impossible questions. What if I didn’t have the means to pay for a private consultation? What if I didn’t have a friend who is a doctor? How long would I have been stuck on waiting lists? Would my family doctor have found my left bundle branch block?
If I hadn’t been so pushy – if I had been a “patient” patient – would I have wound up dead?