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Old 08-13-2016, 11:41 AM
 
Location: State of Transition
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Hello, Canucks! I hope you're enjoying your weekend. I hope you don't mind another question about your famous health care system.

This question is aimed more at people who have had, or who know someone who has had, some kind of chronic health problem that falls outside of the common ones like diabetes, that the system usually handles pretty well. What the question is about is: are there patients who fall through the cracks in the system, and who can't find a doctor or specialist to help them, so their condition festers for years without resolution? Do doctors in your system tend to brush aside patient concerns and tell them they're fine, and nothing's wrong, even without questioning them or doing any kind of exam or testing? Do you find that some doctors don't seem as well-informed as others, and if so, does the system allow for you to go from one doctor to the next to the next, in search of someone who is on the ball?

Even on the subject of diabetes, there are many doctors and nurses in the US who insist there is no such thing as pre-diabetes, so they don't respond to patient complaints of blood--sugar volatility or hypoglycemia, while others take such concerns seriously, and do preventive counseling, and diagnostic testing. That's just one example. Thyroid is another problem area: the insurance companies don't like to pay for the advanced test that diagnoses thyroid disease, so even when the preliminary test indicates there's an imbalance, the patient typically gets told they're fine, unless the levels fall outside of an overly-broadly-defined range of normal. Does your system cut costs by shorting the patient in this way, resulting in unnecessary patient suffering?

Do some patients find they have to resort to "alternative medicine" (is there such a concept in Canada, or do all docs practice "integrative medicine", as in some parts of Europe, where herbs and supplements can be part of MD-prescribed treatment) to get help?


I could give a lot more examples, but don't want to make this too long. Thank you.

Last edited by Ruth4Truth; 08-13-2016 at 11:58 AM..
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Old 08-13-2016, 12:09 PM
 
Location: Vancouver
12,723 posts, read 8,807,399 times
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I've personally never know anyone to " fall through the cracks ". That doesn't mean it can't or doesn't happen. Just like anywhere doctors are human and can make mistakes.

That said, yes, you can seek out any doctor or specialist you like if you don't like their opinion, or want a second or third one. We did this for my father when he was on life support. They happily agreed that another opinion was a smart thing to do and brought in another specialist from another hospital.

Other friends and family have had major health issues and have gotten nothing but stellar treatment.

My sister had thyroid issues and went through test etc and never mention any issues, but I don't have the specifics of her first test results and what would happen in the scenario you posted.

I've been to scores of appointments etc for my mother who has ongoing health issues. I have never come up with anyone brushing her off, far from it.


The insurance side of your question is trickier, as each province administers it's own healthcare, beyond the mandate of the Canada Health Act.

As you've requested the people that will know about specific issues, are the ones that have personal experience.

However the BC government has excellent information about a lot of heath issues, including thyroid ones.

it might contain some answers for you on that subject. In BC at least.

Thyroid Function Tests in the Diagnosis and Monitoring of Adults - Province of British Columbia
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Old 08-13-2016, 12:53 PM
 
Location: Canada
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Quote:
Originally Posted by Ruth4Truth View Post
This question is aimed more at people who have had, or who know someone who has had, some kind of chronic health problem that falls outside of the common ones like diabetes, that the system usually handles pretty well. What the question is about is: are there patients who fall through the cracks in the system, and who can't find a doctor or specialist to help them, so their condition festers for years without resolution? Do doctors in your system tend to brush aside patient concerns and tell them they're fine, and nothing's wrong, even without questioning them or doing any kind of exam or testing? Do you find that some doctors don't seem as well-informed as others, and if so, does the system allow for you to go from one doctor to the next to the next, in search of someone who is on the ball?
I think the experience in Canada would probably be similar to the experience in the U.S. - it depends on the doctor. Not all doctors are equally competent or caring or have the same experiences and knowledge treating various health conditions.

