In sickness and in health: Mainly sickness

Canadian medical doctors are so busy at work, and so protective of their limited social time that it is rare to have the opportunity to talk with them about how the Canadian medical care system works. I had the chance to spend a half hour's talk with a doctor and friend and found the session revealing. I'll call him Dr. Bill, since I did not ask him for permission to use his name. I will try and be faithful to his views, however.

We started discussing a Maclean's article comparing Americans and Canadians. The medical portion showed that Americans spend more on their health care than we do, and on the whole they are assessed less healthy. Both of us agreed that we preferred our health care to theirs. He rankled at the suggestion that our doctor's "have it good" however. He felt that he could earn about the same amount of money in the US and see half as many patients. My own informal research bore this out.

An article, "Is there a doctor in the house" quotes a study in 1991 by The College of Family Physicians of Canada finding that the average GP worked 52 hours each week, plus an additional 17 hours on call. Some see 50-60 patients per day. American statistics are hard to find on this topic, but I found "Patients-per-day Norms" estimated 20-25 on PhysiciansPracitce.com.

What exasperated Dr. Bill was that the system in Canada made it difficult to treat root causes instead of symptoms. For example, to counsel a patient about smoking a doctor has to stretch the truth a little and report a suspected medical condition. As a result Canadian doctors spend a large amount of time is treating conditions originating with weight problems, high cholesterol, smoking, lack of exercise, and so on.

I put the case to my friend that we should be funding the medical system, in part at least, for the health of the patient base rather than by visits or treatments. I suggested that we could create an assessment survey for general health which could be gathering statistics on a patient load: conformation to ideal weight, blood pressure levels, breathing capacity, blood sugars, pulse rates, cholesterol levels, smoking rates, etc. The system could afford to increase funding to clinics that showed the patient population improving in general health, taking into account average ages--knowing that the improvement in health would inevitably lead to diminished need for costly drugs and procedures down the road.

This obtained a smile from Dr. Bill, who said that if such a system were in effect he would have workers phoning to arrange group sessions to teach healthy eating, provide incentives for reduced smoking, plan exercise clubs, and the like. All this is possible now, of course, but it means money out of pocket for physicians, and much precious time.

Obviously we can't stop treating people who have serious conditions, but isn't it about time we started funding for health? If we get what we pay for, and we pay for sick people, what do we expect to get? As my teenagers would say: DUH....