Thursday, November 19, 2009

Medical Musings

So there is some uproar in the US over a recommendation that women not have mammograms until the age of 50, and bi-yearly after that instead of yearly. I note the concerns and the reasons.

But this has already been going on in Canada for a decade, or at least in BC and Alberta. My ex's mom was going for yearly mammograms in the 90s because of breast cancer in her family. In about 1999, she was told to go every other year instead. So two years later she went for a mamm and they found a lump. It had passed through the stages and they found cancer cells in about 11 of 13 lymph nodes in her armpits. She had radical surgery, chemo, and radiation. I am happy to report that she is still in good health and did very well throughout her treatments. However - I have always wondered if it could have been caught sooner if the yearly mammogram had not been cut? It is just happenstance? Did it form so quickly that a yearly one would not have made a difference? We will never know the answer to that but I think about it even more now that the US is facing the same changes.

Another thing for me to note and then predict for the US is a change in the pap smear testing. When I was 18, I was told I should have a pap yearly. But several years ago I was told they decided that every 3-5 years is more acceptable for those who have never had an abnormal result (I am one of them). So now I go every 3 years. Maybe I should insist on going every year? I just don't know. There is no history of cervical cancer in my family but is forcing women to wait 3-5 years the answer? I am not due for another for 1.5 years so what if I already have something starting down there? What could another year of waiting to discover it do to me? The chances are probably very slim but how do I know for sure?

Here are my thoughts on this - it is largely cost-related. If you think about it, every woman over 18 (or from whatever sexually active age) getting a pap every year takes up a lot of time and money. I use a half hour appt slot for a Physical, when normally the doc could see 3 patients in that time period (or six 5-minute walkin patients). Every woman doing that is a strain on our public health system and backs up appts, let alone the cost of having the tests checked out and the results returned. The same with mammograms. I realize they have looked into this and found that a ton of money is going to these programs when only a handful result in positive diagnoses... but aren't they playing with our lives now and experimenting? We won't know for another decade or two if changing these tests to 2-5 yr waits and changing the age to start is going to be better for us or worse. That is one major flaw in a public system. So much of the decision is money-based, it's hard to know if it's for our own personal good, or just good for the coffers. I say it's more the latter. If we had the option to pay into a private insurance company that then decides it will cover yearly mammograms or yearly smear tests, then the money would not be coming from the public tax pile and it would free up more cash for other things (whether it's for people choosing to stay on a public system entirely, or for other medical issues). So I do not understand why we are not allowed to do this. It makes no sense to me.

I am perfectly willing to keep my taxes as they currently are and help fund the public system, but I would like to be offered a choice on top of that. What if I decide it's worth it to also buy private insurance for my family? I do not have that choice though - not for basic health care. It's the govt system or bust (or go to another country). I don't have the money to do THAT but I could figure out the money for a private basic health insurer. Maybe I won't buy that honking huge new tv and put the money towards my family's health instead. But those are just pipe dreams because the option is not available right now and in the meantime, we see cuts left and right. Alberta Health Services has announced a further 1000 job cuts (600 by not filling current vacancies, and over 500 other services that have not been fully specified yet). Some taking voluntary buyout... but the rest is a mystery as of yet. Maybe it's a good thing, maybe it's not. We have to wait and see where the jobs get slashed before we know for sure.

There is talk of closing hundreds of elderly-care beds in Calgary and Edmonton. What if my gran was in one of them and I wanted her to stay put? I can't pull out my private insurer card and say 'don't worry, it's covered'. I would have no choice but to find somewhere else for poor nana if she could not safely live with us (history of senile dementia in my family). There are no real choices and options for most Canadaians/Albertans and now I see the US following suit yet again. If it's not working here and the evidence is right in front of their faces, why are they still playing follow the leader? There are so many things going on down there right now that have been tried in other countries but they seem to think they can do it better. Well,,,, good luck with that.


  1. It's not working here because your hack government doesn't want it to work here. The American health care debate is revolving around the fact that private insurance companies are doing a poor job of providing health care for millions of Americans. A two-tier system is only endorsed by partisan hacks with money to be made - not by medical professionals that have worked in this province for decades.

  2. So there are no doctors in Alberta who think patients having more choice is a good idea? Not my boss's hubby's heart specialist who told him this year that he needs another bypass and shunt surgery but the province will not approve it until he has another heart attack? He doesn't think there should be another option where important health care should not be rationed by the number of surgeries they can afford to approve with their finite budget? That's very interesting.

    It's not a full answer to all that ails us. There are bad insurance companies that are giving the rest a bad name. There are higher and higher costs of drugs and equipment that both private and public agencies must deal with. Specialists in the US paying tens of thousands of dollars (or even hundreds of thousands) a year in malpractice insurance. The list goes on for the bad things going on all over.