With respect to expensive tests, a very general rule of thumb for approval by the Canadian health care system is that the doctor must have reason to believe that the test results could lead to a diagnosis or to a change in current treatment. So if it is known you have disease x and a test would reveal more information but not change treatment, then the test may be denied.
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Old 08-13-2016, 01:45 PM
 
Location: State of Transition
79,081 posts, read 70,989,973 times
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Quote:
Originally Posted by cdnirene View Post
I think the experience in Canada would probably be similar to the experience in the U.S. - it depends on the doctor. Not all doctors are equally competent or caring or have the same experiences and knowledge treating various health conditions.

With respect to expensive tests, a very general rule of thumb for approval by the Canadian health care system is that the doctor must have reason to believe that the test results could lead to a diagnosis or to a change in current treatment. So if it is known you have disease x and a test would reveal more information but not change treatment, then the test may be denied.
Thank you. We seem to have quite a few doctors who just don't really engage with the patient. I also suspect they may be trained to some extent to watch out for complainers or malingerers, so they apply that suspicion very broadly. Also, back in the 90's, there was a lot of press about "medical sexism", I think they called it; studies had shown that women get taken less seriously by doctors than men, with regard to certain types of complaints. It was reported that some medical schools introduced a special course to combat that bias, but there hasn't been any change.

I researched the Swedish medical system, and learned that the government (as it's a gov't-funded system) instructs doctors to keep referrals to specialists to a minimum, and to brush off many complaints. I remember Swedish friends telling me that in order to get medical attention, they had to keep a reserve cash fund, so they could see a doctor who operated outside of the state-run system. It made me wonder if something similar was going on in the US, as well, and if it might be the case in other countries.

I don't mean to make the thread about thyroid, or to limit the discussion to certain topics or conditions. It could be anything. I had a client when I was a massage therapist who picked up some parasites when living in Florida, and tried for 20 years, across three states she'd lived in, to find someone to diagnose and treat her. Her condition deteriorated to the point that it undermined her nervous system, and developed into adrenal fatigue, which is potentially fatal if left untreated. Insurance-based docs and endocrinologists do not diagnose or treat adrenal fatigue, and believe that it's such a rare condition that they'll never run into it in their practice. She developed such a tangle of symptoms that no doctor would take her on as a patient, except for routine care. She finally found an alternative medicine practitioner who step by step untangled the knot of conditions, and treated everything one step at a time. By the time she found that practitioner, she had become disabled, and was living on Social Security disability allowance.

I've run into several stories like this over the years. People who, due to doctors failing to treat them, end up on public assistance, a burden to the state, or having to retire prematurely due to unresolved illness, and consuming their retirement nest egg. For people who are basically healthy, it can be hard to understand that these odd "black holes" in the medical system exist.
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Old 08-13-2016, 02:53 PM
 
Location: Canada
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There will always be black holes in medical science. For example if a disease is so rare that a doctor has never come across it before and if no known treatments have been written about it in the medical literature the doctor has access to, what can the average doctor do to help the patient?

I suspect that what is needed in that situation is the type of doctor involved in research or experimental surgery who would like to end up publishing articles about the case for their own career enhancement.
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Old 08-13-2016, 02:56 PM
 
Location: Canada
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I have a bump on my thyroid and I can't remember what kind of tests I have had but I have an ultrasound every year to make sure the bump doesn't get bigger.

As far as chronic conditions are concerned, my husband has been pre-diabetic for a long time but he never has changed his diet and he is now on the low end of diabetic. It could be easily managed if he would just manage it by watching what he eats. He has other conditions, including congestive heart failure and renal failure and we've been in and out of the hospital many times since March. He had an appointment with a cardiologist almost immediately after his discharge in March and I'm expecting him to have another one sooner than the follow-up originally was scheduled for due to his deteriorating condition. I don't know if any of this falls into your questions?

My doctor is very focused on preventative health care and I almost feel I want to watch what I complain about for fear of being referred to a specialist.

Obviously, just as with any other profession there are some doctors that are better than other doctors.

