Thursday, July 14, 2011

Waiting Line Reality Check

One of the issues that keeps bothering me is the problem of ending up on a waiting list in Canada with a painful but non-emergent problem. You know, those stories about long waits for joint replacements? Although, knock wood, I don't need surgery, I've gone through enough with my faulty parts to make me identify with patients in pain who don't want to wait for relief.

I was fortunate to be able to interview a Canadian physician whose specialty is roughly like an osteopath -- So he sees people for these painful conditions.

When I asked Dr. King about the problem of wait times, he assumed I meant wait times to get in to see him. In a similar fashion to the prioritizing in hospitals for surgical wait times, Dr. King tries to prioritize the cases that are most urgent. Patients who report being in severe pain can see him within a few days, but it can take a month or two for others.

If one of his patients may need a hip replacement (not a procedure he performs), he tries to anticipate their need for surgery. He'll encourage them to get on a surgeon's waiting list when he thinks a patient is likely to require a hip replacement in the future.

But what about when a patient is having a hard time functioning because of the pain? What kind of flexibility is there with the system? Is a hip replacement simply always low priority if it's not due to a fracture? No, according to Dr. King, it's possible to go to the front of the waiting line if a patient is in severe pain or can't function. Apparently, a specialist can successfully put the pressure on to help out a patient.

I took a look at the handy dandy wait time website for British Columbia: For hip replacement surgeries, when I checked the average waits for all of BC, I found 50% are done within about 3 months and 90% are done within about 7 months. There was considerable variation in wait times depending on the doctor a patient chose to see. The website showed some doctors were able to perform 90% of their patients’ hip replacements within a few weeks while other doctors showed 90% receiving the transplant within 14 months.

I also noticed variation in the time to receive some procedures depending on whether treatment was being sought in rural British Columbia or the Vancouver area. Wait times for back surgeries in one of the rural areas were running 90% done within 10-12 months and 50% done in less than 2 months. However, in the Vancouver area, 90% were done within about 4 months with 50% being completed within 3 weeks.

Another complaint one hears frequently is about the wait times for MRIs. Dr. King concurred. "The MRI is a real problem in this country." That is a medical service which can legally be purchased privately, if the patient can afford it. Dr. King said it costs $800-$1,000 to pay privately for a MRI in Vancouver. I spoke to a Vancouver neurologist, Dr. Cashman, who also expressed dismay over the wait for MRIs. When trying to diagnose ALS (Lou Gehrig's Disease), he wants to be able to get a patient in for a MRI right away. But the wait can be impossibly long. On the other hand, when the MRI is being ordered for a patient with a brain tumor, the service is provided promptly.

That being said, both Dr. King and Dr. Cashman like the Canadian health care system very much. In fact, they both came to Canada because they preferred the Canadian system to that of their native countries -- Great Britain and the United States respectively. Clearly, there are trade-offs to be considered with every health care system.

Thursday, July 7, 2011

Dr. Gabor Maté: Healing and Addiction

I knew going into this interview that in some ways, Dr. Gabor Maté viewed all Western medical systems as failures. In preparing for my conversation with Dr. Maté, I found other interviews with him online that clued me in to his perspectives on healing, ADHD, addiction, and chronic disease. And they didn't have to do with whether a government insurer or a private insurer provided benefits or whether a certain high tech procedure was covered.

I arrived at his house at the appointed hour and Dr. Maté invited me to sit down in his kitchen while he fixed some tea. A physician and best-selling author in Canada, I was honored he was taking the time to talk to me.

The major problem with the approach to healing in both Canada and the US, in Dr. Maté's view, is the insistence on separating the mind from the body when considering an individual's health status. He says that if we don't look at the relationship between stress and the immune system, many diseases will never be cured, no matter what the health care system. That doesn't mean Dr. Maté entirely negates the value of Western medicine. He explained that we need to "...get that the medical profession only knows what it knows. When it comes to chronic illness, they really don't know what to do."

Until recently, Dr. Maté was on the staff at the Portland Hotel Society, a Downtown Eastside Vancouver facility that provides housing and professional support for adults suffering from addiction, mental illness, and related problems, and at InSite, a supervised injection site affiliated with the PHS. He treated patients for drug addiction, HIV, and other health problems.

While both the Portland Hotel Society and InSite encourage addicts to seek detoxification and addiction treatment, they do not make abstinence a requirement for obtaining housing and services. They are principally harm reduction oriented. This approach is much more common in Europe, with the United States lagging behind both Europe and Canada. Studies documenting the success of the Portland Hotel Society and InSite have cited benefits including a reduction in the sharing of syringes and an increased use of detoxification services and addiction treatment.

As I steered my conversation with Dr. Maté back toward the subject of Canada's health care system he said, "I know I'm much freer to practice medicine the way I want to in Canada." He emphasized the need to spend as much time as it takes with addicts. This was made more feasible because the Medical Services Plan paid him for the amount of time he spent with his patients and not a set fee per service.

Dr. Maté informed me that the MSP covers all the doctors visits associated with the treatment of addiction. The coverage for residential rehab care is a different matter. Very low-income patients are covered through Social Services. People with private extended health insurance may be covered through their private plan. Some wealthy Canadians pay out-of-pocket for the very pricey Paradise Valley Wellness Centre and similar rehab facilities. Dr. Maté says that although it's a patchwork, "if somebody wants rehab, they'll be able to get in."

Dr. Maté is a fascinating and passionate healer. If you'd like to learn more and take a look at his books, check out his website: .