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Cat Forum / Cat Anecdotes / June 2005Harri Roadcat update #4: still hopeful
The vet got the lab results back on the fluid he drained from Harri's chest. It does NOT indicate rat poison as he first thought, rather it indicates a massive infection. Harri is back on massive antobiotics and the vet will be operating this afternoon to implant chest tubes. Her chest will have to be drained pretty much continuously, since just between when he drained the fluids last night and when he took another x-ray this afternoon a lot more fluid has collected. Current concern is for Harri to survive anesthesia (always a risk with compromised lungs and an ongoing infection). She will be at the vet for probably 3 or 4 more days. And the bill will go up by another $1500 :( But the vet ought to able to get this under control. I sure hope so - I can't imagine going through life without my little Roadcat. The vet will call this evening when Harri wakes up. Dan > The vet got the lab results back on the fluid he drained from Harri's > chest. It does NOT indicate rat poison as he first thought, rather it [quoted text clipped - 13 lines] > > Dan Purrs intensified yet again, Dan. Hugs, CatNipped > The vet got the lab results back on the fluid he drained from Harri's > chest. It does NOT indicate rat poison as he first thought, rather it [quoted text clipped - 13 lines] > > Dan 'Oh my goodness :( Infections are just plain scary. Intensive surgery purrs coming up. Karen > The vet got the lab results back on the fluid he drained from Harri's > chest. It does NOT indicate rat poison as he first thought, rather it [quoted text clipped - 13 lines] > > Dan Major purrs still continuing from here. I asked you for your address to send a little something, but I guess you are too busy to reply. However..I still have some of my Christmas card envelopes and I looked through them. Is your address Harlan or Harlam Lane, number D? I have all the rest. If so, please confirm and a little bit will be on the way to you fpr Harri from KFC & BF. Tweed >>The vet got the lab results back on the fluid he drained from Harri's >>chest. It does NOT indicate rat poison as he first thought, rather it [quoted text clipped - 22 lines] > > Tweed Oh, thank you! I must admit I've only been skimming messages to day - to preoccupied with worrying about Harri. Yes, the address from the Christmas card list is still good - Harlan Lane. Or you send straight to the vet, since all the money I can find for the next little while will be going to them anyway. Harriet Mahoney is currently at: > VCA All Care Animal Referral Centre > 18440 Amistad St > Fountain Valley > California 92708 > > Their phone number is 714 963 0909 Lots and lots and LOTS of purrs Dan. Susan M Otis and Chester > The vet got the lab results back on the fluid he drained from Harri's > chest. It does NOT indicate rat poison as he first thought, rather it [quoted text clipped - 13 lines] > > Dan Deep purrrs going to Harri from Rusty. Winnie > The vet got the lab results back on the fluid he drained from Harri's > chest. It does NOT indicate rat poison as he first thought, rather it [quoted text clipped - 13 lines] > > Dan > Current concern is for Harri to survive anesthesia (always a risk with > compromised lungs and an ongoing infection). She will be at the vet for [quoted text clipped - 3 lines] > > The vet will call this evening when Harri wakes up. I'll be anxiously awaiting your next update and praying for little Harri. So, this is definitely not chylothorax? Candace > I'll be anxiously awaiting your next update and praying for little > Harri. So, this is definitely not chylothorax? > > Candace Not for sure. I think I remember reading that the fluid leakage leading to chylothorax can be caused by infections, so I think it's still possible. I was so distracted that I didn't think to ask the vet this afternoon. Dan >> I'll be anxiously awaiting your next update and praying for little >> Harri. So, this is definitely not chylothorax? [quoted text clipped - 6 lines] > > Dan May I suggest you write down all the questions you have before talking to the vet. When I had surgery, I tend to forget what I want to ask the surgeon. I just gave him the list of questions when he made rounds, esepcially as I couldn't speak at the time. I should have asked him to write down the answers as I forgot what he said. I remember how difficult it was for me when Rusty stayed in the emergency to get unblocked. So I understand you are worried and distracted. But please take care of yourself and try to get some sleep. Winnie >> Not for sure. I think I remember reading that the fluid leakage leading to >> chylothorax can be caused by infections, so I think it's still possible. I [quoted text clipped - 8 lines] >I should have asked him to write down the answers as I forgot what >he said. A good idea. I know, both with Sammy and Rocky I kept forgetting to ask things, only to remember them as soon as I left the clinic. A couple times I'd hop back in the truck and go back to talk to the vet after getting home - good thing it's only a few blocks.  SignatureSteve Touchstone, faithful servant of Sammy, Little Bit and the Evil Spot with loving memories of Rocky (RB) stouchst@JUNKsirinet.net [remove Junk for email] Home Page: http://www.sirinet.net/~stouchst/index.html Cat Pix: http://www.sirinet.net/~stouchst/animals.html First, Dan, I can't fully be in your situation -- but Harri feels like one of my family. > The vet got the lab results back on the fluid he drained from Harri's > chest. It does NOT indicate rat poison as he first thought, rather it > indicates a massive infection. Is there any preliminary diagnosis of the specific organism causing the infection? >Harri is back on massive antibiotics and Unfortunately, with an overwhelming infection, the best choice is to use a "shotgun" approach of multiple antibiotics. Once the organism(s) are identified, fewer and potentially less toxic antibiotics. Again when the organism is known, there may be specific supportive measures that can help. > the vet will be operating this afternoon to implant chest tubes. Her > chest will have to be drained pretty much continuously, since just > between when he drained the fluids last night and when he took another > x-ray this afternoon a lot more fluid has collected. I wish I could tell her "I've been there and done that." True chest tubes are almost always connected to continuous suction drainage until they are almost ready to come out. Again in people, although I suspect it's similar in cats, inserting chest tubes is not a major procedure. I'm just as happy that I got mine inserted under general anesthesia, although they were pulled out with no anesthesia (some doctors use local anesthetics for that). I have dime-sized scars where they were; you can scale that down to cat or pediatric size. I have seen chest tubes inserted in semiconscious or conscious people, using local anesthetics. There are usually several heartfelt OUCHES, but they go in through a small incision between ribs, and only go in a short distance. Their role, and the role of the suction, is not just draining, but also restoring the partial vacuum of the chest cavity, which is necessary for normal breathing. While it will be more difficult in a small patient, inserting chest tubes is often within the scope of practice of paramedics. It's not large-scale surgery. > Current concern is for Harri to survive anesthesia (always a risk with > compromised lungs and an ongoing infection). Agreed. Were this human medicine, I'd assume she would have to be on a respirator. Since a cat is unlikely to tolerate a respirator if awake, she will probably have to be sedated, which is another delicate balance Signature>She will be at the vet for > probably 3 or 4 more days. And the bill will go up by another $1500 :( [quoted text clipped - 4 lines] > > Dan Purrs and healing. I'll send my phone number by email -- call anytime; I work from home. Just give me a quick ring and I can call back; I have flat rate long distance. > First, Dan, I can't fully be in your situation -- but Harri feels like > one of my family. Thanks, I do appreciate that! > Is there any preliminary diagnosis of the specific organism causing the > infection? Not yet, but the vet said that he's running a culture now. I assume that will allow him to get some idea of what organism is responsible. I'm interested in learning that, since I'm hoping it's not something that has the potential of infecting one of the other 5 kitties. > Unfortunately, with an overwhelming infection, the best choice is to use > a "shotgun" approach of multiple antibiotics. Once the organism(s) are > identified, fewer and potentially less toxic antibiotics. Again when the > organism is known, there may be specific supportive measures that can > help. That's kind of what I thoughm based upon the reading I've done. > I wish I