And yes, you can go to any doctor you like.
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Old 08-14-2016, 06:59 PM
 
Location: State of Transition
79,081 posts, read 70,989,973 times
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Quote:
Originally Posted by netwit View Post
I have a bump on my thyroid and I can't remember what kind of tests I have had but I have an ultrasound every year to make sure the bump doesn't get bigger.

As far as chronic conditions are concerned, my husband has been pre-diabetic for a long time but he never has changed his diet and he is now on the low end of diabetic. It could be easily managed if he would just manage it by watching what he eats. He has other conditions, including congestive heart failure and renal failure and we've been in and out of the hospital many times since March. He had an appointment with a cardiologist almost immediately after his discharge in March and I'm expecting him to have another one sooner than the follow-up originally was scheduled for due to his deteriorating condition. I don't know if any of this falls into your questions?

My doctor is very focused on preventative health care and I almost feel I want to watch what I complain about for fear of being referred to a specialist.

Obviously, just as with any other profession there are some doctors that are better than other doctors.

And yes, you can go to any doctor you like.
Thank you for your responses, everyone!

As to the bolded, was he at least counseled about how to manage pre-diabetes, and prevent it from escalating? It sounds like either he wasn't, or he didn't follow the recommendations. Our media say at least 1/3 of the population is pre-diabetic, and people are urged to get diagnosed, but many docs ignore the requests. It's odd. Most only comply if the patient has a family history of diabetes or is in a high-risk population, like First Nations people, for example.
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Old 08-14-2016, 07:39 PM
 
Location: Canada
5,707 posts, read 6,559,181 times
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Quote:
Originally Posted by Ruth4Truth View Post
Thank you for your responses, everyone!

As to the bolded, was he at least counseled about how to manage pre-diabetes, and prevent it from escalating? It sounds like either he wasn't, or he didn't follow the recommendations. Our media say at least 1/3 of the population is pre-diabetic, and people are urged to get diagnosed, but many docs ignore the requests. It's odd. Most only comply if the patient has a family history of diabetes or is in a high-risk population, like First Nations people, for example.
It's not the medical system, it's my husband. When he's in a controlled environment, meaning hospitalized, and therefore has no access to stuff he shouldn't eat, his tests for diabetes comes back normal. He knows all that. He chooses to ignore it. He's been told the same thing for all the 25 years we've been married. He doesn't have a family history of diabetes.
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Old 08-15-2016, 01:19 AM
 
Location: Gatineau, QC, Canada
3,402 posts, read 4,460,917 times
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I'm trying to think of people I know who have had ongoing issues with their health, but there aren't really any I can think of.

I once worked with a girl very briefly who had some sort of thyroid condition. She was trying to move to Costa Rica and her doctor wouldn't let her for the sake of not being able to monitor the situation. I think she went anyways, but I don't know if she was cleared or just broke the orders.

Oh, and my mom has insomnia. She has to drive over to Parry Sound 150 km away every few months to visit a sleep clinic. She spends the night at some place where they monitor her sleeping patterns and then adjust her insomnia medication prescription accordingly. This has been going on for decades, I think.
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Old 08-15-2016, 05:23 AM
 
2,567 posts, read 1,344,926 times
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Quote:
Originally Posted by Ruth4Truth View Post
Thank you for your responses, everyone!

As to the bolded, was he at least counseled about how to manage pre-diabetes, and prevent it from escalating? It sounds like either he wasn't, or he didn't follow the recommendations. Our media say at least 1/3 of the population is pre-diabetic, and people are urged to get diagnosed, but many docs ignore the requests. It's odd. Most only comply if the patient has a family history of diabetes or is in a high-risk population, like First Nations people, for example.
As an American, with no family history of diabetes, I get screened for diabetes at every checkup. I've never heard of a doctor who didn't order that as a routine procedure and there is never push back from the insurance company. It's totally routine, like checking cholesterol and triglycerides annually.
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