As much as we may cherish Canada's public healthcare system, it's in desperate need of an overhaul.
When a specialist physician recently emanated an aura of irritation, dismissed my doctor's referral because he couldn't decipher the handwriting, and asked me to verbally justify why I had been sent to him or risk being rejected for treatment, it became obvious that this was not patient-focused healthcare provision.
Canadians are privileged to have access to a public system of healthcare, in which most fees are socialized. We hear constant horror stories from the USA of people succumbing to preventable and/or treatable illnesses, as those on low incomes often cannot afford private healthcare. You've likely seen crowdfunding efforts, shared on social media, of Americans who required emergency treatment and subsequently received a bill in the five or six figures, resulting in a financial crisis for that person's family.
Although such scenarios are thankfully mostly alien to us here in Canada, our healthcare system remains fundamentally problematic in other ways. As I noted in a previous column, only 71 percent of medically-necessary services are covered by our public system. When Canadians develop health issues above their neck be it dentistry, optometry, audiology, psychiatry, etc. they can end up in the same financial situation as our neighbours to the south.
Unfortunately the problems don't cease there Canada's public health system is also riddled by the lack of an emphasis on patient satisfaction.
What do I mean by this? One problem is that patients often find themselves having to shepherd their own care, especially if they aren't registered with a general physician (or "family doctor"). 4.8 million Canadians did not have a GP in 2019, meaning they visited drop-in clinics, where care can be especially myopic and issue-based, rather than holistic. But even for patients lucky enough to access a regular physician, they can feel rushed and taken for granted. Patients are often informed of test results over the phone by a receptionist to save the doctor's time, rather than a follow-up session to determine the next course of action. At times it can feel like you must chase your own physician to receive an adequate level of service.
Another example of patients having to facilitate their own care stems from physicians not communicating with each other, forcing patients to serve as the intermediary. I recently had an experience where an emergency room physician referred me to a specialist. As I mentioned near the beginning of this article, my consultation was nearly cut short when the latter physician seemed to want to dismiss me, and displayed no interest in reaching out to the referring doctor for clarification. It was ultimately up to me, as the layman patient, to have understood an array of medical conditions the referring doctor suspected and to explain to the specialist why they may necessitate his services a responsibility no patient should have fall into their lap.
Another problem is that as a healthcare patient, you can often feel like a product being assembled on a conveyor belt particularly when visiting specialist clinics. I visited two such facilities last month, and left with a negative experience from both. Some technologists who operate machinery become bored with the monotony of their work and seemingly irritated by human interaction. They become more concerned about completing a task within a short timeframe, rather than taking the time to listen to the experience and needs of the patient. They may incorrectly assume all the information they need is contained in the physician's brief referral, and not wish to discuss matters.
Clinics can also be poor at time management and preparing patients for visits. Not only are pre-scheduled appointments often late to begin, but sessions can be truncated if patients require "too many" procedures that don't fit neatly into a clinic's schedule. Such a preventable dilemma is often discovered while visiting the clinic, rather than when booking an appointment. Specialist clinics can also be lackadaisical when it comes to maintaining instructions on their website, resulting in obsolete information remaining online that contradicts instructions conveyed verbally or on paper.
And while on the topic of paper: why is almost all health information still exchanged verbally in the 21st century? While speech may be the most natural method people use to communicate, it's certainly not the best way to convey a barrage of complex medical information, especially to patients who weren't educated in the industry. Lengthy diagnoses or instructions can easily be forgotten or misinterpreted. Why not put it to paper?
And where paper does come into play, why are physicians still writing instructions by hand often in indecipherable scrawl that other physicians and pharmacists cannot comprehend?
Printing out (or providing online access to) digitally-stored information would be the best option, but that would require the use of an electronic health database. Ontario's eHealth program still hasn't been completed after more than 17 years of efforts, and patients remain unable to directly access their own digital records.
Whenever you visit a new physician, you're expected to be able to recall years of your medical information by memory symptoms, dates, results. That our healthcare system still doesn't capture most such information in a centralized database, in an era of ubiquitous online data, is infuriating. And need I remind you that getting clinics to share information can feel like trying to broker the Meech Lake Accord.
Considering that healthcare is the top budgetary item for most (all?) provincial governments, it's unfathomable how it's been allowed to mutate into such patient-unfriendly manifestations.
Simply put: healthcare in Canada needs to have a greater focus on patient satisfaction. Users regularly feel rushed by an emotionless conveyer belt, despite the efforts of many individual healthcare providers to bestow excellent service.
Is it fair that the revenue of doctors and healthcare clinics is determined almost entirely quantitatively simply by how many patients are seen? Or should patient satisfaction be one factor that determines how much healthcare providers may bill the province for?
Should we allow healthcare users to confidentially rate the service they were provided, and use that data to impact how much money contractors charge the government? Would such a concept encourage the minority of healthcare staff who have an uncaring bedside manner to improve their service?
We must proceed cautiously, as such a reform could have intended consequences. But one thing is certain: the status quo of patient satisfaction is often unacceptable here in Canada, despite the vast sums of money dedicated to healthcare delivery.
By its very name, healthcare shouldn't leave patients feeling frazzled, anxious, embarrassed or angry.
Privatization is not the answer, but instilling an ethos of performance management and customer service into our much-envied public healthcare system may be exactly what if you'll excuse the cringeworthy pun the doctor ordered.
