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I have no time to justify to you, fool, you're blind, move aside for me

Posted on 2006.01.12 at 14:34
where am I: goin' to work again
How I feel about it all: worriedworried
Soundtrack: Dave Matthews Band - Don't Drink The Water
Tags: , ,
Private ER sets stage for showdown in Vancouver

Canadian flist people (especially topaz7 because I think she lives closest), what do y'all think about this? As an almost complete outsider (I'm not Canadian but I do work in the healthcare field), my reaction was basically a shuddery slippery-slope feeling. I may be totally off the mark, here, which is why I'm asking. This is just the first one in B.C., right, not in the whole country?

Also, Americans, what do you think about the way healthcare works in the US, either as opposed to other countries or just in itself?

Comments:


alexisyael at 2006-12-01 19:58 (UTC) ()
OK, here's my experience with the Canadian health system:

It rocks when you need it but don't need it fast (in other words, you have an hour or six to kill at the ER or local clinic).

It is hard as hell to get a primary care Dr., at least in Ontario. I never found one who was taking new patients. One could say I wasn't looking hard enough and that was probably true.

It absolutely SUCKS if you need fast treatment or a very specialized treatment.

I think the bigger issue that this clinic brings up is that the Canadian system really needs to find a way to entice Drs to stay in Canada so that there is a more balanced patient/ Dr ratio. I don't like the idea that people with money are going to get preferential treatment at this private facility, but let's face it, people with money in Canada usually go to the States if they need anything specialized, anyway. (Cancer treatment and such.)

The healthcare system in the US is WAY more fucked up than the Canadian system, tho. Although we have fairly good insurance now, so it isn't quite as awful as it was when we had no insurance... still. I have a $20 co-pay to my primary physician, b/c he is not on our "preferred" plan. Bastards!
try to catch the deluge in a paper cup
primroseburrows at 2006-12-02 05:55 (UTC) ()
I think the bigger issue that this clinic brings up is that the Canadian system really needs to find a way to entice Drs to stay in Canada so that there is a more balanced patient/ Dr ratio.

It's a hard sell, though, and mostly because docs in the US are paid way too much, and do things like order unecessary tests and surgery to jack the price up. :/
alexisyael at 2006-12-02 15:13 (UTC) ()
Actually, the weird thing is that because of HMOs, most docs in the US aren't getting paid nearly enough! However, they are paid more than Canadian Drs and not worked as hard. There's a better patient to doctor ratio. And the US has other things to offer that Canada can't compete with, enticing doctors away (academicaly).

I actually think the entire medical profession needs to be completely overhauled. The idea that a "shift" for a nurse is 12 hours? Totally ridiculous! And it's worse for Docs. But at least they can take breaks and sleep. Nurses can't.

(Which is not to say that *some* Docs aren't overpaid and underworked in the US. And they TOTALLY do a lot of unnecesary tests and have billing policies that SUCK if you're uninsured. But say like my family doc, who is a DO -- not paid enough.)
try to catch the deluge in a paper cup
primroseburrows at 2006-12-03 00:28 (UTC) ()
Actually, the weird thing is that because of HMOs, most docs in the US aren't getting paid nearly enough!

I'll have to look at the stats. Most docs I know drive much nicer cars than I do. *pets temperamental but beloved Jetta*

I actually think the entire medical profession needs to be completely overhauled.

Yep. Starting with ACOG. Please, oh, please starting with ACOG. And after that the APA.

The idea that a "shift" for a nurse is 12 hours? Totally ridiculous!

My shift is eight hours. I've been an advocate for 12-hour shifts at my hospital, actually, because three days of 12-hour shifts is almost full-time, and I think that working three days of 12-hour shifts is less exhausting than 5 days of 8-hour shifts. Usually the days worked aren't consecutive, because hospitals usually have mandatory every-other-weekend type coverage. And the good thing is that if a nurse is working a 12-hour shift there'd be fewer freeze-ins, because it's illegal to work more than sixteen hours in a row (at least in RI). It's not for everyone, though, so the ideal would be a choice between 8-hour and 12-hour shifts.

And it's worse for Docs.

Interns and residents go through hell with their shifts. The "cap" on hours that residents and interns can work is a maximum of 30 consecutive hours and no more than 80 hours a week (according to this, that is). That's unconscionable, IMO.

But at least they can take breaks and sleep. Nurses can't.

This is very true. We do sleep sometimes on night shifts, because I work in a psych hospital which is very different than a medical one. Most, if not all of the patients are sleeping at night. Technically we're not allowed to sleep on our breaks, but it's absolutely a "don't ask, don't tell" situation, because, really, isn't it safer if we sleep?

But say like my family doc, who is a DO -- not paid enough.

