A while back I told a friend that this month’s blog – to coincide with Obama’s own initiatives in the US – would consider Canada’s health care system.
It’s a meaty subject, she said.
Well, yes. Except that in my usual vein, I’d prefer to transport readers into Canada’s health system with me, rather than feed them a bunch of statistics they could look up elsewhere. Folksy (and hopefully entertaining). Not meaty.
Last summer, newly arrived in Canada and buried in paperwork from residency documents to postal delivery, I asked friends and family for doctor recommendations. Better to be prepared. While I awaited my OHIP card (which gave me membership to Ontario’s generous club of socialized health care), I learned a few surprising things about Canadian medicine:
· Women typically don’t have a gynecologist unless there’s a particular reason.
· The regime for routine mammograms, colonoscopies and other such lovelies is far less rigorous than in the US.
· No one likes their doctor.
· Everyone loves their dentist.
The first three points were direct results of socialized medicine. Simply put, there’s not a lot of extra cash swilling around in governmental coffers to bring in the specialists, tart up waiting rooms and reduce waiting times.
But the great Canadian love affair with the dentist – the dentist! – puzzled me, until I visited one. Last autumn I chose my friend Tracy’s dental recommendation over the long list of A+’s populating Toronto’s dental community. I found myself waiting in a tastefully upholstered room with soft music piped in to sooth my anxieties. But there was little wait. I was whisked away from the spa treatment, whether I liked it or not.
In the dentist’s chair, my mouth free of probing utensils, I asked the hygienist about Canadians’ adoration of her profession.
It has to be that way, she said nonchalantly. Dentists are private in Canada. If patients don’t like the service, they go elsewhere.
Our household’s first winter in Canada was happily untouched by major medical visits. (A serious note here: I realize we are hugely fortunate not to be embedded in major medical issues and appreciate that my vignettes are far from representing the nation as a whole.) Outside the H1N1 pandemonium, my visits to the GP and to Laurelle’s pediatrician amounted to a bunch of nothings. It’s only this springtime, OHIP card tucked into my wallet, when I’ve become party to the wonder of Canadian socialized medicine.
Last month my GP (a woman I actually adore – but then she’s a family friend) referred me to a dermatologist. Making the appointment was, I must say, terribly efficient. The wait was three weeks, but my issue was hardly lethal. So one afternoon in late March, I find myself heading into a storefront with large glass windows at a busy Toronto intersection. The large red letters over the shop spell out, engagingly, “The Doctor’s Office.”
The waiting room on the other side of glass windows holds about 40 chairs arranged in short rows. About 35 of them are occupied. At the back of the waiting room, three openings are carved, bank teller-style, into a long glass wall with overhead signs saying “Family Practice”, “Specialist” and “Walk-In.”
I choose the middle window and check in for my 2:00 appointment with Dr D. The attendant retrieves a manila file with the first three letters of my last name and my birth date. She pushes a clipboard through the window.
As I complete the questionnaire, another woman approaches the neighbouring teller. “I’d like to see a doctor,” she says. Just like that. No appointment required. She’s told to take a seat.
The waiting room hardly resembles the plush one at the dentist’s office. Gone are the upholstered furnishings, the warm earth tones and the soothing music. I sit in a middle row next to the storefront windows and check out the beige ceramic tile floors and beige, vinyl-lined chairs. The ceiling is white plasterboard, arranged pop-out style on a metal grid. The receptionists’ bank is mint green. On pale, dusty rose walls hang government-issued health notices under plexiglass. A TV mounted high on the far wall, its sound muted, shows a sub-texted film about how to make strawberry jam.
I scan the other inmates. They’re a mixed bag – men and women, black and white and Asian and Indian – the world dressed in jeans, boots and suits. But rather un-Canadian-like for this nippy day, no one wears fur. And there are no kids. The community flips through magazines or sleeps. A couple guys type on their cell phones. One wears ear buds attached to a cord.
We are a sea of humanity caught in a time warp. But I have an appointment. I’ll slip through this medical purgatory in a matter of minutes.
Occasionally an attendant appears at the mouth of the back corridor and calls someone, usually by the first name, but the pace is leisurely and more inmates file in. A woman coughs into a leopard-printed cloth. I’m here for a cure, I think, not to catch something new.
I busy myself watching the pedestrians and heavy traffic outside the street-level windows. The buildings opposite offer a middling, seven-or-so-story skyline. They neither boast the cleanliness and efficiency of Denver’s downtown (our family’s second-to-last home) nor the character of a French city (our most recent one). I begin to worry how Canadian development stacks up within the wide world.
