Sunday, February 8, 2009

So you think free healthcare is the answer....

The healthcare system in the US may not be the ideal system - let's face there such a thing as a perfect one? From an ex-emergency dept nurse I can tell you there are about a million things that need fixing! However, if you came to my ED and were complaining of chest pain and especially if you had just recently failed a stress test (leaving out a bunch of factors here) I do believe that you'd be triaged in appropriately and that we'd have you back, EKG done, on a cardiac monitor with O2 on and nitro at the bedside. You'd probably already even had your aspirin before the ED doc made it in to see you. Now, if all your tests were inconclusive i.e. no acute EKG changes, enzymes were negative etc you'd probably still get admitted for serial enzymes and maybe you'd even get a diagnostic cath and/or an echo ('cuz you failed that stress test).

Contrast that to showing up at an ED complaining of chest pain and then literally waiting 8 hours before the doc even sees you! Your hospital doesn't do caths so you have to be transported to another facility. But wait....there's a waiting list for caths and heaven forbid you're actually having a cardiac event. I guess they don't measure door to PCI times up in Canada. So you're stuck in the ED because the hospital is capped. Because there is only one hospital to serve a city of almost a quarter of a million people. You're stuck because the can't send you home (your blood pressure is swinging crazily back and forth - diastolic anywhere from 80-120) and they have to wait until there's availability in the cath lab in another city so they can get you there.

I have to shake my head. I think there are many things wrong with the healthcare system here in the US but in comparision to the scenario I described above I think we're doing pretty darn well!!


Jordan said...

Where did this happen?

Yee said...

It's happening right now. My MIL is stuck in the ED in Barrie (hospital shall remain un-named). I guess the bottom line is if you're planning to have some chest pain you're best to do it in the US!

Jordan said...

Things can be bad in the smaller cities. There is a shortage of ER docs and a shortage of family physicians in general, in many smaller communities. The flipside is that people don't usually go bankrupt for medical reasons.

I find the care I get here is just as good as what I got when I lived in the US and it is easier to navigate the system here. There are more resources in the US system but my experience was that there were also more barriers to accessing them. Just my "patient's perspective".

Yee said...

It's interesting to get different perspectives. I guess I'm so used to the way things work down here. Not to say that it's perfect because it certainly isn't but in this instance I find it very concerning that a city like Barrie would only have one hospital to serve the whole population? Futhermore, with a lack of services available at that one hospital patients are put at considerable risk should some major event occur.

Here's my thinking...if you were to have an acute cardiac event in Barrie the closest hospital that has a cath lab apparently is in Newmarket so...I'm assuming that if EMS picked you up and ran an EKG (do they even do that up there?) showing you were having a heart attack they would automatically bypass the local hospital since they don't have the facilities to treat you. They'd have to make the trip to Newmarket which is a good 40mins from Barrie? Sorry to're probably close to dead by the time they get there. This is assuming that everything runs 100% according to plan.

When my in-laws moved back to Barrie from Newfoundland they found it difficult to get access to healthcare. I remember that took forever for them to find a primary care doc and even then it was by some weird twist of fate. My mom tells me that it's almost impossible to get an appointment with her doc unless it's scheduled months in advance.

These aren't small cities - we're talking metro Toronto area. I do think there are pros and cons to each system but when it comes to the fact that people are waiting inordinate amounts of time for urgently need care and procedures...well....

Don't get me wrong....there are tons of things about the system down here that I think suck butt but in this one instance...I definitely think it would have been better to be here than in Canada.

Jordan said...

Sounds like things aren't great in Barrie, and I agree that the primary-care physician issue is huge. We are usually able to see our PCPs in a day or two when things come up, physicals have to be booked farther in advance. Here the biggest impediment to increasing the number of PCPs is not necessarily that healthcare is "free" but that the OCPS puts a very low cap on med school enrollment.

And it's interesting that your in-laws have had a harder time getting access to health care in Barrie than in Nfld. Nfld is usually cited as the textbook example of the problems of public health care.

My only perspective is as a patient (and the husband and father of patients), usually non-emergency situations, and in large cities, at that. But I can say that in Boston it was harder (took longer and more paperwork) to get in to see either my PCP or specialists than it is here in TO. I can easily see, though, how ER care would be totally different.

DarleenMB said...

It isn't the health CARE that's the problem. It's the health INSURANCE, Yee.

almost 40 years ago my health insurance cost me $5 a month. FIVE DOLLARS.

I had to have an appendectomy. fully paid for.

I later had to have knee surgery. FULLY PAID FOR.

The problem really is the for-profit greedy pigs who infiltrated the health care FIELD 30 years ago and turned their bean counters loose.

Health care is NOT a privilege, it is a RIGHT.

Oh and once upon a time, hospitals, like utilities, were owned by the PEOPLE. We need to take them back.

And as far as insurance goes, 95 cents out of every dollar paid in in premiums should go back out to the insureds. right now 95 cents on the dollar goes into the greedy pockets of the CEO's (don't get me started on the BILLION DOLLAR COMPENSATION PLAN ... RE THEFT... by the CEO of United Health Care (which used to be my insurance carrier) and the "investors."

GET THE FOR PROFITS OUT OF HEALTH CARE. That will fix 99% of the problems.