could tell her "I've been there and done that." True chest > tubes are almost always connected to continuous suction drainage until [quoted text clipped - 13 lines] > small patient, inserting chest tubes is often within the scope of > practice of paramedics. It's not large-scale surgery. I am concerned about Harri's potential discomfort, but this vet clinic does these procedures fairly often. They're the only vet place I've heard of around here that does such a wide range of surgical procedures - cardiac surgery, thoracic surgery, joint replacement, hydrotherapy - their list of services runs several dozen items long. I really do appreciate the support and the info, Howard. > > First, Dan, I can't fully be in your situation -- but Harri feels like > > one of my family. [quoted text clipped - 8 lines] > interested in learning that, since I'm hoping it's not something that > has the potential of infecting one of the other 5 kitties. Cultures now come back much faster than they used to, in a modern lab. Back when I was doing bench bacteriology, for example, you had to wait several days before there was enough growth to measure, for example, if the bacteria fermented a particular sugar. Now, the culture media have radioactively labeled sugars and you can detect extremely small amounts of gas well under 24 hours. If you pick the right immune tests, for which you have to have a reasonable idea of the potential organism, you can sometimes tell within minutes. Did they mention having done a Gram Stain? That can be done on the fluid -- preferably centrifuged to concentrate it -- in a few minutes. It won't give you an exact identification, but it helps focus. At the simplest level, if it stains pink rather than purple, penicillin generally won't work. There are other rules of thumb where you can draw inferences. It also might be worth doing an India Ink Stain, which can visualize fungus cells. Thinking about it, there might be clues there in her blood count, specifically the percentages of types of white cells. If there is elevation in a type called eosinophils, that's indicative of an inflammatory disease -- and you often get that reaction from parasites or fungi, but not bacteria. > > Unfortunately, with an overwhelming infection, the best choice is to > > use [quoted text clipped - 36 lines] > > I really do appreciate the support and the info, Howard. I looked at their website and was impressed -- in fact, when I saw what they have in their imaging department, I was in some shock. It was only recently when Kamloops, which is the second or third largest city in British Columbia, got its first MRI scanner. The things they don't seem to have are generally at the research level now. It is sort of ironic they don't have a PET scanner. Realistically, PET scans are still fairly specialized in human medicine. >> I am concerned about Harri's potential discomfort, but this vet clinic >> does these procedures fairly often. They're the only vet place I've [quoted text clipped - 8 lines] > recently when Kamloops, which is the second or third largest city in > British Columbia, got its first MRI scanner. There are long waiting lists for MRI for humans here in Canada, at least in the capital - Ottawa. Winnie > The things they don't seem to have are generally at the research level > now. It is sort of ironic they don't have a PET scanner. Realistically, > PET scans are still fairly specialized in human medicine. > There are long waiting lists for MRI for humans here in Canada, at > least in the capital - Ottawa. Out of curiosity, what do you mean by long? Here in Colorado, I was able to get an MRI appointment in about a week, and that was just for wrist pain, not a potentially fatal problem. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Out of curiosity, what do you mean by long? I remember in a movie I saw they said it was a months-long wait. > Here in Colorado, I was able to get an MRI appointment in about a > week, and that was just for wrist pain, not a potentially fatal > problem. When I had an MRI done last year I was able to get an appointment the same week I requested it. I have insurance, of course, so I was able to go to a private clinic. I'm sure public hospitals here also have long waits. SignatureVictor M. Martinez Owned and operated by the Fantastic Seven (TM) Send your spam here: uce@ftc.gov Email me here: pistorLITTER@BOXaustin.rr.com > When I had an MRI done last year I was able to get an appointment > the same week I requested it. I have insurance, of course, so I was > able to go to a private clinic. I'm sure public hospitals here also > have long waits. Come to think of it, I had it done at a clinic, not the hospital across the street. (Are hospitals by definition public?) Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Come to think of it, I had it done at a clinic, not the hospital > across the street. (Are hospitals by definition public?) No. For example, here in Austin we only have 1 public hospital, which is owned by the City and provides service for low-income people or people without insurance. SignatureVictor M. Martinez Owned and operated by the Fantastic Seven (TM) Send your spam here: uce@ftc.gov Email me here: pistorLITTER@BOXaustin.rr.com All hospitals in Canada are public, funded by government health insurance. But they are always lacking in funds resulting in long waits in emergcy rooms and tests like MRI. Lab tests are also paid for by government health insurance. It is a good thing for low income or unemployed people like me who don't have additional insurance from work. But that also means higher taxes in Canada. We have 15% sales tax in Ontario. I heard there are cases people going south to US. to get MRI or cancer treatments. The wait for MRI can be weeks or months. I heard there are not enough MRI and/or qualified people to run them, at least in Ottawa. The politicians made a big deal whenever a MRI was purchased. Debates are going on whether to allow private clinics. Winnie >> Come to think of it, I had it done at a clinic, not the hospital >> across the street. (Are hospitals by definition public?) > > No. For example, here in Austin we only have 1 public hospital, which is > owned by the City and provides service for low-income people or people > without insurance. > All hospitals in Canada are public, funded by government health > insurance. But they are always lacking in funds resulting in long [quoted text clipped - 3 lines] > don't have additional insurance from work. But that also means > higher taxes in Canada. We have 15% sales tax in Ontario. Don't forget how the health care system has become a political football between federal and provincial politicians. Such problems as we have - and I'd take them any day over an entirely private system - are at least partly due to the feds cutting their contributions drastically, and certain provincial governments taking money for health care from the feds, and then spending it on something else, which tends to annoy the feds, not to mention the patients/voters. > I heard there are cases people going south to US. to get MRI > or cancer treatments. The wait for MRI can be weeks or months. > I heard there are not enough MRI and/or qualified people to run them, at > least in Ottawa. The politicians made a big deal whenever > a MRI was purchased. This sort of thing seems to vary enormously by province and location within a province. We almost never hear of people going to the US for private tests - but we're a lot further from the border than most of the people in Ontario, and we tend to have a poorer-than-average population who couldn't pay US prices anyway. There is *always* a big debate over the purchase and location of any major medical equipment - each region within the province wants its own! I think this is healthy (politically, not medically!). There are waiting lists. I think if you are an emergency, you still generally get seen in a fairly timely manner. If you are low-risk or getting routine screening done, you will have to wait longer. Sometimes, naturally, what doctors consider fairly routine screening, patients consider emergencies, particularly in the case of such dangerous diseases as cancer. We had a case where a post-treatment checkup on a child was postponed beyond what the parents thought reasonable. Being a small province, we have only one child-sized set of equipment of the type needed, and it seems that children take much longer to test than adults, so the waiting list was long. If it gets bad enough, people can insist on treatment out of province, as is done for rare conditions that can't be handled here anyway. That's complicated and tedious, though, and most people, when they are sick, want to be treated near home. > Debates are going on whether to allow private clinics. That was an interesting decision in Quebec. I'm on the 'no two tier' side, very strongly, and the litigants' political rhetoric infuriated me. But