Wednesday, October 26, 2011

Unintended consequences: Democracy and the waiting room

Canadian health care story/question.

Earlier today I spent some time in a doctor's waiting room. I had arrived rather early (sometimes all the traffic lights do go your way) so I settled down with my ereader to while my time away. Waiting rooms are interesting places which can vary radically in the emotional dynamic from day to day. Sometimes there are anxious young parents (or at least anxious parents with young children) who feel guilty that their child may bothering other people in the room. Sometimes there are people who are clearly worried that the news the doctor is about to give them may be bad. There is usually someone who carries with them the aroma of tobacco smoke and next to whom no non-smoker wishes to sit.

Last time I was in that waiting room an elderly woman came in, clutching a plastic bag full of medications. I could hear her wheezing as she went to the receptionist and then I heard her reply that she was too confused right now to remember her own postal code. The receptionist took what information she could get and the woman sat down next to me. She was clearly disturbed and worried so I smiled and said a few words to her and soon she calmed down enough to tell me why she had come in for an "urgent care" visit. Her regular doctor was on maternity leave and so she had never been to this doctor before (which is why they didn't have all her information on file). Her seasonal asthma had flared up, her inhaler didn't seem to be giving her any relief and she was afraid she wouldn't be able to fly to visit her ailing mother if the problem wasn't brought under control. Soon she was telling us (me and spouse) about her mother and the hospital she was in and how much nursing had changed since she had been in training. And as her panic subsided, her breathing became easier and her respiration quieter. In a few minutes my name was called and I left her talking to spouse. My own visit was short since I was just getting the results of some lab tests and as I came back out they called her name and she smiled at me and waved as she went, in her turn, to see the doctor.

Today someone in the waiting room asked me about my ereader and in the course of the conversation I learned that she was an administrator at a heath care unit in a neighbouring community. The waiting room was unusually quiet for that time of day and she was musing about the problems of predicting patient loads. Then I got called back to see my doctor and when I came out she was no longer there.

As I drove home I began to think about the democracy of waiting rooms. Most of us will find ourselves, at one time or another, waiting anxiously in a room full of other people waiting anxiously. Waiting rooms are, for many of us, one of the few places we spend time with people from very different walks of life. What goes on in those waiting rooms tells us much about the society in which we live.

For example: I was in a doctor's waiting room in the US when a man came in who wanted to see the doctor. They would not schedule an appointment for the man, not because the doctor was not accepting new patients (he was) but because the man had no insurance. What he had, instead, was cash. He was willing to pay upfront to see the doctor. His request was denied. Until he could prove he had insurance he would have to go emergency at the nearest public hospital. He pled "but it isn't an emergency. It will take all day if they see me at all. I just want the doctor to...." I heard no more for the receptionist wasn't interested in what the man wanted or needed done. He had no insurance.

For example: I was in a room in emergency at a hospital in the US. My doctor had sent me there for a series to tests to rule out the worst case explanation of the wheezing/tickling in my lungs. I had been wired up and tested for one thing, blood had been drawn to test for something else, I had just had a CAT scan and now I was waiting to see the doctor. Through my door I could see a bedraggled elderly couple--her sitting on a stool and him the floor. She was crying and I gave them some tissues and learned that they had been waiting for 8 hours sitting on a stool and the floor. They were poor, from out of state and had no insurance. I sat in my private room (I had excellent health insurance through work) and waited in comfort for reports on my tests. They sat in the hall and finally someone came by and did something that looked and sounded painful to the suppurating lesion on her arm. Then my doctor came in, told me that there was nothing wrong, all the tests were negative and I was free to go. I checked out, paying a copay that was probably more money than that bedraggled couple had to their name.

Like most Canadians I have complaints about the short comings of our health care system--but the most important thing is that for the most part Canadians are all in the same boat. Canadians who are comfortably well off receive, for the most part, the same care as Canadians who are not. If there is a shortage of doctors wealth won't buy your way into a doctor's practice. If there is a shortage of rooms at the hospital wealth won't buy you a bed a poorer person can't lie on. When my American friends say, in condemnation, "you can't buy your way to the front of the line" I nod my head in agreement and approval. Because when you can't buy your way to the front of the line you are highly motivated to make sure that that line is never very long.


  1. I agree with you about Canada's health care system, but I think it's important to point out that in Canada we do not have free and equal access to all types of medical care--just M.D. and hospital visits. Prescription medications, which are essential for many people's care, are out of pocket. Ontario has a limited subsidy program for some medications, but there are tons of meds that the program just refuses to cover.

    I pay about $240/month for health care, and that's just for private medical insurance plus co-pays for prescription drugs. It was closer to $800/month when I didn't have the private insurance and did have psychotherapy costs. I am unemployed, so the money effectively comes from my (luckily well-off) parents' pockets. Because the Canada Health Act is limited to M.D.s (most psychotherapy is provided by psychologists and social workers) and hospitals, many people in Canada cannot get the care they need.

  2. Kiselileia: The problem with the lack of access has, I think, much to do with the fact that most Canadians are unaware of the facts you mention. As we have a generation of people who have grown up with what Americans like to call "socialized medicine" I find more and more Canadians shocked at the idea of having to pay out of pocket for medical supplies/needs.

    My hope is that because we all share the same waiting lines and waiting rooms that we will rebel at the evidences that we still seem of unequal access.

    BTW, re drugs -- have you looked into your alumni association? When I returned to Canada from the US I looked into plans that would help to underwrite any costs I might incur and found that I could buy very affordable prescription care coverage through my alumni association. Though I will be honest the first thing that struck me was that almost every drug in Canada was dirt cheap compared to the cost of the same drug in the US.

  3. Hmm, I have not looked into whether my alumni association has coverage. It's worth checking out. I currently have a plan that accepts people coming off of group plans (the student association one, in my case) without a medical assessment, but I'm paying $150/month and have a 20% co-pay on my prescriptions. Thanks for the information.

  4. I'm rather surprised at your story of a U.S. doctor's office that wouldn't see a man paying cash. Indeed, I find it unbelievable. It has been my experience in states from California to Louisiana that doctor's offices really PREFER cash-paying patients, because then they don't have the hassle of dealing with insurance paperwork. The California clinic I went to in fact gave you a steep discount for paying cash *on time*.

  5. @dragoness-e: They might prefer if you pay cash -- but only if you are someone who has insurance. The problem is that you may have enough cash to pay for a small procedure but what it the results of that procedure indicate you need something major.

    So, if you have insurance they love your cash.

    Remember, that generally those who don't have insurance also don't have jobs. And people who don't have jobs tend not to pay their bills. And Doctors find it difficult to walk away from people who don't have the money but do need the care. So, to solve the problem, don't see the person without insurance.

    If you do some research on the net you will find that quite a number of doctors will only accept cash if you also have a credit card and they can run a credit check on you first. Others don't feel like going through all of that.


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