Waiting pains

>> The future of medicine looks bright, provided you have money

by JOHN EDMONDS

A medical report on the state of the Canadian health care system might well read like so: "Patient is a pale shadow of its former self, racked with frequent painful spasms. Canada Health Act has lost most of its teeth. Health ministers suffer from verbal diarrhea. Prognosis: further deterioration unless action is taken."

As anyone who's recently been to an emergency ward can tell you, reforming the health care system is inevitable. But will the government's prescribed treatment be more public money? Or an open-door approach to privately purchased medical services?

Some people within the system believe Quebec is quickly and deliberately headed towards the latter. "They won't say this out loud," says Dr. Carl Bloom, assistant professor of diagnostic medicine at McGill University, "but I think the Quebec government is moving towards a system where all medical imaging and elective surgery is done by the private sector. I think Quebec is ahead of most of Canada on this one."

The waiting game
In some areas, privatized medical services are already well-entrenched. Consider high-tech diagnostic technologies like MRI (Magnetic Resonance Imaging). An MRI machine is a noisy, claustrophobic tube they stick you in for 20 minutes, giving a very detailed picture of the inside of your body without having to peel back or poke through any of your outer layers. MRI is a leading-edge diagnostic procedure that is highly useful for tracking tumours, neurological disorders (like MS) or muscular and skeletal problems.

But the machines' benefits come with a hefty price tag: around $2 million or more depending on the model, plus additional millions to install and operate. So there aren't that many of them: only about 14 in the greater Montreal area.

Mary (not her real name) is a 30-year-old Montrealer with chronic back problems. In 1997 she started to feel pain in her back, which quickly became so bad that at one point her legs collapsed from under her. After several days in bed she went to the Montreal General Hospital, where she waited in pain for hours on a gurney in a hallway. When she was finally examined, Mary says, "They couldn't tell what was wrong with me, but they wouldn't give me an MRI because they said I was in no immediate neurological danger. But I was in too much pain to even take a taxi home." They sent her home in an ambulance.

Mary's problem worsened in 1998; numerous X-rays and CAT scans revealed nothing. "All this time I was on narcotics (Empracet) for the pain," says Mary. "Finally I just gave up, and I think they gave me the MRI because they knew that I was liable to commit suicide if I couldn't make any progress."

The MRI exam revealed what none of the other procedures had detected: a herniated disc in her spine. Surgery was performed, but within a few weeks the pain returned--to the point where she could no longer sit down. The hospital agreed to give her another MRI, but she had to wait five months (three months to see a neurologist, and two months in line for the machine itself) before she got the scan--which showed that the disc had again herniated.

More surgery was performed in December, but she's still in pain. She goes this week to see if they'll give her another MRI exam--for which she will likely wait another five months.

Problem solved for $600
If you had problems like Mary's, and you also had $600 to spare, which she did not, you could go to a private clinic like the Reso-Concorde in Laval and get an MRI exam done in 10 days. All you'd need besides the cash is a prescription which you could pick up from your family doctor or any walk-in clinic or CLSC. No delays. No whining to get on the list. Just pay.

Currently in Montreal, there are four private clinics with a fifth slated to open soon. The Reso-Concorde will soon be adding another MRI machine. "The demand is there," says Concorde's Diane Marceau.

Is it cynical to think the government knows that, by starving the public system, they will create demand for private health care?

Whatever the case, Dr. Bloom says the system is evolving just the way he wants it to. "If people want to pay for an MRI to be done expeditiously, then I think they should be allowed to do so." :

more news...