the judges' decisions were much more nuanced. SignatureCheryl > Don't forget how the health care system has become a political > football between federal and provincial politicians. Such problems [quoted text clipped - 4 lines] > something else, which tends to annoy the feds, not to mention the > patients/voters. I like the idea of healthcare for everyone, but I don't want it at the expense of my ability to get the kind of treatment I choose. Call me a capitalist pig. I put my money where my mouth is -- I always choose the insurance plan that gives me the most flexibility in seeing whatever doctor I want, and yes, that's always the most expensive option. It seems like there must be a way to cover the less-fortunate while still giving those who want it the freedom to get the treatment they want, see the doctor they want, etc. I just don't trust the government to decide for me what treatment is or isn't necessary for me to live a healthy life. I do think the cost of medical treatment here in the US is insane. I have wondered if moving to a "true emergency" insurance setup (routine care wouldn't be covered, but big expenses would be) would help, but I spoke to my aunt, who has been in the insurance and medical biz for a long time; she said that if the insurance companies don't cover preventative care, most people won't choose to get it, and that ends up costing the insurance companies more in the long run. It's definitely a sticky problem. > That was an interesting decision in Quebec. I'm on the 'no two tier' > side, very strongly, and the litigants' political rhetoric > infuriated me. But the judges' decisions were much more nuanced. I don't know anything about this particular instance, but why are you against a two-tier system? Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca >> Don't forget how the health care system has become a political >> football between federal and provincial politicians. Such problems [quoted text clipped - 34 lines] > I don't know anything about this particular instance, but why are you > against a two-tier system? Thing is where I work anyway, the insurance keeps going up, but the options keep getting smaller and smaller. I'm beginning to wonder what use it is. You can hardly choose anyway and you are paying more and more for less choice. It's not like I can even get my employer to pick a different coverage. > I like the idea of healthcare for everyone, but I don't want it at the > expense of my ability to get the kind of treatment I choose. Call me I think most reasonable people would agree with you. I would like there to be basic and emergency health care for everybody, regardless of income or insurance. It sickens me to think that in the richest country in the history of the world, there are kids who don't have basic medical care, not even vaccines! Anyhow, universal care for everybody and those who want more can pay for it themselves. What's not to love about a system like that? :) SignatureVictor M. Martinez Owned and operated by the Fantastic Seven (TM) Send your spam here: uce@ftc.gov Email me here: pistorLITTER@BOXaustin.rr.com > I think most reasonable people would agree with you. I would like there > to be basic and emergency health care for everybody, regardless of [quoted text clipped - 3 lines] > Anyhow, universal care for everybody and those who want more can pay for > it themselves. What's not to love about a system like that? :) Hey - come to the UK, that's pretty much what we have here! With the pros and cons of both systems, i.e. you can wait a ridiculous length of time and get your treatment for free (well, for the taxes you already paid), or you can pay a heart-stoppingly huge amount of money and get it done immediately. ;-) Deb. Signaturehttp://www.scientific-art.com "He looked a fierce and quarrelsome cat, but claw he never would; He only bit the ones he loved, because they tasted good." S. Greenfield > Hey - come to the UK, that's pretty much what we have here! With the > pros and cons of both systems, i.e. you can wait a ridiculous length of > time and get your treatment for free (well, for the taxes you already > paid), or you can pay a heart-stoppingly huge amount of money and get it > done immediately. ;-) That's what we have here, too, except that what was completely free before now does cost a little. But much less than private doctors and hospitals. SignatureMarina, Frank and Miranda. In loving memory of Nikki. marina (dot) kurten (at) pp (dot) inet (dot) fi Pics at http://uk.pg.photos.yahoo.com/ph/frankiennikki/ and http://community.webshots.com/user/frankiennikki > > Hey - come to the UK, that's pretty much what we have here! With the > > pros and cons of both systems, i.e. you can wait a ridiculous length of [quoted text clipped - 5 lines] > before now does cost a little. But much less than private doctors and > hospitals. Ah - interesting, sounds like what we will end up with, too. I think the Govt would like to introduce more 'pay as you go' treatment here, but they'll face a huge battle in the process. Deb. Signaturehttp://www.scientific-art.com "He looked a fierce and quarrelsome cat, but claw he never would; He only bit the ones he loved, because they tasted good." S. Greenfield One of the problems with a 2-tier system in Canada is that the private clinics and hospitals will draw away doctors from the public ones where they are paid by the government. Private places will presumably pay the doctors more. There is already a shortage of doctors. Many many doctors have left for U.S. Same thing with nurses from what I heard. Of course there are pros also. The waiting list may be shortened if any who can afford it go to private places. Winnie >> I like the idea of healthcare for everyone, but I don't want it at the >> expense of my ability to get the kind of treatment I choose. Call me [quoted text clipped - 6 lines] > Anyhow, universal care for everybody and those who want more can pay for > it themselves. What's not to love about a system like that? :) > One of the problems with a 2-tier system in Canada is that the > private clinics and hospitals will draw away doctors from the public > ones where they are paid by the government. Private places will > presumably pay the doctors more. There is already a shortage of > doctors. Many many doctors have left for U.S. Same thing with nurses > from what I heard. Devil's advocate: Isn't the shortage of medical professionals due to the lack of pay? Seems like the Canadian government needs to pay them what the market will bear, or they will continue to lose skilled workers. In a two-tiered system, some of those salaries will be paid by private funds, which leaves a larger pool with which to either pay for more doctors or pay more per doctor. > Of course there are pros also. The waiting list may be shortened if > any who can afford it go to private places. The waiting lists for both private and public facilities. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Devil's advocate: > Isn't the shortage of medical professionals due to the lack of pay? > Seems like the Canadian government needs to pay them what the market > will bear, or they will continue to lose skilled workers. In a > two-tiered system, some of those salaries will be paid by private funds, > which leaves a larger pool with which to either pay for more doctors or > pay more per doctor. I think the lack is partly due to low salaries, and partly, especially for nurses, in the lack of full time jobs. And there's no particular reason to assume that a private system would provide better pay (at least, for employees, as opposed to doctors running their own business) or that a government system, facted with fewer patients, wouldn't start trying to cut costs beginning with the payroll. One concern is that private institutions will save money by hiring fewer, less qualified personnel, especially in nursing. There is already talk of that in nursing homes. Reduce the number of registered nurses, and hire more licenced practical nurses and even more minimally trained 'home help' aids who can be paid little more than minimum wage and few or no benefits, and you've saved a ton of money. Then you ensure that as many positions as possible are short-term, contract, part-time ones. The same approach is happening in public hospitals, of course, but private ones would be likely to go even further that way since they need to make a profit for their owners, and that's one obvious way to do it. SignatureCheryl >> Devil's advocate: > [quoted text clipped - 24 lines] > go even further that way since they need to make a profit for their > owners, and that's one obvious way to do it. I don't think that would happen because the private clinics would have to compete against each other for customers and wouldn't want word to get around that their clinic is poorly staffed. Just look at the clinics for the stuff that people are already on their own for, plastic