Be forewarned: this is a multiple segment posting. The first part I wrote several weeks ago after I thought I was done with my first round of working within the Canadian health system. In fact, I wrote up the first part on the way back from my 2nd visit to the health clinic in the very coffee shop where I am now writing. However, upon returning to the apartment, I found a note which prompted part 2 and changed my overall perception of things.
The first post; written on July 13, 2007
Pre-Part X or I have (no) insurance?
So, it was a dark and stormy night. Well…not quite. But my stomach was hurting near my naval and it was hurting bad. We’d just finished moving and the pain was acute. So I had to do something.
Ana asked HR about what I should do. They realized we should be covered but nobody had put us in the system. And that, while our forms went through, we should pay out of pocket and would get reimbursed at a later date. No problem. And, it would give me the chance to see some things first hand.
Where to go? Toronto is currently understaffed with medical professionals. Finding a doctor can take time. You have to call around and find one who is currently taking patients. So, if you don’t have a doctor, as I don’t, you go to the walk-in clinic.
I find a list. The closest is not far from the house. So I pack up some reading material and head out. Only to get lost. Nobody can tell me where the clinic is. I’m in the right building, but I can’t find a map. After wandering a bit, I do locate a small tri-fold map in a stand in the basement of the building and manage to locate it on the top floor. Glad I wasn’t bleeding or they would have had a hell of a mess to clean up…
So, up the stairs and to reception. The nice lady says, “Just go to the left and give them your Health Card.”
“Urm…I don’t have a health card. But I do have insurance, but haven’t received that yet either.”
“Oh, no problem. Just pay them via credit card.”
Okay, let’s go in.
Section A: Getting to Dr. Pokey-finger
So, I’m officially within the confines of the clinic (no longer standing outside in the pseudo-mall that is First Canadian Center) and looking through a plexiglas window at a gentleman. He says, “What do you need?”
I say, “I need to see a doctor for some abdominal pain.”
He says, “Eh?”
So, I lean down, way down, kind of sticking my butt out and say, through the small metal mesh, “I need to see a doctor for some abdominal pain.”
“Oh,” he says, “Let me see your Health Card.”
Well, we then go through the explanation that I don’t have one and will have to pay out of pocket. Blah, blah, blah. “Have a seat.”
Sitting down to read a bit, I look around the room. This isn’t my idea of a clinic. Some of these people are wearing three piece suits. Nobody looks destitute on any level. There doesn’t seem to be the same view of public health clinics I think exists in the States.
After a bit of a wait, they call me back. The nurse comes in and asks my info (no blood pressure or weight check) such as allergies and symptoms. I give her the basics and she says the doctor will see me soon.
Soon must be Canadian slang for next week because that is what it felt like. But, she finally did arrive and I hopped up on the table and unbuttoned my shirt.
Now, the pain I was having was located around or in my naval. Sometimes it was pretty bad. Kind of like my belly button decided to pop off and roll around on the floor. Fortunately, it didn’t, but was throwing a tantrum over the lack of freedom.
Dr….well, let’s just stick with Pokey-finger said, “I think it might be a hernia.” Which I already knew because a friend of mine had just had hernia surgery for pain in the exact same spot and, upon comparing symptoms, he said, “Yeah, you need to see a Dr. now. Don’t put it off.”
She then decided there was gold and jewels hiding in the nether portions of my naval and did the best job she could to find them. She probed DEEP. Very DEEP. It was excruciating. I came close to falsely admitting I was part of the war on terror when I remembered I wasn’t in Gitmo, but on an examination table in Toronto. No, I’m not playing that up. (Well, maybe a little)
Dr. Pokey-finger said, “Well, I can’t find it.” As I lay there cringing. “But, it sounds like a hernia. Since you’re paying out of pocket, let’s just send you to get the stitches instead of having to pay for the ultrasound.”
Slowly, between the bouts of weeping, I explained that I did have insurance but was paying out of pocket until we got our cards and such. So, she decided to send me for an ultrasound and turned to flee the room. I stopped her with a few quick questions which she said she couldn’t answer and left to get me a referral.
Out to reception. Payed $65 and then I limped home.
End of part one.
Section B: The Ultrasound
There is a story about how difficult it was to find the ultrasound center, but it is just too long. The short form is: I walked around downtown trying to find a number for ANY of the businesses. The road I was on had so many large buildings they all had numbers on the perpendicular roads which were much larger streets than the one on which the center was located. Finally asked a deliver guy who said, “I wish I had $5 every time someone asked me that. I bet I get that exact questions three times a day.” I believe it, it was a pain.
Off to the building, up to the floor and into the waiting room. Pay $171 (they had said it would be $275 on the phone) and into the changing room. Down to the skivvies and into the robe. Lock up my backpack and off to the area that looks like a living room only there are two women who are clothed and I’m not wearing much. Okay, interesting, I can deal with this. At least I’m wearing a robe.
After a ten minute wait I get called in. They goop me up and pull out the little bar-code scanning-like thingy and I get to look at my individual organs on the monitor. “Breathe in and hold. There’s your gall-bladder.” Looks like I swallowed a baseball. Cool.
Over on one side, over on the other. On your back. Now, she’s scanning down the center line of my abdominal muscles. I can actually see the individual overlapping muscles. Then a good amount of focus on my naval area. My eye couldn’t see any gaping holes, but then I am not trained and was looking at the screen upside down and puffed up like a blowfish most of the time.
