Acces to Good Medical Care -at Home and Away

Summer 2006 CSANews Issue 59  |  Posted date : May 28, 2007.Back to list

Last week, when my ear plugged up for several days and my own physician was not available, I decided to go to a walk-in clinic for service. After a few basic questions including my health card number, I was given the number "29" and told that I would be seen in about 2 ½ hours. Returning after 2 hours, I had still another hour to sit in the crowded waiting room reading last year's magazines before having my problem treated. As I examined the other "numbers" in the waiting room, including seniors, children and babies, I realized that most of these patients had no regular physician of their own. And I was reminded of how far we've slipped in providing acceptable access to many medical services, especially primary care.

Having a family physician is not only mentally reassuring, it is also good for your health! Knowing and being able to rely on a well-trained, competent physician who also knows your medical, social and family history assures you a better chance of timely and appropriate medical care. And yet, because of the restrictions of medical student and residency positions in Canada by governments in the past, many seniors and others are left with no family physician and disrupted, uncoordinated medical care. This affects quality and continuity of care in many cases. This article will focus on how to achieve optimal service from health-care professionals at home and when away.

Getting a Family Doctor
If you are fortunate enough to have your own personal physician and are pleased with his/her care, nurture the relationship and count your blessings. But physicians move or retire. Some become hospitalists or ER physicians and there is often no one replacing them. Or, you may be moving to a new community and find yourself unable to get a new family doctor. And when physicians do take on new patients, younger patients and families often take precedence. When snowbirds tell me of their troubles with finding primary care services, I am often surprised that their only effort was to call several physicians' offices and then give up.

If you're unable to get your own physician immediately, research the location and hours of any nearby walk-in clinic. Get there early, if possible, to shorten the wait. If all else fails, you will have to use the emergency room, but otherwise, do not use the ER for non-emergency medical problems. Many communities have allied medical services such as diabetic clinics, mental health services, podiatry or chiropody clinics, optometry, etc. which do not require a physician's referral and may be helpful. Teaching hospitals usually have specialty-specific outpatient clinics for fractures, pediatrics, obstetrics, gynecology, prostate, ophthalmology, dermatology, endocrinology, etc. which also don't require referral from your personal physician.

Governments have begun to pay more attention and provide increased funding and innovative solutions to this crisis. In Ontario, for example, family health groups and teams have now been formed and provide additional resources to the family physician, such as nurse practitioners, mental health consultants, dieticians and soon, physician assistants. Although medical school enrolment and residency positions have both been increased, it takes years to correct such inadequacies and the increased availability. The funding of allied health-care workers working side by side with physicians is a welcomed addition to health services and should empower physicians to register larger numbers in many of their practices.

Waiting Lists
Another major issue related to acceptable access is the waiting time for completion of many necessary medical and surgical procedures. Cancer treatment, including radiation therapy and chemotherapy, cataract surgeries, knee and hip replacement and cardiac procedures have been areas with such deficiencies. A combination of under-funding, insufficient specialists and lack of equipment and/or surgical suites has been cited. Improvements are being made in many areas and governments have committed to addressing this crisis very actively. Some early success is emerging.

But you may well experience such delays personally. There are some initiatives which you can take to diminish the negative impact on your health. furthermore, if you are faced with an exceptional delay, it may affect your travel health insurance unless you are individually underwritten.

Second Opinion
When you or your physician recognize a need for a second opinion, an appointment with the specialist's office is usually made by the referring physician and a consultation form is completed by your doctor and sent or given to you to take to the specialist. The majority of times, a referral is self-evident, e.g. cardiac chest pain needs a cardiologist, acute appendicitis needs a surgeon and significant asthma needs the opinion of an allergist. But in some cases, the need is less evident. Usually, if your physician recognizes that there is doubt about the diagnosis and/or the appropriate treatment, it is your doctor who will recommend a second opinion.

But there may be a time at which you decide that a second opinion is desirable. This may occur because of the seriousness of the diagnosis or proposed treatment, when there is lack of response to a treatment that has been underway, when you have grave doubts about the initial diagnosis or proposed treatment, or when you seriously believe that there may be a diagnosis and successful treatment for your condition that has eluded your doctor. In such cases, you have the right to request and receive a second opinion. In most cases, the doctor will comply. If there is some opposition and your request is legitimate, be persistent and impress upon your doctor that you simply want reassurance that there is nothing else available in the way of management of your condition. It is always in your best interest to go through your family doctor for the consultation, as a written report and opinion will be sent to your own doctor for your medical file. furthermore, most specialists now see patients only upon referral.