surgery, chiropractor, etc. Those places are well staffed and equipped. All I can say is that if we ever have to move back to Canada (and I'm really hoping that won't have to happen), we will keep an emergency bank account with money to return to Thailand and have treatment here at one of the private hospitals. -- Britta "There is no snooze button on a cat who wants breakfast." -- Unknown Check out pictures of Vino at: http://photos.yahoo.com/badwilson click on the Vino album > I don't think that would happen because the private clinics would have > to compete against each other for customers and wouldn't want word to > get around that their clinic is poorly staffed. Just look at the > clinics for the stuff that people are already on their own for, > plastic surgery, chiropractor, etc. Those places are well staffed and > equipped. There are - and will be - those, and then there are - and will be the others. Consider homes for the elderly who can't afford well-equipped places, and can't get into a government place. > All I can say is that if we ever have to move back to Canada (and I'm > really hoping that won't have to happen), we will keep an emergency > bank account with money to return to Thailand and have treatment here > at one of the private hospitals. And I can't imagine any circumstances that would impel to me travel outside Canada for health care. In fact, if I became sick while travelling, I'd move heaven and earth to get back here. But of course, it would be a boring world if we all agreed. SignatureCheryl > I like the idea of healthcare for everyone, but I don't want it at the > expense of my ability to get the kind of treatment I choose. Call me > a capitalist pig. I put my money where my mouth is -- I always choose > the insurance plan that gives me the most flexibility in seeing > whatever doctor I want, and yes, that's always the most expensive > option. I can see whatever doctor I want, assuming the doctor is willing to see me (some don't take new patients, or only see people by referral). I can choose whatever kind of treatment I want - and if I can't get it here AI can go elsewhere. If I have the money. > It seems like there must be a way to cover the less-fortunate while > still giving those who want it the freedom to get the treatment they > want, see the doctor they want, etc. Well, how much choice you get depends on the design of the system. > I just don't trust the government to decide for me what treatment is > or isn't necessary for me to live a healthy life. I have far less trust in the insurance companies doing so. I have private dental insurance (not covered by medicare in my province) and my dentist and the insurance company are disagreeing about my teeth. > I don't know anything about this particular instance, but why are you > against a two-tier system? I think it will end up with the richer people going private, and since they get their care that way, there will be reduced funding and support for the public system. It's not an absolute thing. There is some private health care - like my teeth, see above. And if I want my breasts fixed up (for cosmetic reasons, not after accident or cancer surgery) or laser eye treatments when glasses work just fine, I can have it done, but have to pay out of my own pocket. That doesn't bother me at all. I want the core stuff, treatment of illness and accidents, treated by one giant insurance scheme run by the government and paid for by everyone. SignatureCheryl >> I don't know anything about this particular instance, but why are >> you against a two-tier system? [quoted text clipped - 9 lines] > illness and accidents, treated by one giant insurance scheme run by > the government and paid for by everyone. Those are all good points. I guess some part of me wants to believe that I can have my cake and eat it too -- I want the poorest to still have coverage, but still be allowed to get better coverage or pay for better treatment. One MRI machine per region -- that's just insane to me. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Those are all good points. I guess some part of me wants to believe > that I can have my cake and eat it too -- I want the poorest to still > have coverage, but still be allowed to get better coverage or pay for > better treatment. One MRI machine per region -- that's just insane to > me. I was talking about regions in general, and machines in general - but to put it in perspective, you could put the population of my entire province in a suburb of a biggish city and hardly notice the increase in population. Most of our regions have very small populations spread over very large areas, so the fights about whether it is cheaper and/or better for the patients to have treatment X or test Y fairly near their homes or really far away are carried out in this context. It would be positively insane to *put* an MRI in many of these areas because there are too few people needing one, and difficulties in getting qualified operators for them. But where to draw the line occupies a great deal of local political debate. SignatureCheryl >> Those are all good points. I guess some part of me wants to >> believe that I can have my cake and eat it too -- I want the [quoted text clipped - 14 lines] > them. But where to draw the line occupies a great deal of local > political debate. That's fair. I don't know how easy it is to find an MRI in a rural are of the US, either. But it sure seems like people think it takes longer to get an MRI in Canada than it does to get one in the US, in general. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > That's fair. I don't know how easy it is to find an MRI in a rural > are of the US, either. But it sure seems like people think it takes > longer to get an MRI in Canada than it does to get one in the US, in > general. Maybe it does, on average. That doesn't worry me much as long as everyone gets seen, the urgent cases quickly and the non-urgent ones less so, with no more screw-ups than are unavoidable for any human endeavour. I have't looked into this in a lot of detail, but I gather that the stats on waiting lists are really, well, useless. Different groups start counting waiting time differently, and the results can't be compared at all. Maybe Howard knows more. I do know that someone recently did a news story on how long, from diagnosis, someone with a particular cancer had to wait for surgery. Next day, one of the local surgeons who does such operations was on the news saying that there actually wasn't a waiting list at all, since proper treatment of such cancers involved something else first - chemo or radiation? - and the surgery was done *after* this preliminary treatment, which took up all the 'waiting period'. For example, the current local waiting period for a mammogram is about a year. If you are over 50, it's about two months. If your doctor finds something suspicious and then orders the mammogram, ie not routine screening, well, I know someone who got the mammogram, had the surgery, had the cancer diagnosis confirmed, and chemo started in about a week! People tend to choose the time period that suits their purposes, especially if they are writing newspaper articles. SignatureCheryl > All hospitals in Canada are public, funded by government health > insurance. But they are always lacking in funds resulting in long [quoted text clipped - 10 lines] > a MRI was purchased. > Debates are going on whether to allow private clinics. At least in some Canadian provinces, hospitals that have a MRI are given a cap on acceptable reimbursements for MRIs. That usually means the hospital will reserve some slots for true emergencies. Ironically, while they will not be paid by the government for additional examinations, and the current Canadian law does not allow those who can afford it to pay out of pocket, there's no restriction on fee-for-service veterinary use of the equipment. So, some Canadian hospitals are making MRI services available to veterinary patients that pay up front, so these patients can get it while human patients cannot. Neither the current Canadian nor the current US models are perfect. Healthcare economics are not simple. There are proposals, one of which I think is very promising, that might work much better in both countries, even with local modifications. > All hospitals in Canada are public, funded by government health > insurance. But they are always lacking in funds resulting in long [quoted text clipped - 12 lines] > > Winnie It must be different in BC because I know for sure that there are private clinics there. A friend of mine paid $1500 about 5 years ago to have knee surgery without waiting at a hospital because he wanted the timing to work out in order to let him play tennis during the summer. -- Britta "There is no snooze button on a cat who wants breakfast." -- Unknown Check out pictures of Vino at: http://photos.yahoo.com/badwilson click on the Vino album >> All hospitals in Canada