Updated: Dec 10, 2019
The Canadian Healthcare system has always been admired by countries around the world, however, when compared through the Health Care System Performance Score, Canada scores 9th out of 11 countries (Commonwealth Fund Analysis, 2017). Our biggest comparison is the US, and yes due to our universal system it is better in some ways but most European countries have much superior healthcare systems.
I’ve been a nurse for 17 years and worked in acute and primary care in both urban, rural and remote areas in Canada. I believe our healthcare system is broken.
It wasn’t until I lived in Prague for a year that I realized how significantly broken our system is.
Before living abroad, I thought I was just burned out, that I was flawed in my thinking. I thought my patients and my family had just had bad experiences and I was in disbelief that the entire system functioned like this. I believed my thoughts regarding our healthcare system were silly and that I had unrealistic expectations.
While living in Europe I had the opportunity to work for a company that sourced and auditing healthcare providers and facilities for the US military all over Europe, the Middle East, and Africa. I got to witness healthcare in Europe first hand by talking to providers, touring facilities and discussing care expectations with patients. What I saw over there that doesn’t exist in Canada was:
Healthcare was accessible
Patients could easily access care either through a private or public system.
Long waitlists to see a primary provider didn’t exist, you could get an appointment in days.
There were Urgent Care facilities near or close to ER departments to divert less urgent issues away from hospitals.
There were no delays in seeing specialists, this could and would occur within days to a few weeks.
Wait times for surgeries such as joint replacements were 6-8 weeks post-diagnosis.
The private system took the pressure off the public system to decrease wait times for surgical lists.
There was a focus on Wellness
Taking time off to heal was encouraged, a week off work for a cold was commonplace not only for your own recovery but to prevent spreading illnesses to others.
Healthier lifestyles are encouraged – less food, more exercise, stress management with adequate vacation time and shorter workdays.
Prescriptions for nature, exercise and supplements are common practice.
Most countries have benefits that include chiropractic services, eye care, dental and if not the employer’s benefits or flexible spending accounts provide adequate coverage.
Remuneration of providers was based on salary
Physicians and allied health practitioners are salaried.
There is no pressure to pump people through the system, so providers can provide the care they want to provide.
There is no such thing as one issue per visit.
Care was based on best practice and excess investigations and testing were avoided, however, if a test was needed like a CT or MRI, they were easily accessible and didn’t add to delays in seeing specialists.
Private healthcare was very highly regulated and fees were caped by the governments so that facilities and providers were focused on patient care and not money.
Our healthcare system is designed to treat symptoms and illnesses. It is excellent at moving people from a waiting room to a clinician, having a symptom or illness treated, and then out the door. It lacks accessibility and patient-centeredness.
Wait times to see primary care providers can be weeks to months and to see a specialist you are looking at 3 months to a year in many cases. This is dangerous. This causes more issues as patients wait. Chronic pain rises with patients left suffering which affects their mood and level of functioning or medications are prescribed in which patients become dependent and addicted to.
The system doesn’t cover gold standard treatment options such as physiotherapy or value dental health and it impacts on our overall health and wellness.
Unless you have a private drug benefit program government-assisted coverage doesn’t generally cover the best pharmaceutical option. So adjustments are made based on what is covered and not what’s best practice.
The system doesn’t focus on wellness because we are too busy focusing on disease and illness.
The system isn’t patient-centered it is an impersonal experience that focuses on the providers’ preferences, number of patients seen, and average wait times. It doesn’t acknowledge our patient’s vulnerability, their fear, their comfort or address all their needs at any given time.
As providers and healthcare professionals we forget………
We forget that we are in a position of power and patients are incredibly vulnerable when they see us and are scared. We get into people’s personal space, touch them, and require many of them to undress and it’s the first time ever meeting them. We focus on what they are not doing such as eating healthy and exercising versus commending them on what they are doing and acknowledging how difficult it is to make lifestyle changes.
We forget that to us a clinic or hospital setting is comfortable, the noises, chaos, confusing layouts, hundreds of people wearing lab coats and scrubs with their head down speeding to their next location is normal. Our patients are rarely comfortable in these environments, they are anxiety-provoking and confusing.
We forget that our hours of operation are not conducive to working people’s lives. That people must book time off to attend appointments. This sometimes is unpaid leave or the use of a vacation day. Our patients' time is equally as valuable as ours.
We forget that not everyone can afford or has access to childcare so they need to bring their children to their appointments or to the emergency department.
We forget that many of our clinics require patients to pay for parking or are not accessible to public transit.
We forget that we speak in a medical language that most of our patients don’t understand.
We forget that most people don’t have medical knowledge and what seems obvious to us isn’t obvious to our patients.
We forget that our patients can’t describe their symptoms or situations in the terms we learned in school and we have to read between the lines and ask more questions.
We forget that it takes time to warm up to someone and trust them and be honest about how they are thinking and feeling – we rush the process because we have 15 mins.
We forget to communicate with our patients, we make assumptions they know what the next steps are or don’t feel it’s necessary to share because we are dealing with it. Knowledge is power and knowledge makes our patients feel safe.
We forget that we are human, and we can show our vulnerability to our patients. It isn’t wrong to say we don’t know the answer but will find out. This type of interaction is greatly appreciated by our patients.
So why are we surprised when our patients have high blood pressures during their visits, leave their chest pain complaint to when they are walking out the door, don’t return for follow up, or get agitated because they feel judged, overwhelmed and can’t process their anxiety.
My awareness of these issues leaves me NO CHOICE but to practice differently. I believe……….
I believe that healthcare should be truly wholistic and patient-centered.
I believe that my patients are more than their symptoms.
I believe I’m here to listen, teach, support and validate my patient’s concerns and walk alongside them while they navigate the healthcare system.
I’m not alone, most providers want better for their patients but they are constrained by the bureaucracy of the health care system.
This leads to many healthcare professionals suffering from burnout and losing their passion for their profession. The system needs to evolve.
Evolving into independent practice allows me to:
Challenge the current healthcare system, prove other methods of delivery are capable and wanted by patients.
Reignite my passion for healthcare and not walk away from my career which I was close to doing.
Promote and advocate for the Nurse Practitioner Role that the system is severely underutilizing.
Provide patient-centered wholistic care through:
Meeting my patients in their homes or office.
Treating the whole person rather than the symptom or chief complaint.
Incorporating my patient’s current situation including their supports, healthcare values, and beliefs, socioeconomic status, to create a personalized health care plan that works with them.
Giving patients an alternative option for healthcare services.
How do you want to see the healthcare system evolve?