Health-care system in a thousand pieces

For the elderly, or for caregivers trying to support them

We have all experienced the medical system in one way or another, and while I am optimistic about health care in Canada, in general, it doesn’t make navigating the system any easier.

I listen to a lot of stories from adult caregivers, or adult children of the elderly about the time and effort and persistence necessary to get a clear picture of what must be done and to line up all of the services that are needed.

The health care system operates under the assumption that each person has a primary physician who will coordinate treatment.

In other words, we go to our family doctor, who then makes the arrangements for us to visit specialists, who then make the arrangements for our treatment and either contact us directly or put the communication back to our doctor for consultation purposes.

There are cracks in such a system that lead to plenty of horror stories at some point. For example, not everyone has a family physician.  There are a limited number of them, with an ability to serve a limited number of patients, and it is quite common to move to a new location only to find that no one is taking new patients.

For many, this leaves the emergency department as the initial medical contact and that is definitely not the way to go.

Emergency departments are set up to do stabilizing treatments of traumatic events and to call in appropriate help to life-threatening situations. They are trained in this aspect of care and good at it.

But their waiting rooms are full of people with minor injuries, flus and colds, and chronic conditions that may be very uncomfortable, but not necessarily life-threatening.

Emergency departments are not trained, equipped or staffed for such medical needs and, thus, the ‘poor service’ they render creates a lot of frustration for those who get sent away with very limited treatment after a very long wait.

Perhaps the second greatest crack in the system is the demands made on first-line physicians. Sitting down and having a long conversation with a doctor who is interested in the full picture of his patient’s health and welfare is a quaint notion of a Norman Rockwell painting.  Today’s family physician has a waiting room bursting at the seams with an aging clientele that has multiple issues.  It’s a day-long race to get them in, get a quick sense of what might need further investigation, do the paperwork to begin the referral process to specialists or for additional testing, then get to the next patient who is already annoyed at waiting more than an hour or more.

For many doctors, there just isn’t enough time to practice medicine the way they would like to and they, too, are challenged to make the system work.

But perhaps the biggest crack in the system is the sheer volume of options and processes.

With an increasing emphasis on tiny specialties, a patient can find him or herself running from one end of town to another, visiting testing centres, specialists’ offices, pre-op appointments, post-op appointments, not to mention filling a host of prescriptions often coming from different specialists with no clear sense of the effects of such multiple medications.

For the elderly, or for caregivers trying to support them, it’s a jigsaw puzzle of a thousand pieces, often without the advantage of knowing what the end picture is supposed to look like.

What we think should happen, and what the medical system is set up to process, can be two very different things and it’s not unusual for patients to find themselves completely frustrated, confused and missing a step that takes them back to square one in getting help.

Medical care is better than it has ever been if you can get on track and stay on track but the complexity of the system, and the multiple communication channels that can arise as a patient begins to navigate it, simply make it very difficult for the elderly to understand.  And the one person in the system that should be engaged in guiding them through it, the family physician, is overwhelmed with such demands.

If I had one place in the medical system where I would place additional resources it would be at the entry level, with enough family physicians, nurse practitioners or physicians’ assistants to have someone sit down with me for a half hour and help me understand the steps necessary to get the help needed. When you’re ill, the last thing you need is to launch on a voyage of discovery in the hope you randomly find the right direction.

Graham Hookey writes on education, parenting and eldercare (

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