At the base of my view, occupying the spot that’s kitty-corner across the intersection, is a Second Cup. I need a caffeine fix. I wonder whether anyone would notice if I popped out briefly.
I quash the thought. My name will be up soon. I have an appointment.
The strawberry jam-making show morphs into a program on teeth-whitening. A girl in yellow and hot pink rain boots walks into The Doctor’s Office with her father. It’s 2:30 pm. The end of the school day.
I’ve been sitting in this chair for 30 minutes now, trying to focus on an anthologized magazine article about Obama’s ascendency. Obviously I’m having a tough time. Quiet apprehension fills any doctor’s office. People here have issues.
In the row behind me a man talks on his cell about a seven-month old daughter. She’s the third kid and he needs a sitter. I shift in my chair. The guy’s wearing a grey suit and overcoat. Glasses perch on his nose. His hair is side-parted, slightly graying. He explains to his contact – and to the waiting room – that is wife has a job interview. “She’s really easy-going,” he says. I assume he’s talking about the baby.
At 2:40 pm, a teenage couple walks into the waiting room. She approaches the Walk-In teller. “How long’s the wait?” A couple seconds later the girl says cheerily, “Oh, I don’t need it that bad!” She spins around and practically skips out of The Doctor’s Office with her guy.
But that wait – her wait – doesn’t affect me, right? I have an appointment!
At 2:55 pm, I learn about Rosalee, the facilities person. She’s doing more than pushing a couple balls, a male voice says behind me. “Yeah, you can take a gross-up factor of something like 12 or 15 percent,” the voice says.
I glance backward. It’s the easy-going seven-month old’s father. He decides to reschedule his doctor’s appointment so that he can hop on a conference call. I watch him amble along the sidewalk on the other side of the glass, phone at his ear. One inmate discharged. At least temporarily.
And there’s that Second Cup shop again, shouting my name.
“Grace,” an attendant calls from the back corridor. It’s 3:05 pm. The girl in the yellow and hot pink rain boots asks her father, “Do they know all our names?”
At 3:10 pm, I return to the Specialist window. In a quiet voice – for fear I’ll look like a queue-hopper – I enquire whether the system has lost my file. You know, the file attached to the 2:00 appointment.
The receptionist mumbles that I’m next and disappears into the corridor. I return to my seat.
The father and daughter in rain boots approach the Walk-In window at 3:20 pm. “It’s a long wait,” the receptionist says. “At least an hour.” The pair walks out of the slammer, already having done a chunk of time.
One hour and 25 minutes after my appointed time, I am summoned. I follow an attendant down a dusty rose corridor. Now how long do I have to wait until Dr D is available? “Five minutes,” I am told.
Five minutes turns out to be a good estimate. Dr D looks over my issue, a scar in my armpit – which sounds poetic if it wasn’t also true. Just leave it alone, she advises. That takes all of about 50 seconds.
So I figure, now that I’ve waited an hour and a half to see the good doc for an issue that she addressed in less than 60 seconds, I may as well ask her opinion on another dermatological issue or two. It’s a matter of decency – of using our time efficiency.
Dr D responds to my queries with such enthusiasm that she poses further questions back to me. We check out freckles. We look at eczema. We compose a theory linking one issue with another, and then debunk it. We enjoy a lovely conversation, one which would’ve been even more delightful over a cappuccino and biscotti from that Second Cup across the intersection.
But I can draw out this tête-à-tête no longer. At this point I’m only delaying the next inmate. So Dr D and I wish each other adieu, and I walk out of the pen into the fresh air.
Of course I didn’t drop a single penny on the ordeal. That’s the blessed beauty of Canada’s socialized medicine machine. But that assumes Benjamin Franklin was talking rubbish when he declared, “Time is money.”
Since my dermatological drama, I’ve overheard two women at lunch raving about their shared dermatologist. “Don’t you just love his 7:00 a.m. appointments?” one said to the other.
So I asked my (Canadian) husband about the private dermatologist channel in Toronto. The mere idea stunned him. “They’re all public,” Pierre insisted. All Canadian health care fans out from a central caretaker – the general practitioner. The good GP lines up specialists, dermatologists included, and the government foots the bill. You only have to play by the government’s waiting times.
And those waiting times don’t only happen in the waiting room. In fact, Pierre had just returned from his own appointment with a specialist. As he lingered in the waiting room for an orthopedic surgeon, he overheard another patient at reception. Surgery under this doctor’s knife, she was told, only could be booked in 2012 – a full, two-year bottleneck.
It’s no surprise that the root of the wait is funding. One thing that Canadians, as a population, hold dear to their hearts is socialized medicine. The national government pays a sum to its provincial governments for health care, and the provincial governments use this funding and its own cash to foot medical bills within the province. As medical costs increase, it’s the provincial governments that feel the financial squeeze, but they hardly back away from the national government’s edict of medicine-for-all for fear of losing federal money. And so patients share the squeeze.