    What would another party in Alberta suggest to do about the costs and rationing? Are you saying the Liberal or NDP parties would change that? Then please explain why so many BC and Sask residents come to Alberta for care. If it's so great there with a differing govt leading the way, why did my cousin wait 10 months for back surgery and almost lose his home in the process (disability was not enough to cover his mortgage and other bills for such an extended period of time). He got bumped up after some cancellations or would have been waiting longer.

    My entire family lives in New Brunswick with a few scattered in NS and Ontario and they are unhappy as well and have been for decades. 6 years ago my friend in Toronto waited 12 months for an asthma specialist to see her infant son. He was no longer an infant when he finally got the appt. The list goes on, Canada-wide, over shortfalls that have been going on long before the Conservatives took the helm, and despite different govts leading the various provinces.

    Is the answer to keep going the way we are now? With fewer people working, jobs cut and slashed left and right, where are the tax dollars going to come from for next year's budget? If that is the only income for paying for our basic health care and more and more people are out of work - how is the system to be funded?

  3. Kez.. I think your post speaks volumes. There are clear problmes in our "perfect" health care system.. and not just in Alberta. All over Canada we see limitations on the ability of the system to handle growing demand.

    The solution? I'm not sure. I do know that the U.S. system is not the answer, of that I think there is no doubt.

    What we do need, though, is some serious multi-party dialogue without partisan ideology clouding full and open discussion about looking at all options, including two-tiered health, user-fee health, de-listing of more health, increasing taxes if necessary.. the solution cannot be driven by one point of view.

    To refuse is to just wait for a ticking bomb to go off.

  4. While sitting in walkin clinics over the past few years, I wondered if perhaps people should be charged $10 a visit. In one way, it could cut down on the number of people who go for frivolous things and at the same time bump the system up a bit more. I proposed the idea to some friends and it was about 50-50 for response until we got further into discussion about the number of people who go for the sniffles, a sliver, etc. But then we thought about the number of people who do not have a family doctor (but want one, just can't find one to take them on) and they would be charged for a service they aren't getting enough of (ie, paying through their taxes to support general practitioners even though they themselves do not have one).

    Or charging 10 bucks when someone shows up at an Emergency room for a non-emergency (ie - the sniffles). But that causes it's own problem as well because who determines what an emergency is - it might differ from person to person. A cold in a young child or asthmatic could be more serious than a cold in an otherwise healthy person. So it's not perfect, it was just an idea.

    I thought of it in 2005 when I had very sudden sharp pains in my left side. Over the course of 15 minutes I went from being fine to throwing up from pain. There was a walkin clinic right beside my work so I decided to go there first to see if they thought I needed more medical attention. But when I arrived (exactly when it opened), there were already 12 people lined up - laughing, joking, chatting away and not looking sick in the slightest. I did the math at 5 mins or more per appt and decided I would be better off heading straight to emergency (which was full, but after I threw up several more times and no one in the waiting room wanted to be anywhere near me lol, I was allowed in. Turned out to be kidney stones).

    But anyway I thought of how many years I have had to sit in waiting rooms full of people who don't appear to be ill at all, wondering what they are there for. Would a $10 walkin user fee deter those who could maybe just crawl into bed and try to get rid of their cold on their own instead of insisting on getting a prescription for codeine cough syrup on their way out the door.

    I remember one local doc telling me around 1pm that he had already seen 40 patients and there were dozens more behind me, plus there would be a night clinic as well. That was already $400 in possible fees collected let alone the rest of the day, and the rest of the doctors on walkin that day. And there were two other clinics in town that day. I thought that perhaps if you were attending the walkin service of a doctor you were NOT on the list for, 10 bucks could help out with something at least. Who knows.

    Going back to paying a premium in alberta could funnel millions back in. At $44 a month, and even saying only half a million Albertans pay it, that's about $22 million into the system every MONTH, is it not? My brain is tired lol. When people are willing to pay $500 a month for a new car, $2000 a month for a mortgage, $100 a month for internet and cable or satellite (etc etc), why wouldn't they be willing to pay $44 a month (or $88 for an entire family) toward their own health care??? I don't get it.

    Some say that perhaps the PCs removed the premiums so we could all see how highly the system relied on it, and then they will bring back premiums at an even higher rate. I guess that's something we have to wait to see, but it wouldn't surprise me if it does happen.



These are my views and opinions. If you don't agree or think I am sadly misguided, that is your view. Feel free to share your thoughts but I also reserve my right to moderate content (IE foul language, excessive flaming, etc).