Alan2005

Are you mystified about central organization of the police? The military? The postal service? Why are these things put on a pedestal?

It's a matter of being pragmatic and picking the system that works best for any given sector. The free market is great for many (if not most) things, but dogmatically applying it to everything doesn't always provide the best solution. For healthcare it is demonstrably less efficient (costs more, less coverage).

BristolUK

Not necessarily ahead of but arguably it is provided as a right- depending on where and which country - by means of things like minimum wage, child benefits, social housing, safety net welfare benefits etc.

All funded similarly.

Pulaski

In the US there is no unemployment pay in most states (unemployment pay is provided by states, not the federal government) except to the extent that you have "paid in to the system", so young people don't get it, and it runs out for most people after just a few months (less than a year). Social housing is extremely limited, even if you have young children - I knew a young woman who had two children, one listed as disabled (autistic) and she was on a waiting list for over a year to get any housing assistance. Another couple, both of them disabled couldn't even get onto the waiting list!

In short, life sucks if you're poor in the US, but not having health insurance is far from the only problem the poor face.

BristolUK

That would be why I had the rider depending on where you are, because it all varies from place to place.

It seemed to me you were saying health care was 'provided' by government (to whatever extent) so why not food, clothing, and shelter as well...or even ahead of it.

Pulaski

No I was saying "IF" healthcare were to be provided by the government ...."

Alan2005

I personally like that idea of state provided healthcare - everyone will get treatment eventually and something like a brain tumor won't bankrupt anyone. Whether or not the government should have a monopoly on it is a different thing entirely. I used to think not, but living here has changed my view on this somewhat.

Stinkypup

I was originally going to try and multiquote, but then lost the will to live-I will read up exactly how one can do this for next time!
This might fit say when patients go private in the UK-relieving the NHS of the space to be used up but not in Canada. I didn't suggest it was anything to do with customer loyalty, when we get faxes about walk-in clinic attendances, we can't ignore them, we actually have to act on them to ensure that these patients don't slip through the net-we haven't been able to assess these patients ourselves and often they see a walk-in clinic doctor for about 2 min. and then turfed out of the door-we are often left to pick up the pieces. I would agree that patients need to be able to access care, no one should be denied this but they don't always get equivalent care if they attend a walk-in clinic versus a GP office.

Stinkypup

ALEX2201: What possible reason could there be for having to wait 2 years. I am in good health and not in need of any appointments I just wanted to register. Nope you have to wait for 2 years. Pointless muppetery. I will just go to the walk ins and Casualty if it is that bad.

My GP back home did appointments from 8 - 1 and walk in from 1:30 to 5 every day. Spectacular use of common sense.

If I had a GP and they were whinging about me going to a walk in despite it taking weeks to get an appointment and not doing walk in sessions I would just laugh at them. They are a doctor for the wrong reason. Hypocritical oath.[/QUOTE

I swear that this is a response that one would read in the Daily Mail. If you are healthy and have no need of any appointments then no you don't need a GP. As I said in an earlier post, sometimes WICs suit patients, especially the young and healthy, they can pitch in on weekends/out of hours and get the treatment that they need, often acute easy to deal with stuff. It is when patients register with me and then just solely go to a walk-in clinic -that is when the issue arises-I am unable to look after these patients long-range and frequently have to ensure that things that are picked up as a result of blood tests etc. are dealt with as frequently they are not in a walk in clinic they just say go and see your GP. I can reassure you that I am not whingeing as you so nicely put it. I spend my time in my office seeing patients on my list. If I then subsequently decided that I would go and do walk-in clinic shifts, then my office patients would probably have to wait weeks for an appointment-thereby perpetuating the problem. I have difficulty in replying to your last three sentences which seem to be plucked directly from the comments section in the Daily Mail

Stinkypup

I am not sure how your GP can request an MRI scan covered by MSP-this doesn't make sense-we cannot do it and I cannot see how he can. RICH you are presuming that you will have to see an orthopedic specialist. 95% of rotator cuff problems are dealt with without needing any surgical intervention nor orthopedic assessment. I find it surprising that your GP did not suggest physiotherapy input as per worldwide guidelines which cover rotator cuff/soft tissue shoulder injuries.
If after a trial of fairly aggressive physiotherapy there was no improvement then as you run your own business, I would seriously consider getting a private MRI scan so that you can function.Yes it is irritating and expensive but it may save money in the long run. An early MRI scan will ensure that an early complete tear of a rotator cuff can then be referred on urgently if surgery is anticipated. I have to say that this happens incredibly infrequently though. Typically there are partial tears which are not dealt with by any surgical intervention.
As I think Bristol said, and I would agree with we can and often do pick up the phone and talk to a specialist ourselves if we felt that there was urgent need and get you seen typically very quickly once they have the information. You would not need to wait another two years.

Stinkypup

I absolutely agree with your comments here, I think an ability as in the UK to go private if you wished whilst seemingly unfair to probably a lot of people would enable people to take this route if they wished and could afford it thereby reducing the waiting times for the state-funded system for say MRI scans.

If a lot of you feel frustrated with regard to waiting times, especially to get investigations and see specialists, can you imagine how we feel having to deal with this several times a day throughout our working week trying to get our patients seen in a timely manner. I have to say that orthopedic surgeons are particularly difficult to access-part of the problem is that they cannot clear their waiting lists because they are given inadequate time to operate in the operating room and subsequently there is often a huge backlog. Never mind waiting a long time to actually see them in the first place, there are even longer waits then subsequently for patients to be operated on which is even more frustrating for both patients, ourselves and the surgeons themselves who typically went into surgery in order to operate!.

