Last week I posted an X-ray of my right foot that I received after spraining my ankle. I knew when I went in that I would want copies (who wouldn’t?!), so before getting into place to have the X-rays taken I made sure to ask the radiologist/practitioner who was working with me. He immediately said “yes”, that I would just have to speak with the receptionist.
After having the X-rays taken, I hobbled out to the front desk where the receptionist seemed startled that I was standing in front of him. He stared at me until I spoke. I told him that I’d like to get a copy of the X-rays that were just taken. He hastened to tell me that oh no, they don’t normally do that, and he’ll have to speak to the doctor, etc etc.. He went away for a few minutes and then returned to tell me again that they don’t normally give copies unless there is a fracture and this would be a special exception. He made a pretty big deal about what I had thought would be very little extra trouble. After all, they were already making copies for my family doctor.
I left the office frustrated. I felt like they had been on the verge of denying me something that should really just be available to me. They had information pertaining to me and my health; I should have more right to those materials than anyone else on the planet.
Another X-ray of my right foot.
I just read this article by Dr. Makary (a surgeon at Johns Hopkins in the US) calling for transparency and accountability in the American health system.
This got me thinking about our system here in Canada. How transparent are we? Dr. Makary makes a point about there being no (or few) stats or useful information available to the public about hospitals, so potential patients cannot make informed decisions. These same patients will check online descriptions, recommendations, and ratings for restaurants before sitting down to eat. Shouldn’t they have a similar opportunity for something as important as their health?
After moving to Vancouver I went in search of a new family doctor for my partner and I. The first thing I did is go to the official website for the College of Physicians & Surgeons of British Columbia to look for doctors who were accepting new patients. Armed with a list, I then looked at online reviews by google-ing each potential doctor and using Healthcare Reviews. I and those close to me have had many experiences involving medical doctors who provide obviously incorrect diagnoses, and poor suggestions of prescription drugs that lead to uncomfortable consequences (for the patients). However, I also think the first two family doctors I had growing up were chosen because of their convenient locations. This time, I was keen to find someone good.
For family doctors at least, there is a reasonable amount of reviews online. But what about the rest of the system? I had to fight (sort of) to get copies of my X-rays, but the last time I saw my family doctor, she told me that I can see the results of blood tests online! I found a GP using online reviews, but I still haven’t found a dentist. Because an evidence-based approach is very important to me, finding a physiotherapist for my ankle that I didn’t think would prescribe power-bands or reiki has been very difficult (I think I succeeded, but I haven’t had an appointment yet, so we’ll see).
In a quick google search for ‘transparency in the Canadian health system’ I came across the ‘Health Council of Canada‘ that advocates for transparency in healthcare. Unfortunately, they only do so in Saskatchewan, and claim to be the first such organization in Canada. Despite this claim, I also learned of the Canadian Institute for Health Information (CIHI), a federally funded group that collects and distributes information about the quality of healthcare across Canada. They even have this nifty (but slow) tool that theoretically should allow me to compare hospital performance across the country. That is what it claims to do, but I will never know for sure because it loads so slowly.
At this point, I’m not sure what to conclude about what I’ve seen and learned about our system in Canada. For a number of areas there are tools and outlets for getting information at both a small scale (e.g. individual doctors and specific test results) as well as a large scale (e.g. hospitals, provinces, general performance across the country). However, in some places there holes and lags. At the smaller scale, there aren’t enough dentist reviews for me to make an informed choice, and getting copies of my X-rays was trickier than it should have been. At the larger scale, the tool for assessing hospitals is too slow to be effective for general use, and the reports provided by CIHI don’t report their data very effectively: In ‘A Snapshot of Health Care in Canada as Demonstrated by Top 10 Lists‘ are they presenting totals across the country, or averages per hospital? If the latter, there really ought to be error bars so we can see how variable these values are. If the former (i.e. totals), well, I think averages would be more informative for a general consumer like me… especially if they further disseminated the information by province or county.