Medical Care, Away from Home
Snowbirds, in particular, should be aware of the proper preparation for travel and know the appropriate measures to take in order to receive optimal care while away. In preparation for your trip, be certain that you carry in your purse or wallet a list of the exact names and doses of any medication that you take. Be sure that you have enough for your entire trip. Keep the drugs in their original pharmacy containers to lessen any uncertainty at international border crossings. Keep a one-page, written record of your past medical conditions and surgeries, your present conditions and treatments, any allergies and your family history. In the event of a medical emergency, such information is then readily available to a treating physician. Carry with you a copy of your latest electrocardiogram (ECG) – a great advantage for a new doctor assessing any chest pain which you may suffer. Be sure that you've had your yearly medical exam and don't forget your travel medical insurance.

Access to quality medical care is usually good throughout Canada and the United States, however, this is less certain in many other worldwide destinations. How can you help to receive optimal medical care while away? If you are staying for an extended time at one destination, investigate the various options at that site. Where is the nearest hospital? Are their services in your language? Is the hospital accredited? Where is the nearest recommended physician's office or walk-in clinic? Do neighbours or locals have any recommendations? Most travel insurance assistance staff have lists of reputable hospitals and can give you that information in advance, in case of need. for physician's services, they may also be helpful in directing you to appropriate care. Don't use the emergency room for non-urgent problems. Find out in advance where you can see a doctor, if the need arises.

For quality, English-speaking care in Mexico, there is an excellent new book called "Mexico Health and Safety Guide" published by MedToGo. See their website at www.MedToGo.com. This book lists more than 50 good hospitals, as well as more than 200 English-speaking accredited physicians.

Travellers to other non-English-speaking countries will find value in contacting IAMAT, the International Association for Medical Assistance to Travellers, a Canadian non-profit organization established in 1960. Their aim is "to advise travellers about health risks, the geographical distribution of diseases worldwide, immunization requirements for all countries, and to make competent medical care available to travellers by Western-trained doctors who speak English besides their mother tongue." They can be reached at 519-836-0102. Their website is www.iamat.org.

Whenever you require medical treatment while travelling, seek early assistance from your travel health insurance assistance company. Their medical professional staff is familiar with services throughout the world, including issues of specialty capability, quality, language and costs. In some cases, evacuation to a more suitable facility or repatriation home may be indicated and this will be arranged by them.

And finally, be sure that you choose wisely in determining your destination, being mindful of any significant health conditions that may require attention on your trip. Avoid cruises if you suffer from serious heart disease. You will require evacuation if unstable. Avoid mountainous regions if you suffer from any lung disease. You're liable to have respiratory troubles. Avoid remote areas where good medical care is unavailable if you have medical conditions
Seek attention early when symptoms arise.

Getting good medical care is a challenging situation for all of us. Part of this task is our own responsibility in getting into good medical hands in the first place, both at home and away. Hopefully, this advice will help.

Tips on Getting A Family Doctor

  • If suitable, have your former physician refer you to a colleague prior to the separation.
  • Check with a neighbour, relative or county medical society for doctors' names.
  • Find out who is about to establish a new practice.
  • Write letters to a number of local family physicians requesting their services.
  • Ask your neighbour, friend or relative to make a personal request, directly to their doctor, at their next visit.
  • Ask the doctor's office to put you on a waiting list and ask if you can fill out an application for admission to the practice.
  • Make a personal visit to the secretary/ nurse when the office opens, for a personal introduction and plea.


Avoid Long Waits

  • Seek attention early for cataracts, hip and knee arthritis and other elective treatments if it appears that a wait for the procedure is common.
  • If the wait to see the appropriate specialist is unacceptable, see if another specialist can see you sooner.
  • Look to other geographical centres in Canada, where waiting times are shorter and earlier intervention may be possible. Remember, your health card provides reciprocal services in each province with no extra personal charge for a necessary medical procedure.
  • Diagnostic tests (MRI, CT scan, etc.) are always available in short order for those near the U.S. border and who have the finances to pay for the service. Even though your physician is Canadian, most such facilities will accept his/her written request for the test.
  • If your wait is for a life-threatening condition, such as cancer or heart surgery, and the wait seems unacceptable, go public, lodge complaints and notify your member of the legislature.




Related links
MedToGo
International Association for Medical Assistance to Travellers