are public, funded by government health >> insurance. But they are always lacking in funds resulting in long [quoted text clipped - 24 lines] > Check out pictures of Vino at: > http://photos.yahoo.com/badwilson click on the Vino album Just heard on the news that there is going to be a new private clinic in Toronto that offer services not offered in the public health system. Ontario just recently stopped coverage on physiotherapy and eye exam for those who are not seniors. So I am cutting back on my trips to a physiotherapy clinic as I don't have a job and the associated supplementary insurance. Good thing my shoulders are getting better. Last year I had to go for physiotherapy twice a week. Can't afford that now. In a preverse way, I hope I become a senior before they cut any more health services for those who are not seniors. Winnie > It must be different in BC because I know for sure that there are > private clinics there. A friend of mine paid $1500 about 5 years ago > to have knee surgery without waiting at a hospital because he wanted > the timing to work out in order to let him play tennis during the > summer. Medical systems are run provincially, so that does vary. In Maclean's they said that part of the reasoning behind the Quebec judges' decision was the fact that exactly what is allowed to be done privately varies across Canada, so Quebec's law was probably too rigid since other provinces had different ones. SignatureCheryl >> Come to think of it, I had it done at a clinic, not the hospital >> across the street. (Are hospitals by definition public?) > > No. For example, here in Austin we only have 1 public hospital, > which is owned by the City and provides service for low-income > people or people without insurance. Hrm. Yeah, that checks. The hospital we use is pretty posh; the rooms for in-patients are all large, with only one patient in each. I wonder where the closest public hospital might be ... Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Hrm. Yeah, that checks. The hospital we use is pretty posh; the rooms > for in-patients are all large, with only one patient in each. > I wonder where the closest public hospital might be ... I visited the US hospital where my father was being treated. I'm afraid the elegant decor simply made me wonder why they were spending money on that instead of on patient care! I'm more used to utilitarian paint jobs and chairs, with portraits of long-gone administrators and doctors, or possibly helpful posters on common ailments instead of framed artwork! I know, I know, in a for-profit system, you have to make everything look nice, and offer all private rooms, because that's what the customers you are trying to attract want. SignatureCheryl > > Hrm. Yeah, that checks. The hospital we use is pretty posh; the rooms > > for in-patients are all large, with only one patient in each. [quoted text clipped - 10 lines] > nice, and offer all private rooms, because that's what the customers you > are trying to attract want. No, not all for-profit hospitals emphasize looking nice. For that matter, the non-for-profit hospitals still compete for voluntary admissions. As an example, the hospital closest to me is for-profit. Of the next two, the larger had been not-for-profit but was bought by a for-profit chain. The other nearby one is not-for profit. The closer for-profit hospital (Northern Virginia Doctors) is by far the least attractive. I think it's improved some, but the last time I was a patient, the food was bad by the standards of hospital food. Nevertheless, it has excellent nursing care and a generally attentive staff. Its emergency room is lightly loaded, and the place least likely to have a long wait for a minor emergency. It's a level III ER, while the other two are level II. For really serious things, there are at least three level I within ten miles -- I think two more as well, but one or two of them may have dropped to level II. All the Level I's are not-for profit. Of those major hospitals, however, the biggest Level I has a high-dollar VIP wing with exceptionally beautiful rooms, to compete for people that have a choice. You can also pay for special meals in a regular room. All the hospitals do offer optional amenities, some at extra charge and some not. One thing that is increasingly common is allowing an extra bed to be put in a private room, so a friend or family member can stay with the patient. I'm still mystified by one not-for-profit hospital to which I occasionally consult. After another not-for-profit put in wireless Internet access for patients and visitors, my client immediately felt they had to do it to attract patients. Now, admittedly, I do take a laptop to the hospital when I'm in for tests, but not when I'm really sick. The reality of the most effective US funding models, the Federal Employees Health Care plan, has many more than two tiers. People are given a choice of multiple plans at different prices, depending on geographic area. When last I looked, there were ten or twelve option in the Washington DC area. It wasn't a pure hierarchy of increasing benefits. For example, one recent plan is run under Catholic rules -- they will not cover contraception, abortion, and some fertility medicine, but they are cheaper than several other plans. One of the reasons the Clinton healthcare plan failed -- the critical oe was absolutely awful political and public relations handling -- was that it forced all care to be within the system. I understand that this is generally true for Canada, although certain services, such as cosmetic surgery, are outside. A good many healthcare policy analysts see a hidden benefit in outside-the-system care: as long as it has to comply with the same safety standards, it can sometimes demonstrate alternate ways for improving safety or quality. >> Hrm. Yeah, that checks. The hospital we use is pretty posh; the >> rooms for in-patients are all large, with only one patient in each. [quoted text clipped - 11 lines] > look nice, and offer all private rooms, because that's what the > customers you are trying to attract want. Your viewpoint is so ... odd to me. DH has been an in-patient at our local hospital several times. Having a private room makes a lot of sense, as it reduces the chances of catching something from another patient. As nurses are checking in on the patients every 15 minutes or so, it also reduces the amount of disturbance while the patient is sleeping. And I was able to spend the night in DH's hospital room -- they even had a small pull-out couch and provided me with blankets and snacks. I'm not sure they would have let me stay had there been another person in the room. The artwork makes it feel more homey. All of this contributes to a more comfortable environment for the patients, which I believe translates directly to a faster recovery! If I'm sitting in an examination room waiting for the doctor, sure, give me some posters and brochures on medical stuff. All of the ER rooms I've been in have useful posters -- the one we visited Weds night (when DH broke his wrist, *sigh*) even talked about how to preserve dismembered body parts *shudder* But I don't think the "expense" of a few framed posters from K-Mart, or a non-institutional paint color, are going to break the bank; they do make the place feel a lot more comfortable, both for the patient and for the family. Another point you might consider -- often hospital decorations, visitor nooks, and other such things are donated. Even commercial hospitals do get donations. ... Well, I wondered what DH would think of all this, so I asked him his opinion. As a several-time in-patient, what does he think? He said he's all for a few touches to make the room seem less institutional. He also mentioned (without prompting from me) that the decorations they use "aren't Picassos" -- they're cheap, but they do cheer up the room. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Your viewpoint is so ... odd to me. DH has been an in-patient at our > local hospital several times. Having a private room makes a lot of > sense, as it reduces the chances of catching something from another > patient. As nurses are checking in on the patients every 15 minutes or > so, it also reduces the amount of disturbance while the patient is > sleeping. Private and semi-private is nice, and available in small numbers. I found the main benefit was that you didn't have to put up with your room-mates' visitors. I didn't find it reduced the other main disturbances - people wanting to examine, inject, feed, draw blood - at all! > And I was able to spend the night in DH's hospital room -- > they even had a small pull-out couch and provided me with blankets and > snacks. I'm not sure they would have let me stay had there been another > person in the room. The artwork makes it feel more homey. All of this > contributes to a more comfortable environment for the patients, which I > believe translates directly to a faster recovery! I suppose that's the theory. I want OUT and am not calmed by the decor. I suppose it does allow me to distract myself by speculating on the hospital's use of it's budget. I should perhaps explain my hospital visits (well, I do clerical work in a hospital; I mean my non-working visits) are divided into (a) too sick or scared to notice the decor (b) too bored to think of anything other than escape and (c) too worried about whoever I'm visiting to care about the decor. It's in the 'bored' stage I start wondering about the decor and who on earth they have working in the kitchens. If they have kitchens. Some places have contracted out the job and the stuff is trucked in from some industrial park, which explains a lot. Sell the cheap pictures and hire a cook, at least part time! > If I'm sitting in an examination room waiting for the doctor, sure, > give me some posters and brochures on medical stuff. All of the ER [quoted text clipped - 4 lines] > paint color, are going to break the bank; they do make the place feel > a lot more comfortable, both for the patient and for the family. > Another point you might consider -- often hospital decorations, > visitor nooks, and other such things are donated. Even commercial > hospitals do get donations. Both good points. SignatureCheryl >>Hrm. Yeah, that checks. The hospital we use is pretty posh; the rooms >>for in-patients are all large, with only one patient in each. [quoted text clipped - 10 lines] > nice, and offer all private rooms, because that's what the customers you > are trying to attract want. Hi there! I work as an RN at a local not for profit hospital. It is in every way as good, or better (offers more services around the clock) than the local not for profit hospital. We are also trying to attract the "paying" patients. : ) A vast majority of our patients have private insurance or Medicare coverage. The only real difference between us and the for profit place is when someone uninsured comes to their ER door, they stabilize the patient, then send them to us for further care. This just happened with a young child whose pediatrician was actually one of THEIR physicians, but they sent her to us anyway... even though her doc couldn't follow her at our facility. So, yes, we are all in competition and need to be concerned with what kind of environment we offer our "customers", as well as what kind of medical care they get. : ) I'm wondering where Cheryl is from that the hospitals aren't decorated as nicely. It must be in a place where there isn't competition among hospitals for their patients. Shel > I'm wondering where Cheryl is from that the hospitals aren't decorated > as nicely. It must be in a place where there isn't competition among > hospitals for their patients. Newfoundland, Canada. I don't think we ever had any for-profit hospitals! They were run by religions or government, and they tended more to the clean and servicible than the professionally decorated in appearance. The new childrens' hospital is bright and cheerful, what I've seen of it, though. SignatureCheryl > No. For example, here in Austin we only have 1 public hospital, which is > owned by the City and provides service for low-income people or people > without insurance. Over here that's known as WOMACK Army Medical Center. <ironic grin> Pam S. > > When I had an MRI done last year I was able to get an appointment > > the same week I requested it. I have insurance, of course, so I was [quoted text clipped - 3 lines] > Come to think of it, I had it done at a clinic, not the hospital > across the street. (Are hospitals by definition public?) "Public", in this context, means the ownership is by a non-profit independent organization, or a governmental entity. In the US system, "procedures" such as MRIs are reimbursed promptly and well in many cases, encouraging the market to make lots of them available -- literally an oversupply in some areas. Offhand, I can think of 4 or 5 within a 5-mile radius of my house. > In the US system, "procedures" such as MRIs are reimbursed promptly > and well in many cases, encouraging the market to make lots of them > available -- literally an oversupply in some areas. Offhand, I can > think of 4 or 5 within a 5-mile radius of my house. That's not a bad thing, is it? I mean, promptly reimbursing MRIs. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > > In the US system, "procedures" such as MRIs are reimbursed promptly > > and well in many cases, encouraging the market to make lots of them > > available -- literally an oversupply in some areas. Offhand, I can > > think of 4 or 5 within a 5-mile radius of my house. > > That's not a bad thing, is it? I mean, promptly reimbursing MRIs. It's complex. The US healthcare system has been sufficiently under the control of MBAs rather than MDs that the higher reimbursements are for "procedural" medicine -- a measurable test, operation, etc. -- than for "cognitive" medicine -- taking histories and TALKING to patients. There is also an academic bias toward specialization rather than general medicine. Specialists tend to be the people that make the most use of procedures. Given the huge debt facing most medical school graduates and residents, they sometimes pick the higher-paying/better-reimbursed specialties that ones that they both might prefer and where they might be more needed. Good clinicians remind students "treat the patient, not the chart. The chart isn't sick." I'm on a trauma surgery mailing list where the acronym VOMIT has become popular: V ictim O f M odern I maging T echnology In some situations, there is a tendency to get overly dependent on MRI or other imaging or other laboratory results, and not pay as much attention to the actual patient. Sometimes a real disease with an unusual presentation doesn't get treated because it doesn't show up on some lab or imaging test, even though the history and physical are consistent with it. On other occasions, patients may be subjected to major surgery due to something visible on an image, but not necessarily supported by other clinical evidence. MRIs, Digital X-Ray, CTs, PET, SPECT, and a wide range of other imaging and laboratory tests have immense value. Used without thought, they can also run up immense costs. There's also the US malpractice mess, where expensive studies may be ordered to be in the chart if there's ever a lawsuit, not because the study had any particular obvious clinical benefit to the patient. I'd probably suggest that Canada has too few of certain facilities, but the US might do with a few less in oversaturated areas. In my area, a suburb of Washington DC, we have radio and television commercials, usually by well-known professional athletes, urging patients to have their MRIs at facility A rather than B. Sorry, athlete endorsements, shows of the elegance decor, or the choice of background music are not rational factors for picking an imaging facility and radiologist. >> Out of curiosity, what do you mean by long? > [quoted text clipped - 7 lines] > week I requested it. I have insurance, of course, so I was able to go to a > private clinic. I'm sure public hospitals here also have long waits. My mother's doctor scheduled an MRI for her. As I recall, we only had to wait two days for the appointment. MaryL >> Out of curiosity, what do you mean by long? > > I remember in a movie I saw they said it was a months-long wait. Months! You'd be lucky to get only months. Let's just say that Dennis couldn't get his herniated disk diagnosed in Canada...ever. The wait for an MRI for him would have been upwards of 1.5 years. They wouldn't even put him on the waiting list though. Just kept putting him off with physio and massage and exercises. Like any of that stuff helps! That's why he ended up waiting till we got over here to Thailand. He walked in to a private hospital in Bangkok, asked for an MRI and was having it done within minutes. $200. 