I'd bet that MDs get paid a whole log more than DOs. It's isn't fair, especially because DOs are often a better choice, IMO. I don't have a doc at all. We go to a nurse-practitioner. Even my ADD person is an NP. *g*

alexisyael at 2006-12-03 16:00 (UTC) ()
My step-mom likes her 12 hours shifts, but I personally think there's no way that could be safe (at least, if the nurse is in a ER situation, or surgery or something where she really couldn't nap.) My step-mom is in L&D (but she's cool). I don't think I'd want to be the patient at the end of a 12 hour shift, tho. (Actually, this reminds me that the suckiest nurse my best friend had during her labor was the first one, who was on the last hour of her shift. When the new nurse came on board, she was much cheerier and friendly... hmmm....)

I think my DO is making the same as a regular MD around here... but I don't really know.

Cars really aren't a great indicator of wealth. A lot of people (at least around here, and in Southern CA) put themselves into serious debt al b/c they want a new car with bling. Silly people. But whatever.

Though Psychiatrists and OB-Gyns are the docs that I would think would make the most in the States (oh, and surgeons). Family practioners, not so much. And those are the ones that are seriously lacking in Toronto.

Also, probably doctors in RI are paid more than the ones in Alabama... the standard of living is different down here, too.
(Deleted comment)
try to catch the deluge in a paper cup
primroseburrows at 2006-12-02 05:59 (UTC) ()
For the most part, I agree with you. There are some individual people who try to buck the system, but yeah, it's easy to be corrupted. Docs don't even work with patients directly during their first two years of medical school. They study pathology, but don't see patients. No wonder they talk about patients as "The mastectomy in room 404" instead of "Patty Jones, who had a mastectomy yesterday". They come out of the trenches with blinders on.
Noelle
inmemoriam at 2006-12-01 20:26 (UTC) ()
eltonroo will have lots to say about this no doubt. i agree with him on the matter of private healthcare.

you're right -- it is a slippery slope, and that's the short answer.

interestingly enough, though, right now times are tricky with everybody working at their optimal level best to make sure that private healthcare works and that public healthcare works -- since both have an agenda to promote. but later on, what will happen once people (again) get comfortable with the system and complacency sets in?

in the last 5 years, my father received some damn fine cancer treatment, and he's alive and well today. i wonder if he benefitted directly from this competitive environment -- but the short answer is that he received his treatment from the public healthcare system like any other cancer patient would have received. he paid no extra, did not go to any fancy clinics. the public system did not fail him him, and it's a success story.

in these early days of insecurity and competition for the hearts and minds of canadian citizens, everybody is giving their best. ironically, it's a good time to get sick. 10 years from now, though, oy...
try to catch the deluge in a paper cup
primroseburrows at 2006-12-02 05:30 (UTC) ()
he paid no extra, did not go to any fancy clinics. the public system did not fail him him, and it's a success story.

And that's the thing, isn't it? It's so frustrating to me to see patients come into the (private) hospital unit where I work and either a. have to be literally turned out into the street when their insurance runs out
b. self-pay and have to pawn their soul to get the help they need.

c. not be able to get into the longterm rehab facilities they need because their insurance won't pay for it.

I work on a detox unit. The patients who are discharged without proper followup or too early end up causing insurance companies/taxpayers MORE money than if they had the opportunity to get the care they needed in the first place. And worst of all, it's not the patients who are at fault, it's the healthcare system that's completely failing them. Even our public system is fucked up, because of the lack of funding and the red tape and the basic bullshit. And of course people with addictions are judged when they relapse, instead of being treated as people with an illness just like a diabetic or a cardiac patient. Grr.

My mother and I were talking about healthcare as a right last week. I said that I think that the homeless and the filthy rich have the right to exactly the same, good-quality care. And I know there's issues with Canada's healthcare system, but from everything I've seen, it's exponentially better than ours.

in these early days of insecurity and competition for the hearts and minds of canadian citizens, everybody is giving their best. ironically, it's a good time to get sick. 10 years from now, though, oy...

In ten years I'll be that much closer to retirement, and I'm still not ruling out spending at least part of that time in Nova Scotia. Chances are I'll be getting sick a lot more in ten or twenty years than I am now. *sigh* Hopefully I'll still be able to carry a picket sign. *g*
Smelly
topaz7 at 2006-12-01 20:50 (UTC) ()
My health care experiences have been top notch. Both my own childbirth experiences, kids' injuries, my injuries, specialists, emergency care, and my dad's palliative/general elderly ailment care. Maybe it's where I live, but those long wait times you always hear about have never actually happened to any of us.

I hate the idea of private facilities, but we've had private MRI and other diagnostic clinics for quite a while now. I think we're already further down the slope than you might think. The private ER - I saw the article on CBC and deliberately didn't click on it because I knew it'd get my blood pressure up!! No, I'm not in favour.