Quebec is an aberration to this rule – but then, isn’t it always? A couple years ago the province launched a means by which people could pay for some medical services, approaching a more middle-of-the-road approach to medicine as found in France or Britain. And frankly, the province can’t foot its medical bills anyway. So Quebec tests the federal government. Politically speaking, who wants to upset Quebec? And anyway, which minister would dare to pull any province’s socialized medicine funding?
Closer to home, Toronto has its own wrinkle in the system. Medcan is one of the few medical clinics in Canada that derives the bulk of its funding from private sources – firms, individuals and insurance plans – rather than the government. It focuses on preventative medicine, administering a battery of scans and tests to clients as part of their annual, five-hour, full-body tune-ups.
Medcan provides a host of other services, but of key interest to its 30,000 clients is the clinic’s ability to get patients into specialists. And fast. Medcan basically puts it like this: If we can’t get you into an appropriate specialist within ‘x’ weeks (with ‘x’ depending on the seriousness of the issue), we’ll pay to send you over the border to the US.
Medcan is semi-private health care in a world of ultra-socialism. But, well, I’m not one of the 30,000. (Full disclosure: I am American. I’ve never let go of my private US health insurance, and I don’t plan to. Having it reminds me of the assurance I felt in the late ‘90s, when I lived in Johannesburg on an American passport: I knew I could always leave. But while US medical insurance is the ultimate back-stop, it hardly speeds me through Canadian queues.)
My second visit to a Canadian specialist in as many weeks would not catch me out. My friendly GP had put off my routine mammogram until I was covered by Ontario health insurance, so four months after booking an appointment and nearly two years after my previous X-rays – an interval that will send shivers through American breasts – I prepared for my first Canadian incursion. I dropped a heap of compelling reading material into my bag and headed to Mt Sinai Hospital.
I admit I was curious. Karen, my American friend here, told me she was “very impressed” with the mammogram unit at Mt Sinai. She called it “first-world” and, interestingly, “American.”
The first thing I notice upon entering the hospital’s wide entry portal is the name written grandly overhead: Seymour and Tanna Schulich. How fitting. As I approach the unforgiving machine that’s about to crunch down garage-door style on my boob for the first time in Canada, I am reminded of the guy who wrote a business bestseller that lists four traps to the successful businessman, the last one being “assistants with big breasts.”
I take the hospital’s lift, rising swiftly past The Kimel Family MRI Centre and the Wasser Pain Management Centre, to finally disembark at the Marvelle Koffler Breast Centre. Inside the Centre a plaque greets patients: “The Marvelle Koffler Breast Centre is grateful for the support of the following donors.” A long list of names follows.
I head toward the reception desk. There’s only one man ahead of me. A plaque on the wall expresses appreciation to so-and-so but doesn’t explain why.
A man? At reception in the mammogram unit? I eavesdrop. He’s asking how to make a donation.
The Marvelle Koffler Breast Centre is decorated in a blend of neutral colours and forest green, with wooden trim and…. I hardly have time to notice or enjoy the facility’s relative comfort, or to attack my reading pile, as a staff member summons me to an X-ray room.
I should’ve listened to Karen. This place is top-notch. And the procedure does remind me of my last mammogram, performed at a hospital in Denver.
Moments later – no need to pass by reception to pay the bill – I head back to street level. In the elevator I scout for a sponsorship plaque within that confined space. No joy.
But now I realize two things. First, health care – at least from the little I’ve seen of it – works more agreeably with some private help.
And second, not having a plaque of its own within any Doctor’s Office or sprawling hospital corridor – no matter the level of service rendered – the Government gets no thanks.
A friend passed on your blog and I am thoroughly enjoying reading them. Here is why. I am in a very similar situation to you - only reversed. I am Canadian - yes, still have my Ontario driver's license even though I have been living in Denver for almost 3 years. I still spell things "canadian" - like colour and cheque - so I completely appreciate your views as an american living in canada. Toronto is still my home and hope to be back there soon, but continue on with your adventures and experiences and I would be happy to share mine. I work in health care, in fact at Mount Sinai whenI lived there, so can fully appreciate your experiences. Thanks for sharing your stories - it helps me feel connected to back home.....
Posted by: LD | April 23, 2010 at 10:29 AM
Many thanks for your comment, LD - my geographical opposite! By all means, do share with us. A real side benefit this site is that it allows readers to reflect on their own experiences.
Posted by: French Lessons | April 23, 2010 at 02:54 PM