2 days later he had surgery to remove the herniated disk. The doc said if he had left it for another year or 2, he would have ended up in a wheelchair due to irrversible nerve damage. Don't even get me started on the "wonderful" Canadian medical system. I have other horror stories. It would be great in theory but in reality it doesn't work due to staff and equipment shortages. Sure everyone's covered, but what good does that do you when you've waited so long that you're dead or permanently crippled??? -- Britta "There is no snooze button on a cat who wants breakfast." -- Unknown Check out pictures of Vino at: http://photos.yahoo.com/badwilson click on the Vino album <snip> > Don't even get me started on the "wonderful" Canadian medical system. > I have other horror stories. It would be great in theory but in > reality it doesn't work due to staff and equipment shortages. Sure > everyone's covered, but what good does that do you when you've waited > so long that you're dead or permanently crippled??? I'm sorry you had such a terrible experience with the Canadian system, but I have to point out that such experiences are not typical. I can just remember when it came in, and hearing our local doctor say that he welcomed it, because now he got paid for all his work, not just the stuff his patients could afford! Since then, I and my family have used the system for a wide range of problems - from 'normal' preventative care through a long-undiagnosed crippling neurolgical problem, serious mental and physical illnesses, including cancer (some cases fatal, others not). Not all in the same person, of course! I'm not saying there haven't been delays and frustrations, and one or two medical workers certain relatives of mine can't think of without cursing. But overall, I wouldn't trade the system for anything else. No one died waiting for treatment, although some died in spite of the best treatment. No one was crippled by bad treatment or lack of treatment, although of course, that sometimes happens in the best systems Some of my relatives lived in the US, and have had treatment there. It was good, because they had good insurance. Even with the good insurance, if one cancer had returned, that relative would have no longer been covered for treatment at all. I was enormously relieved when she returned to Canada and re-established her residency here. SignatureCheryl > <snip> >> Don't even get me started on the "wonderful" Canadian medical system. [quoted text clipped - 24 lines] > covered for treatment at all. I was enormously relieved when she returned > to Canada and re-established her residency here. I can't tell you how many horror stories I've heard lately, and I've come to the conclusion that no matter where you are, it is just a matter of luck in getting the doctor that can figure out your particular problem. I mean, it doesn't seem to matter what the problem or who the doctor. It's like the luck of the draw, whether on insurance or not! It seems that if you can find the really specialized places you have better luck than just going to the hospital. But you have to be diagnosed first! Personally, I'm thinking if I get sick, I want to go where Harri Roadcat is recovering. > I can't tell you how many horror stories I've heard lately, and I've come to > the conclusion that no matter where you are, it is just a matter of luck in [quoted text clipped - 4 lines] > hospital. But you have to be diagnosed first! Personally, I'm thinking if I > get sick, I want to go where Harri Roadcat is recovering. Some doctors are better than others, and even the good ones have bad days. I suppose even the bad ones sometimes have good days and get things right. I think I lost any belief that doctors were any more infallible than the rest of us many years ago. I'm fortunate. Years ago, when I needed some minor thing taken care of, and was tired of the constant new faces at the rural clinic near my home at the time, I followed the suggestion of a friend and called up a GP she recommended in the city I live in now. She's still my GP, and I have a great deal of respect for her knowledge and general approach to her patients. I only wish she were younger! Eventually, I suppose, she'll retire, and I'll have to sign up with one of those young whippersnappers who look like they should still be in high school! Any time I've needed additional care, I've taken her advice on what to do and who to get it done by, and her office has taken care of booking tests or specialist's apppointments. My mother's got a GP she doesn't really like, and although I've encouraged her to start the process of finding a new one (a bit more of a difficult process in her city than here), she doesn't want to go to the trouble of doing that, either! SignatureCheryl >> I can't tell you how many horror stories I've heard lately, and I've come to >> the conclusion that no matter where you are, it is just a matter of luck in [quoted text clipped - 28 lines] > process in her city than here), she doesn't want to go to the trouble of > doing that, either! Boy when you find a gem, keep it. I know, my mom just goes to this one clinic because it is convenient and she can always get in, but she always has last year interns. Some have been good and some have been dismal. She has at least gotten to choose which intern she wants now and there is one she really likes that she will begin seeing in July. I know it is better than not going, but even one of her specialist doctors mentioned that he wished she had ONE regular doctor she always saw, but she wouldn't be able to have it right around the corner like this clinic is. > I can't tell you how many horror stories I've heard lately, and I've > come to the conclusion that no matter where you are, it is just a [quoted text clipped - 6 lines] > thinking if I get sick, I want to go where Harri Roadcat is > recovering. Luck definitely plays into it, but this is why it's so important to me to have choices. If I don't think a particular doctor is going to help me, I see a different doctor. When my dentist seemed to be suggesting an awful lot of invasive dental work, I found another dentist and got a second opinion. I've now moved over to that second dentist. When I got an evaluation from a psychiatrist and she tried to prescribe me a drug, and then got snippy when I hesitated and asked her to explain why she would prescribe that particular drug, I went back to my doctor and got a referral to another psychiatrist, this one a lot more interested in actually communicating with me. I also try to choose a PPO that lets me go to a specialist without needing to see my GP first. The one time I decided to try my GP first, she made the wrong diagnosis, and I wasted about two months doing ineffective PT before I gave up and went to a specialist, who was able to address the real problem. Finding the second dentist was also interesting ... I actually found him because my temporary crown fell out (and got eaten). I called on Friday, but apparently most dental offices around here are closed Fridays. I called the dentist on call, but he just told me there was nothing he could do; that I'd just have to try not to break the tooth over the weekend. Well, I was freaking out. My dentist had made such a big deal about how my tooth didn't have enough material to withstand the pressures of eating, etc. I went through the yellow pages, calling dentist after dentist. Finally, finally, I found one who was open. They squeezed me in after their normal business hours, and he was able to fill the tooth with some kind of material that did the job. It didn't even take 15 minutes. I wonder, in a socialized medical system, would I have had better or worse luck? Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca >> I can't tell you how many horror stories I've heard lately, and I've >> come to the conclusion that no matter where you are, it is just a [quoted text clipped - 39 lines] > I wonder, in a socialized medical system, would I have had better or > worse luck? It sounds like you are one of the lucky ones with very good medical coverage. Trust me, not all packages are equal. > It sounds like you are one of the lucky ones with very good medical > coverage. Trust me, not all packages are equal. That's why I've said repeatedly that choice is what's important. I've always chosen a PPO. I realize that not all companies offer that, however. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > Luck definitely plays into it, but this is why it's so important to me > to have choices. If I don't think a particular doctor is going to [quoted text clipped - 28 lines] > I wonder, in a socialized medical system, would I have had better or > worse luck? With government supported health system in Canada, we still have a choice of doctors. You can go to any doctor you want. All licensed doctors are paid by the government insurance. But there is a shortage of doctors and lots of people can't find a family doctor. Lots of doctors do not accept new patients. I shudder to think what will happen when my GP retires. There are always the walk in clinic. Specialists do need referrals, but once you see them you don't need further referrals. But again it can be a long wait to see a specialist. I waited months to see a dermatologist or an opthomologist. Dentists are not supported by the health system. You pay them yourself unless you are covered by supplmentary insurances. Again you can choose to go to any dentist. Winnie > Specialists do need referrals, but once you see them you don't need > further referrals. But again it can be a long wait to see a > specialist. I waited months to see a dermatologist or an > opthomologist. That freaks me out. I value my ability to see a specialist when *I* want to see one. GPs don't always have the knowledge they need to treat a problem. The specialist may not, either, but at least there's a better chance. Again, I think it is great that anyone can get treatment in your system. I wish we had that here. But not at the expense of my ability to choose to pay for speedier/more convenient/whatever service. