Friday, December 04, 2009

Why is Canadian Medical Care Trending Toward Mediocre Doctors?

Recently a fellow Tweep on Twitter lamented the health care he received for an acute injury (acute meaning happened suddenly, will heal, end of story; chronic means it goes on and on till you want to scream). He opined that it was probably because the doctor wanted to squeeze more money out of the system, forcing him to return for a second unwarranted visit. He may be right, for OHIP pays so little, especially for repeat visits, that more and more doctors are fudging the rules to try and earn a decent living.

A digression: physicians and surgeons, even ones who work in university hospitals, are self-employed and must pay for all office expenses, salaries, etc. out of their OHIP earnings. So that whopping $18.50 your GP or specialist got paid for seeing you for the 6th time that year goes to pay for all the stuff you saw in hir office, including the secretary or nurse. Gee, I wonder why more and more GPs are limiting their consultation time to 7 minutes and examining patients less and less...

Anywhoo.

The other reason this specialist -- an orthopedic surgeon I'm guessing, and surgeons are notorious for, how do I put this nicely, not seeing you as human -- probably saw the tweep for all of one minute is incompetence, mediocrity, a habit of treating patients as widgets on an assembly line.

I've been bumping up against this in my attempts to find solutions to my internal functioning problems, particularly with my heart and internal thermostat, caused by my closed head injury (or traumatic brain injury -- whatever you call it, it was a bunch of bangs to my brain). I thought it was because the brain is so little understood and so few physicians know about it (seriously, the lack of understanding is shocking). But as one person said to me: "doctors know more and more about less and less" and that applies to every field of specialty.

For a broken bone or ankle sprain or the flu, this is no big deal; these things do heal as long as that bone is set properly. But if you have an injury or illness that affects multiple areas of your body, you're, um, f'd.

Over and over when I'd be forced to see a neurologist, I'd be reminded of the physiology course I took in the Faculty of Arts and Sciences at the University of Toronto. I was taking a specialist in Psychology and wanted to understand the actual workings of the body and brain (I also took neurophysiology). My physiology course was a year-long, intensive, hands-on study of the human body. We barely had enough time to fit everything in. I took it in the same building as the medical students. You'd think then they'd be taking a similar course to mine, right? After all, their whole field of study is predicated on understanding how the basics work: physiology and anatomy.

WRONG!

They studied physiology for less than half the time I did.

So how did they learn everything I did in less time? Did they squeeze in more hours? No. Did they skip a few steps? I wonder.

I wondered every time I saw a friggin' neurologist, who all tested my reflexes, cause as you know those are the barometer for whether you have a brain injury or not, that and knowing who the Prime Minister is. Anyway in physiology, we were taught and had to test every single reflex an adult human has. We read about the one babies have. There are more reflexes than your average GP tests for, and I'm lacking one of them as I discovered in Physiology. The neurologists never knew because they forgot to test a couple of reflexes, being as the hammer isn't used to test those ones I guess. So did they not test them because they didn't learn them in their basic physiology and neurophysiology courses? Or were they being lazy?

Either way, it was incompetence, mediocrity, piss-poor medical care, for if they couldn't be bothered or didn't know enough to test a basic reflex, one necessary for survival in the cold, then what more higher-functioning things did they not know about?

So I have to wonder about this tweep's encounter with the health care system. Was it really all about the money? Or was it more about OHIP compensating doctors so poorly that more and more are developing habits of mediocrity -- do a job and go home -- and more about the crap medical education so many receive that they just don't know the basics anymore, never mind have the foundation to be able to help people with complex problems like mine -- and more about specialists becoming so specialized that they know lots about, for example, the thyroid and nada about the rest of the endocrine system or the basics of how the thyroid interacts with the rest of the body.

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