after eight years, i have a less-than-ideal observation about ontario health care

Since moving to Canada in 2005, my experiences with Ontario's health care system have been extremely positive. Through the public system, my partner and I have been able to access health care whenever we needed it, in convenient and pleasant settings, at no cost - that is, paid for with our taxes. The quality of care has been at least as good, and often superior, to anything I experineced in the United States.

I love our public health care system, and I would love to see it expanded.* Single-payer, nonprofit health care is the only system that makes any sense.

When I fractured my foot, I experienced a flaw in the Ontario system for the first time. The consequences for me happened to be minimal, but many people are affected seriously, and negatively. And apparently, the flaw stems from attempts to improve the Ontario health care system.

Like many people, I had no idea that bones in my foot actually had fractured. I couldn't put any weight on my foot without excruciating pain, but it seemed impossible to have broken a bone doing essentially nothing! That day, I continued to limp on it, and iced it. The next morning, when the foot was swollen and purple, I realized something was wrong.

We waited about four hours at Urgent Care (which seems reasonable to me), got a temporary plaster cast, and was told to report to the fracture clinic the following day. At the fracture clinic (part of the hospital's outpatient services), I was seen by a technician, who removed the plaster cast, prepped my x-rays for the orthopedist, and even prepared the walking cast, knowing that's what the doctor would ask for. The clinic was a large room separated into cubicles by curtains. Every patient there was waiting to see an orthopedic surgeon.

The doctor came in, turned his head towards the x-ray for a split-second, told the technician to fit me in a walking cast, and continued on to the next patient. I am not exaggerating: the doctor was in my cubicle for less than five seconds. He glanced at the x-ray so quickly that I could hardly believe he saw it at all. He was in and out of the cubicle without breaking stride.

The technician explained the walking cast to me - when to use it, when I could remove it - and told me to book a follow-up appointment in six weeks.

That night, I was in quite a bit of pain and called the clinic to ask if I should be concerned. Someone answered my questions by phone, but I felt that a simple hand-out for patients would have been very helpful. Perhaps a few different variations of FAQs could cover most questions about fractures, saving staff time, saving patients concern, and potentially preventing patients from worsening their condition or even returning to the hospital unnecessarily.

The fracture clinic was extremely efficient; it was too efficient. Everything was so fast and bare-bones that I couldn't help but wonder if if quality was being compromised.

Six weeks later, back at the Clinic, I waited only briefly for another x-ray and another glance from a doctor. The technician told me to wear sturdy sneakers, and I was on my way.

Once out of the walking cast, I had painful muscle spasms in my calf and hamstring, and went for some massage. Before long, I also realized that six weeks of immobilization had badly weakened my injured ankle, already chronically weak. I knew I need physiotherapy and booked some appointments.

The physiotherapist told me that her professional community in Ontario is endlessly frustrated and upset by the outpatient fracture clinic. My experience was absolutely typical: blink and you miss the doctor's visit. In my case, the fracture was common and not complicated, and the diagnosis was correct.

But, said the therapist, in many cases patients are sent home without treatment... and when the pain doesn't go away, and they come back, they learn that the first doctor blew the call, missing a fracture.

In addition, said the therapist, patients are not given information on after-care, and no one suggests physiotherapy. This, of course, leads to slower and less complete healing.

But here's the most interesting part. The physiotherapist said that this assembly-line treatment is a result of the focus on reducing wait times. Hospitals are under so much pressure to reduce wait times and meet patient targets that quality is being sacrificed.

Reducing wait-times has been the over-riding goal of Ontario health care for several years. In the Canadian context, "wait-times" generally refers to waiting for treatment in hospital emergency departments, waiting for orthopedic surgeries like joint replacements, and waiting for cancer diagnosis and treatment. It does not mean how long you wait to see a doctor on the day of the appointment, as many USians think.

So it would seem that this aspect of our public health care has been a victim of its own success.

The answer, of course, is not privatization and it's not a two-tier system where people with means can opt out. The answer is a more fully-funded public system. In this case, the answer might be as simple as giving doctors five minutes more per patient.

* We have prescription drug coverage and dental insurance through my partner's job (and might through my job one day, too). If we didn't have that, a hefty chunk of our income would go towards prescription drugs, and perhaps in that case we would buy a private insurance package. The absence of dental and prescription coverage is a serious heath care gap, especially as fewer and fewer jobs include benefits. I wonder how much more coverage Ontario could afford if corporate taxes were restored to 1999 rates? How many fighter jets would buy us universal prescription coverage?

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