BC's a funny place, we generally vote to the left in federal elections and flop around between extreme left and extreme right in provincial elections. So we have had strong funding of health care, followed by slashing of health care, and back and forth. It's left us with an odd sort of system wherein private facilities can get a foothold (we're right-wing right now, with the dreadfully misnamed Liberal Party of BC ;D)

That's all I got for now. Will think about it a little more and perhaps post again.

try to catch the deluge in a paper cup
primroseburrows at 2006-12-02 05:38 (UTC) ()
It's left us with an odd sort of system wherein private facilities can get a foothold

I think you guys are a lot like our West Coast. Oregon, for instance, seems to have either liberals or conservatives. It's not a criminal offence to possess less than an ounce of marijuana (there's a fine, but not jail time), but a referendum voted to pass a constitutional amendment banning same-sex marriage. Geh.

(we're right-wing right now, with the dreadfully misnamed Liberal Party of BC ;D)

I'm pretty sure I've got NDP written all over me. Maybe I should run for office. In Pawtucket. Yay third party!
Smelly
topaz7 at 2006-12-02 22:11 (UTC) ()
NDP eh? I vote NDP quite often meself, unless the candidate is a complete wanker.

Dunno if you've seen this: http://www.cbc.ca/canada/story/2006/12/02/bc-clinic.html#skip300x250

After some last minute posturing on both sides, it looks as if they're going to run it within the Health Act, i.e., they'll charge our health plan instead of individuals. I was surprised to see the provincial gov't taking a strong stand against it; I thought Campbell's Fraser Institute buddies would have pushed him to support it. So that's good news for the health care system.
try to catch the deluge in a paper cup
primroseburrows at 2006-12-02 23:37 (UTC) ()
NDP eh? I vote NDP quite often meself, unless the candidate is a complete wanker.

I got NDP as a result in a couple of those "What Canadian Political Party are You"? quizzes (every time I think I'm a geek to take these things, I boggle at the sheer geekage it takes to create them and feel better), so naturally I go running over to the NDP website and check them out. Affordable housing, check. Environmental protection, check. Healthcare for everyone, check. Protecting workers' rights, check. Justice for aboriginals, check. Ethics in government, check. Yadda, yadda.

The NDP seems very close to our Green Party, which is what I get in the American version of the tests (yeah, I know, Canada has a GP too, but for some reason the NDP appeals to me more). I'm really an independent, which I'm proud of, because I'm a New Englander, and we're famous for our independent views. *g* I do tend to vote Democrat most of the time, but there are times...*points to Chafee icon* I vote Green occasionally and sometimes even Cool Moose (!), but for the top spots a Green vote is more likely to take votes away from a Democrat. I actually voted for Nader in the 2000 election, but only after I was positive that Rhode Island was going Democrat. I'm not a fan of the Electoral College, but for once it allowed me to vote my conscience without feeling I was ruining the bigger picture. Lot of good it did me. :/.

Dunno if you've seen this...

Yes, I did! :) It looks like an actual compromise in favour of *gasp!* THE PEOPLE! It also seems to be something that might start actual movement on the problems within the system? I dunno, I'm just peering through the window, but it sounds good to me.
Smelly
topaz7 at 2006-12-02 23:57 (UTC) ()
It also seems to be something that might start actual movement on the problems within the system?

We can hope!
try to catch the deluge in a paper cup
primroseburrows at 2006-12-03 00:06 (UTC) ()
Yay, compromise!

Dear Dubya: Plz get out of the White House a clue. kthxbai.
I Am Canadian
dragonflymuse at 2006-12-01 23:48 (UTC) ()
Well, this kind of thing has been a while in coming; it started off with the opening of private, for profit diagnostic imaging clinics (as the wait times for MRIs and the such can be long, depending on the purpose of the test). Some folks view it as a slippery slope to privatized health care, or a validation of the frequently discussed 'two tiered' healthcare model (our public one and a private one for those with the means to pay for care).

Wait times are the frequent argument for allowing private facilities; however what that doesn't address is the misuse of the emergency health care system by some parts of society (and those who use the ER because they don't have/can't find a general practitioner for their primary care). This clinic will therefore be found, in due course, to be in violation of the Canada Health Act, once the care they provide has been audited.

Aside from provoking more of the same old debates, I don't think this clinic sounds the death knell of socialized medicine. Yes, socialized medicine has flaws, but unlike private health care, it is based on equal access to health care for everyone, and not just those who can afford $199 for a basic emergency assessment.
try to catch the deluge in a paper cup
primroseburrows at 2006-12-02 05:47 (UTC) ()
Aside from provoking more of the same old debates, I don't think this clinic sounds the death knell of socialized medicine.

Maybe not, but I keep thinking of how World War I was started with a single assassination. A big honking assassination, but still.