And…we’re done. Thank you very much. The doctor will call you in 3-5 business days.
Back into my clothes and I have to find food. It is almost 11 and I haven’t had anything to eat since before midnight. Lashing down my inner-cannibal I manage not to eat any of the tasty looking members of society until I find a Quizno’s open (most places don’t open for lunch until 11:30) and pounced on a sub with all claws extended. Mmmmm….calories.
Now it is time to wait.
Section C: Could I get a call?/Good news
After more than a week had passed, I decided to call the clinic. Ha! Good luck finding it on the website. Realizing, no matter that I am really good at finding things on the net, this website is certainly designed to foil the best of us. So I call them up and, on the third try, manage to get a human being. This human being says, “Nobody is answering, can I take a message.” Sure.
They call back and I am told, “Your test came back negative for a hernia.” Okay, what do I do now? “Well, go see a doctor.”
Great. So I grab up my backpack and take off for the clinic. Sign in, tell the same guy through the same grate who I am. Then wait (though this wait was much less) and I saw a different doctor. Repeat most of the early experience without the horrid probing. The doctors says “You probably pulled something in your abdominal walls. Just take care and give it time to heal. Let pain be your guide.”
Fortunately, I just read an article about arthroscopic knee surgery. The article said that most of this type of surgery has no benefit for the patient other than making them rest and rehab the joint for a few weeks. Something which should always be done first since the surgery is invasive and does carry risk. That article carries some weight for me. Since I would have been down 4-6 weeks with simple hernia surgery, I’ve decided to just kick back until the beginning of August before considering any training or serious physical effort. Let the body heal up before starting to break it down again.
I’ll limit myself to groceries and carrying my backpack full of books and my laptop to the coffee shop for the time being.
Conclusions (part the first)
Not a bad system, though I’ve only touched a snowball on a glacier. Overall, my experience, if I had been paying out of pocket with no hope of reimbursement, would have been around $300. We could absorb that without hurting ourselves. It just means I would have to put off buying a Wii for another month or two (if Ana will ever let me buy a friggin’ Wii), but not a serious financial hit.
But, the original doctor wanted to send me straight to surgery to save some money. All of $171. If I hadn’t had insurance, how much would the surgery have cost? I’m sure it would have been quite a bit more. And I would have had stitches and local anesthesia and the whole ball game.
Add to that the fact that the ultrasound came back negative. Admitting the person who gave the ultrasound could have missed something or not known her job well, I could still have a very small tear. But I think it kind of doubtful.
How much would that hurt a family who is on limited means? That kind of burden could be a month’s groceries. Easily. So far, I’m not entirely certain it is a better system. But it is something I’m certain to experience as I progress in this society. Once we buy a house, we’ll find doctors close to home or work. And I’m certain I’ll have some more small injuries over time.
Time to leave the coffee shop, meet the wife and start the weekend. Adios.
The second post: July 27, 2007 (two weeks later)
Well, let’s follow what happened since the first post. I went home, planning to post part 1. However, upon getting the mail, I discover a letter from the clinic. Inside is a letter sending me to a local hernia clinic. Which left me saying, “What????”
I made several phone calls, none of which was able to get anyone who could tell me what was happening. As a result, I had to just wait until Monday morning to find out more information. It was not a short weekend.
Monday I call the clinic and ask if someone can give me some information. They took my name and number and said they would look into it. A few hours later, I got a call from the lady who wrote the referral. What I find out is she did not know there was a referral for an ultrasound. Her referral simply said I needed to be scheduled for surgery and the only place I could work with was this particular center.
She did tell me that if the ultrasound came back negative, I should not go to the hernia center, but should just wait out the pain and see if it subsides. Something I had already figured on prior to the weekend.
Updated conclusions
As you can read above, up to the 13th I was pretty happy with the system. Different from my experiences in the States, but I had a personal doctor and knew the system. Centralization can make most things easier and more comfortable.
However, after getting the letter and bouncing back into limbo, I can only conclude the system here does suffer from an over-abundance of beaurocracy. Without a central figure to help manage things, it seems you can get misinformation in the shuffle.
I’m not slamming the system as a result. I have cranked the grade down a bit, not quite the B+ I would have given it before, but still above average. Yet there is a more pressing thought about this type of scenario. Why I don’t know if national health care is possible in the States.
Being truthful, the Canadians have it together. I have not waited overly long in any government line. I can always get someone helpful on the phone if I have questions. In fact, almost every aspect of the every government agency, so far, has made the US system look like something from 17th century Antarctica (though I think the Penguins could do a better job) and is a bit embarrassing by comparison.
If this system is so well funded and the people seem to be very serious about the jobs they do (not to mention easy to speak with, patient and knowledgeable) and still has some problems, what will a US national health system look like? Considering how poorly our government would fund such a system (do you really think the hard-line conservatives wouldn’t fight to keep it from getting the $s to do the job right?) and the number of ambulance chasers who will be drooling to sue every time the slightest mistake occurs, how could it possibly launch with great success? And the scope of the US is massive. Almost better to start it up in major cities and roll out from there.
Please don’t get me wrong. I’m not against the US developing such a system. But the few cracks I see here will be chasms there. Make certain you have a good doctor and be ready with a major alotment of patience.