In our area, if patients say report rectal bleeding, they can be seen incredibly quickly and scoped often within two weeks. I think that this is impressive.In the UK, there were cancer referral guidelines-if patients were suspected of having cancer than they have to be seen by a specialist within two weeks. Unfortunately once seen, subsequent investigations potentially could take months which made the two week rule fairly pointless.

This has got way off track from the original question posed but I suppose that is not surprising given the complexities and frustrations experienced by both patients and doctors working within the health systems in whatever country you live in be-it Canada, the UK, the United States, Timbuktu! Nowhere is by any means perfect however much money you throw at it

BristolUK

I think you're just playing with words there. Forget whose money it is that the government is using, it is government of some form running healthcare (allowing for some private exceptions run according to government requirements). Just as it's government running those other things using money sourced similarly.

BristolUK

Obviously the wait time to be registered isn't good. But you can actually get registered without the orphan list. I did, albeit because the others were already registered there after their 12 months on the waiting list.

I've heard people succeed with finding one via pharmacists.

At least the orphan list is fair to everyone in that everyone waits their turn. Or should that be equally unfair?

Pulaski

Not in the US, it isn't!

In the UK and Canada, healthcare is rationed according to the government's bureaucratic rules, because of limited funds, thereby ensuring everyone is inconvenienced (in the UK those who want private care are "inconvenienced" by the cost or insurance premiums). In the US healthcare is rationed by ability to pay. Neither is great, but IMO the US system is less bad, and certainly works better for me, although I am a minimalist consumer of healthcare - my last GP closed my file and archived it because his staff assumed I had gone elsewhere, or perhaps they just thought I had died!

snoopdawg

There is definitely a place for Walk in Clinic, but they should not be providing your normal health care unless you do not have a GP.

There is a massive shortage of GPs in Canada, we are able to close lists so we can try to provide holistic care to those we have.

I do not mention WICs on the rare occasion I take on a new patient, if they bring it up- as a new ( amazingly wonderful!) new patient did a couple of days ago, my answer is that I have no problem with WICs. There is one I would prefer patients to use if possible , there were two, but it is closing . My preference is because they are "normal" GPs i.e. have their own office, they tend to be more vigilant , offer better care although not all of them. I say that out of hours, it's always ok to use a WIC, in hours, try my office first. We all create "urgent" appointments of varying lengths that appear the day before and on the day plus if I hear of someone in need, I'll often try to help, BUT I know it's not always possible. In that case, yes, please do use the WIC.
I have put notices up advising patients of our urgent appointments so I do get frustrated when our appointments stay empty and patient go to the WIC- often at the same time- I can see the time stamp! Why wait an hour or two there, when we could see you either on time or with a short wait! I'll often point it out when I next see that person and they say "I thought you would be full"- fair enough- but at least try next time.
I think I have only once asked someone to leave my list for attending WICs. She was a fairly young- 40's- very unstable diabetic with early kidney failure. She needed very tight, vigilant control of her diabetes. Initially she came regularly but always needed prompts re her lab work, but gradually she just stopped attending. I managed to pull her in and we had a long talk about my worries for her future, she agreed to do labs and attend ,but I don't think I saw her again! She went to various WICs, never did lab work, no-one checked her BP , comments were made in the WIC report that she said she did labs and saw me regularly. NO-ONE ever checked!!!!
I wrote to the WICs- advising them that this was a lie! I wrote to her saying that I was ok if she didn't want to see me but please stop using walk in clinics and find another doctor as I was worried about her. But IF she wanted to see me then fine- I was happy to see her! However it all continued, utterly frustrated, I asked her to to leave my practice, I felt she had made her choice!

I have had patients go to WICs attempting to get "drugs" that I have not felt appropriate- those people are dealt with very strictly with warnings- so far everyone has then complied, I think they are shocked that I found out and once they knew, they know the 'game is up" as it were!! However, there could still be those who do not tell the WIC they have a doctor and are double dipping as it were! They are a worry and we as physicians must be more vigilant, the following is advice to physicians that the CPSBC sent a link to yesterday:

https://www.cpsbc.ca/for-physicians/...2016-V04-01/03

The College does not like WICs, they prefer full continuity of care, I partly agree but until there are enough GPs to cover all hours and all patients , WICs remain an essential part of BC ( and I suspect Canadian) healthcare.

Just a final note- for anyone out there trying to get a GP- don't bother with waiting lists unless it's for a new doctor to town.
I suspect that the vast majority of doctors do as we do. I would never take on an "unknown" patient now. I am full but people move etc so I do have spaces occasionally. I only take patients by referral. Most are close relatives/friends of current patients who I know well, like and TRUST! So I trust them to only suggest new patients who are are similar to themselves! I do also take rare ones from a social worker I know and trust and as with this week new guy, from hospital doctors whom I know.
We have lots of patients in town with no GP, most are ok with WICs- its suits their lifestyle- they work etc. As one earlier poster said, they are fit and well, well unfortunately they are exactly the ones who in times of need, don't need a GP, a WIC will do, ( if we were fully staffed it would be different).
I'm on the lookout for those in need, who need regular visits, they don't have to be "worth" a lot money wise to me. It's very difficult saying no to patients I really like, but I usually have to say it several times a day!
Anyway- If you want a GP- find a friend who has a GP, is the nicest person you know (!) and ask them to ask their doctor if they could take you on!

Finally- I notice that old Stinky has been replying!!! I apologize for any duplication- we never communicate at weekends!

Alan2005

Yeah, I can see how the US system is excellent for those that don't need to use it.