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > That freaks me out. I value my ability to see a specialist when *I* > want to see one. GPs don't always have the knowledge they need to > treat a problem. The specialist may not, either, but at least there's > a better chance. It freaks me out that people go to specialist for generalist care - like using an ob/gyne instead of a GP. What a waste and how silly! A GP has a much broader knowledge than a specialist and can spot early signs of trouble in a wide range of areas. Then, if needed, you go to a specialist in whatever area the GP found a problem. > Again, I think it is great that anyone can get treatment in your > system. I wish we had that here. But not at the expense of my > ability to choose to pay for speedier/more convenient/whatever > service. Whereas I prefer to have a GP to keep an overall eye on my health, while saving everyone's time and energy by not consulting a specialist for stuff a GP can handle. I'm not really a fan of speedy care except in emergencies, since I tend to think that a lot of stuff clears up on its own. But if I'm uncertain about what care is needed, I can get the GP's opinion in a day or so, or an ER doctor's opinion in hours - how many hours depends on who gets there ahead of me, and what the triage nurse thinks of my symptoms compared to everyone else's. It works for me. SignatureCheryl > It freaks me out that people go to specialist for generalist care - > like using an ob/gyne instead of a GP. What a waste and how silly! A > GP has a much broader knowledge than a specialist and can spot early > signs of trouble in a wide range of areas. Then, if needed, you go > to a specialist in whatever area the GP found a problem. I think it makes more sense to do a yearly general health exam with a GP and a yearly GYN exam with a GYN. That way you get the benefit of both specialties. > Whereas I prefer to have a GP to keep an overall eye on my health, > while saving everyone's time and energy by not consulting a [quoted text clipped - 7 lines] > > It works for me. It hasn't for me. I've tried putting things off to see if they get better. I've tried going to a doctor immediately. I've tried going to a specialist immediately. Putting things off -- DH hurt his wrist last week playing hockey. I probably would have sat it out for a while, but he decided to go straight to the ER, even though it was a fairly minor pain. Turns out he broke a bone in his hand, and online resources specifically say that early detection is the key to it ever healing properly. If he'd waited a week to get it looked at, the bone might already have started dying off. Seeing a GP first -- well, I did this with my wrist. She diagnosed it as tendonitis and sent me to a physical therapist. Two months later, zero improvement to my wrist, meaning I couldn't even pick up a purse, or the rim of a bicycyle wheel. Finally I went to an orthopedic surgeon. He was able to look for several conditions my GP hadn't even heard of, and eventually got me fixed up. Granted, it's not like you can get immediate attention for everything, anyway. My GP can almost always see me the same day. It's rare that I'd get to see the ortho surgeon within a week, unless I maybe had a bone sticking out of my shin or something. I don't go to a doctor every time I have the sniffles, but if I have an injury, a GP is rarely going to have as much information as a specialist. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca >> It freaks me out that people go to specialist for generalist care - >> like using an ob/gyne instead of a GP. What a waste and how silly! A [quoted text clipped - 5 lines] > GP and a yearly GYN exam with a GYN. That way you get the benefit of > both specialties. I used to do that for years. But now my GYN is so overworked she referred her patients back to the GPs for checkups.. If a GYN problem is found or suspected, the patients can then go to the GYN. I can't even get through the phone to make an appt with my GYN this year. So looks like I have to go back to my GP who rather I have my GYN exam with my GYN. Once I waited hours even with an appt. as the GYN was performing surgery in the hospital. I have a friend who can't even find a GYN in town. Winnie >> Whereas I prefer to have a GP to keep an overall eye on my health, >> while saving everyone's time and energy by not consulting a [quoted text clipped - 37 lines] > an injury, a GP is rarely going to have as much information as a > specialist. > I think it makes more sense to do a yearly general health exam with a > GP and a yearly GYN exam with a GYN. That way you get the benefit of > both specialties. I've never even seen a gyn except when referred to one by my GP. She does any gyne stuff whenever I drag myself in for a checkup. I try to make it once a year, at my age. > Putting things off -- DH hurt his wrist last week playing hockey. I > probably would have sat it out for a while, but he decided to go [quoted text clipped - 3 lines] > a week to get it looked at, the bone might already have started dying > off. When I sprained my ankle, I went to the ER. I was headed towards the place when I sprained it (I work in the same building) and I suspected my GP would simply send me for an X-ray anyway. It seemed silly and painful to cross town to be told I needed an X-ray when I was so close to the facility anyway. There was no break, and I had that confirmed within a few hours. Seeing my GP first would have added another few hours but not changed the diagnosis or my condition. > Seeing a GP first -- well, I did this with my wrist. She diagnosed it > as tendonitis and sent me to a physical therapist. Two months later, > zero improvement to my wrist, meaning I couldn't even pick up a purse, > or the rim of a bicycyle wheel. Finally I went to an orthopedic > surgeon. He was able to look for several conditions my GP hadn't even > heard of, and eventually got me fixed up. If the GP's treatment isn't working, I'd expect a referral, and ask for one if it wasn't offered. > I don't go to a doctor every time I have the sniffles, but if I have > an injury, a GP is rarely going to have as much information as a > specialist. It depends on what it is. Mine was right about the whatchamacallit, some foot problem I had, and she was right that it would go away with rest. She was also right about my knee, although in that case I did ask for a referral. The orthopedic surgeon agreed with her. Obviously, we can both get timely treatment under our respective systems. I'm sure unsatisfactory treatment, such as you had and I know some people in Canada have had, is also provided in both countries. SignatureCheryl > > I think it makes more sense to do a yearly general health exam with a > > GP and a yearly GYN exam with a GYN. That way you get the benefit of [quoted text clipped - 21 lines] > hours. Seeing my GP first would have added another few hours but not > changed the diagnosis or my condition. You were asking about how waiting times are calculated, and, if I might refocus a bit, ankles are a good example of how both to reduce waiting time and make care more cost-effective. There's a good trend in medicine to keep reexamining how clinicians do things, and to encourage the things that can be proven useful, and to stop doing the things that don't. "Evidence-based medicine" is one of the terms for this approach. Let's take a Canadian-developed and generally accepted evidence-based approach, the Ottawa Ankle Criteria. Studying the evidence of many ankle injuries, some fairly simple rules will tell the clinician if it would be clinically useful to have an X-ray. The prior practice was to send everyone to X-ray, which often delayed care and pain relief to people that had a bad sprain rather than a break. X-rays are really useful only if there is a break. The rules are simple, although you have to know the anatomy of the ankle: Unable to bear weight immediately and in ED? Tender on lateral malleolar tip or posterior aspect of lateral malleolus (particular places on bones)? Tender on medial malleolar tip or posterior aspect of medial malleolus? If any answer is true, there may be a break and an X-ray is justified. Otherwise, treat as a sprain. Severe ankle sprains, incidentally, can be more disabling than mild ankle fracture. I am a true professional here, having had ankle fractures on three occasions, and more sprains than I like to remember -- certainly three or more bad ones. So, one of the first rules of avoiding delay, and reducing costs: don't do tests that aren't justified if there are ways to rule out a condition with history and physical. Conversely, one of the second rules is "if something doesn't get better, look in more detail and that may require specialists or a |
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