Yes, socialized medicine has flaws, but unlike private health care, it is based on equal access to health care for everyone, and not just those who can afford $199 for a basic emergency assessment.

I agree, and wait times aside, I think that the US should take serious notes. It'll never happen, o'course, because we take "Life, Liberty and the Pursuit of Happiness" to the extreme and abuse it like crazy. I mean, after all, Thomas Jefferson said Americans were "endowed by their creator" with the right to these things, and who are we to question God, except hmm, what about separation of church and state? Um.

It really bothers me that my country is full of insistence that their Right to Bear Arms be preserved all the while thumbing its nose at the basic right to the same good healthcare as everyone else (which is waay more 'unalienable', IMO).
Isis
isiscolo at 2006-12-02 01:57 (UTC) ()
I'm an American, and I am hoping with crossed fingers that our system gets reformed soon. Right now, too much money is going to pharmaceutical companies (because they need so much money for ADVERTISING! ARGH!) and to all the administrative layers. On the other hand, the care I have received has been very good. But, you know, I'm fairly well-off; I can pay for it. And wow, I have paid a lot.

I lived for three and a half years on a sailboat, traveling around the Caribbean. My husband had to see a doctor for emergency eye care in Florida, and it cost us $160; his problem flared up again in the Bahamas (because the Florida doctor had not done enough!) and it cost us $25, and his painkiller prescription was very cheap there. He had a crown re-glued in the Bahamas as well for $20. I saw a gynecologist in Grenada (who had been trained in Cuba, and was very good!) for $25. The allergy medicine I buy here for $65/3 months cost me $15 in the Dominican Republic, and $11 in Venezuela. I got a skin disease that was diagnosed for $10 at a clinic in Honduras, and the medicine was very cheap. My husband had surgery in Colombia, and we know lots of Americans who had surgery in Colombia, Panama, or Venezuela.

It is true that the lower cost of drugs and doctor's care is less in these countries because the average wage is less. But the cost in the US is disproportionately high; it's like, in the US a prescription costs as much as two expensive meals out, and in Colombia it costs half an expensive meal out.
try to catch the deluge in a paper cup
primroseburrows at 2006-12-02 05:53 (UTC) ()
It is true that the lower cost of drugs and doctor's care is less in these countries because the average wage is less.

Not to mention that doctors in the US are paid more money than they should be, and they get more money for ordering more tests and more medical procedures that they don't need to do. This is one reason why the Caesarean rate in the US is 30.2%. despite the fact that the World Health Organization says that no region in the world is justified in having a caesarean rate greater than 10 to 15 percent.
Doug
eltonroo at 2006-12-02 16:43 (UTC) ()
Slippery-slope. Thin-edge of the wedge. I expected this to happen in a province like Alberta but not in British Columbia which actually has some history of democratic socialism.
I work for a nursing union and we are opposed to any further erosion of our cherished Canadian public medicare system. The facts are pretty clear that our system provides comprehensive health care coverage to all Canadians regardless of their income, and it does so at an overall cost that is less than what is spent by Americans (as a percentage of GDP). So the Americans spend more on health care for a private system that leaves millions without any coverage at all, and millions with inadequate coverage.
Economists also point out that our public health care plan gives Canadian employers a competitive advantage when competing with their American counterparts.
The problem with allowing a private system for those who can afford it is it leads to the eventual erosion of the public system. All the good doctors will go to the private system where they can make even more money. Eventually the government stops adequately funding the public system.
Our public system is not perfect. It needs to be better coordinated and integrated. It also needs to be expanded to include a national drug plan and homecare. It does not need to be privatized.

Smelly
topaz7 at 2006-12-02 22:12 (UTC) ()
I couldn't agree more. I hope it stays public. It's really to everyone's advantage if it does..except the privileged few.
Doug
eltonroo at 2006-12-04 21:15 (UTC) ()
you can say that again!!
:)
try to catch the deluge in a paper cup
primroseburrows at 2006-12-02 23:49 (UTC) ()
Our public system is not perfect. It needs to be better coordinated and integrated. It also needs to be expanded to include a national drug plan and homecare. It does not need to be privatized.

It's interesting that this is similar to what Americans (including me) say about Social Security. Including the part about drug plans and homecare. :)
Doug
eltonroo at 2006-12-04 21:16 (UTC) ()
that is why we consider you an honorary Canadian!
:)
try to catch the deluge in a paper cup
primroseburrows at 2006-12-04 23:02 (UTC) ()
The US? I dunno about that.
Doug
eltonroo at 2006-12-05 00:29 (UTC) ()
no just you. well and maybe any other elton fans.
try to catch the deluge in a paper cup
primroseburrows at 2006-12-05 06:31 (UTC) ()
Canada: A nation of Elton fans. This could work.
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