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In the last decade or so, I've broken my foot twice. The first time, I spent a few hours in the ER, shuffling around to the x-ray dept. and waiting to see an orthopaedic surgeon. (I got xrays, because the hospital was the one that had developed the 'Ottawa Ankle Rules' that are now used worldwide, to help avoid wasted costs from x-raying every sprained ankle that walks in; the resident had determined that my foot was likely broken; it was.)
When I saw the ortho, he inquired whether I had supplemental health insurance, and if so I could have the fibreglas cast (so I could bathe) rather than the plaster. I said no, but how much was it? $100. Well gimme it, I said. I have the $100, no problem. No, he said, it isn't worth it. But I want it, I said. Well, he said, you don't really need a cast. Just be careful. So I was, and the whole thing ended up costing me nothing out of pocket. I had waited 2 days to go to the ER, so by then the over-the-counter codeine/acetominephen I had was adequate for pain. And I had loads of crutches in the attic; this is a klutzy family, and I am the last repository for its junk.
The second time, I was out of town and broke my foot just before leaving for the 5-hour drive home. Fortunately, I always break the left side of my body. I stopped at the local ER on the way into town, but it was the middle of the SARS thing and I had just come from Toronto, the locus of infection, so things were taking a while and I decided not to wait. Went to the walk-in afternoon at my community health clinic the next day and saw 3 nurse practitioners, got sent for an x-ray (pretty much at my insistence -- I'd applied the Ottawa Ankle Rules to myself and determined I was broken in exactly the same place, rather than sprained, or I wouldn't have bothered going, I just wanted to be sure that the fracture wasn't displaced), and got the same advice: be careful.
One morning two years ago, my dad, aged 72, had been feeling unwell. He drove from the trailer camp he was spending the summer at, an hour from me, to the nearest town, and took his bp and pulse at a drug store. Pulse of 35. Went to the nearest walk-in clinic: a private practice providing services within the plan. They sent him immediately to a lab for an EKG. He went directly back to the clinic. They sent him immediately to the ER. By the time he called me, mid-afternoon, he was in the ICU hooked up to monitors and being scheduled for transport to the tertiary hospital in my city for a pacemaker implant 3 days later.
He was delivered there by ambulance, but sent back because he had developed a hospital staph infection at his IV site, and because there was no bed available at the cardiology dept -- this was not good. He was kept in for a few more days, then released, and treated with antibiotics. He's a senior cit, so he had a $2 copay for the meds. At the end of the month, I picked him up and took him to hospital for the pacemaker. Total cost to him: the $2 copay for the prescription. Unless the drug store where he went didn't charge it; many don't.
My co-vivant was diagnosed with Type 2 diabetes 3 years ago. He'd been symptomatic for 2 weeks, but figured he had a bladder infection. Being impatient, he went to a walk-in clinic. They had him go to a lab next day for fasting blood tests. They called that evening with the results (sky high blood sugar, obviously diabetes) and we went in for a consult.
I then persuaded him to go to the local community health clinic -- a non-profit organization within the health plan, that also provides multiple social services to a neighbourhood. I go to the one in the neighbourhood where I used to live. He was lucky, the CHCs have been overloaded lately, and there are wait lists to get on the patient roster. Within 2 weeks, he'd seen his doctor twice, had more blood tests and an EKG, and we'd seen a nutritionist.
He continues to have complete blood tests, and see his doctor, every 3 months, and the foot care specialist periodically, and specialists as needed on referral (last month he saw an opthomologist and an endocrinologist, since there has been difficulty controlling his diabetes; the time between referral and appointment was about a month, I think). His present meds cost pennies a day. The clinic gives him its samples for the more expensive cholesterol meds -- it doesn't need them for most of its patients, because they're largely low-income and have drug cards that require only the $2 copay (the copay was a mean-spirited Tory govt invention a few years ago).
My dad flew home from Florida at the end of January 2003 with joint pain, and went straight to the ER near my sister's home near Toronto. That was a Saturday; he was given an appointment for Monday with an orthopaedic surgeon. But on Sunday his leg pain was so bad he was afraid he had another blood clot, so went back to the ER, had a chest x-ray, and learned that he had spots on his lung. Cancer. He had a lung biopsy on the Tuesday and was kept in hospital when he did not spring back from the procedure properly. The joint pain and breakage, it turned out, was melanoma that had metastasized to his bones (and also to most of his organs).
He was in hospital for about 6 weeks, seeing an internist, an oncologist and an orthopaedic surgeon several times a week each. He had radiation therapy at the nearby big city cancer care centre, scheduled on 2 days' notice and transported with my mother by ambulance; he had multiple x-rays and a couple of bone scans, and he would have had an MRI, scheduled on 3 days' notice, but his pacemaker prevented that. Ultimately, when his condition just didn't stabilize so that chemo could be started, and the morphine was not addressing his pain, he was scheduled for hip surgery, on 2 days' notice, but rejected at the last minute because of his very poor overall condition. Two days later he was delivered to my sister's house by ambulance with my mother, a half-hour's drive, and set up with a hospital bed, morphine drip, various accessories and a prescription for a sedative, and a visiting nurse. Two days after that, he died.
Total cost to us: about $25; the sublingual version of the sedative prescribed at the end was not covered by the govt.'s seniors' drug plan. I wasn't happy about that, since he was largely unconscious and unable to swallow, and needed the under-the-tongue kind.
Yes, there are bad anecdotes too. People do wait too long for some procedures -- joint replacements are one of them, and that problem is worse in some provinces than in others. Some cancer treatments are apparently not available as soon as they should be -- and a major problem there is that the budget-slashing and off-loading of costs a decade ago resulted in loss of skilled personnel and failure to train replacements, particularly radiation therapists.
But these anecdotes really reflect what is usually available, and in these cases available to people of very low income: my retired father, and the people in my neighbourhood who go to our community health clinics, or to the private-practice physician of their choice.
And they reflect what should be available, and any gaps in care that do exist can be addressed without starting down the very slippery slope of privatization.
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