About to submit spousal sponsorship forms for my wife.

She has a permanent medical condition which means she needs to take Thyroxine. I know we will need 3 month private medical insurance for Ontario before we are covered by OHIP etc.

I assume it will be a good idea to get our friendly British GP to equip her with enough thyroxine to last a couple of months before we move (if we can).

But my question is that AIUI it is very hard to find a Canadian GP taking on new patients and most people use walk-in clinics. How does that work with permanent conditions like this. Would she have to attend every time she needs a repeat prescription or what?

I take Synthroid, which appears to be what Thyroxine is called in Canada. I have been an insulin dependent diabetic for 20 years and, IIRC, I have been on Thyroxine/Synthroid for the last 17 years or so. I have to visit my GP every time I want a new prescription. In England, I obtained repeat prescriptions by simply ticking the medication that I required from my last prescription and dropping that into a "repeat prescription" box at my English GP's surgery.

The cynic in me believes that my Canadian GPs are milking the system. They never examine me but they insist on a consultation. The consultation usually lasts less than a minute. They insist that prescribing medication requires a consultation and they, no doubt, believe that their examination of me is justified.

I have had 3 GPs in Canada, and all of them have used the same procedure.

I attend for HBA1C bloodwork every 3 months and none of them have been above 7.

I look forward to hearing what Stinkypup and Snoopdawg have to say about their procedures and the differences between British and Canadian requirements.

As you can guess AC, the systems in the UK and in Canada whilst providing medical care are funded differently and this creates different experiences. At present, in the UK, a practice is funded mainly per capita, to look after X amount of patients per year, you get paid an amount per person (a surprisingly small amount) per year. The prescribing mechanisms are a lot more sophisticated in the UK whereby we never used faxes as we do now, electronic prescribing enabled seamless sending of prescriptions with repeats to the pharmacies and the patients just pick up the meds. Say someone who had just hypothyroidism , I would make sure that they would come in annually and check BP, do health screening , check bloods including thyroid function tests and then issue a px for a years worth of thyroxine which would be say 3 months and 3 repeats held on the system at the pharmacy.

Dealing with diabetes is different - we had a lot of boxes to tick to ensure that we were providing best care- BP/cholesterol/kidney function/foot care/checking patients were getting eye screening etc so patients probably should be seen quarterly or if well controlled 6 monthly.

In Canada, I personally would actually deal with the patients very similarly as I think would Snoop. We are paid in simplest per encounter which re courses what you have experienced. If the patient just had hypothyroidism, get bloods every 6-12 months and issue meds if stable for a year. 3 month Px and 3 refills. Often it isn't that simple and people have other conditions , eg hypertension which would need if well controlled 6 monthly checks.

Diabetics should as you do get 3 monthly bloods. If stable and patients were getting bloods then I would see every 6 months. Not just for one minute, I would always check BP and get a clinical update. If I'm going to get someone in, it has to be to achieve a health benefit to the patient, not just a financial one for the doctor. I acknowledge quite a few docs do just pull patients in for refills but they should always do some health screening when you are in, it shouldn't just be a cash grab.
Chronic disease management is quite complex and diabetes falls under that umbrella. If we gave say a diabetic patient meds for a year, youclearly get your bloods done regularly but a lot wouldn't and when diabetes gets out of control due to lack of monitoring, the patients can get into real trouble.I hope that helps. Sorry about the long reply.

Oh with regards to the OP question wrt OH attending walk-in-clinics, I don't do WICs but she may well have to attend every 3 months. You may get a sensible doc who might give her 6 months (3 months plus one refill) if bloods are reasonably current. Sadly it is indeed tricky to get family docs but by no means impossible

Thanks for the reply.

In England I attended a diabetic clinic at the local hospital every year. The hospital did my bloods that day and they turned them around so that, when I saw the specialist, s/he had them. The specialist would also check my eyes and photos of them were taken each visit. I believe that that was something to do with sugar in the blood affecting something in the eyes.

In the 9 years that I have been in Canada, I have never seen any form of specialist and have never had my eyes looked at, despite repeated requests to my two previous GPs to enable me to do so. I am in the process of switching GP and I saw her earlier this week. Apparently, this was a "meet and greet" and she spent 10 minutes with me briefly going over my history. I then had to be booked in next week for a "physical" following which she informed me that she will make a determination as to what meds I should be on.

I have no idea why the physical could not have occurred contemporaneously with the meet and greet. As I am 45, I guess that she didn't want to shake my hand after sticking her finger up my bum. One would think that one could proceed the other - but I am not as clever as she is and I suspect that there is a good reason why the meet and greet and the physical need to be at least a week apart.

She indicated to me that, at that time, she will provide me with a standing order for my bloods that will likely be the same as the standing order I currently have, but with her address upon it. Quite how she believes she will be able to determine what meds I need without first having my blood work is beyond me, or why she wasn't able to provide me with a standing order earlier this week so that I could have my blood work done in time for next week's appointment. She only offers appointments from 9:00 a.m. to 2:00 p.m. so, in essence, each time I see her I lose half a day from work.

Rant over

Re specialists - one stop shops in UK not common,especially in rural areas. I typically point my diabetics to see their optometrist, they don't need a referral from us, onus then is on the patient to go- outside our remit. The optometrist will do the same eye exam that you got in the UK Also re specialists- you would be referred to specialist if we were having problems in the office getting diabetes under control. Your control is good, why see specialist?

My process for you would have been- meet and greet appt (not a physical as this takes me 20 mins minimum for men), request transfer of records from previous GP, new standing order is required, at that first appt issue your meds if you need them, no changes until bloods are back, as you say. Separation of meet and greet and physicals always done- first appt is information gathering which in itself can be very time consuming- this has nothing to do with cash grabbing or gaming the system
Re her part time working, yes I can understand that this could be inconvenient for you but at least you have a GP and you are the one who chose to change! In the UK the majority of GPs are women and a high percentage over there will be working part time as well.

Thanks for the reply. I have a picture now. Her hypothyroidism was diagnosed three years ago, but seems stable on her dosage and not causing problems.

Yep- fairly straight forward but probably should still get 6 monthly thyroid fx blood tests. WIC should serve her well until she hopefully gets a GP

I'm on Synthroid and have annual blood work otherwise the prescription just repeats.

For eye exams my optometrist referred me to the eye specialist after measuring high pressures in both eyes. I see the eye doc every 6 months and have had laser surgery for glaucoma. No GP involvement at all.

I remember that.

My doc used to do repeats by fax but then stopped. He often doubles up on 'family' appointments too, which, I suppose, doubles the fee he gets.

I have all that done. Unfortunately the eye place is so far out of town it would involve three buses and still be short of the clinic. Three bus stop waits isn't something you want to do even outside of winter so it's $50 return by taxi.

And a couple of years back they split the appointment into tests one day and another day for the consult. Fortunately for my last consult I was able to see him on his hospital day, five minutes walk around the corner.

My doc wants me in to review results each time. And usually it's "that's good, that's good...no reason to change anything" and he might ask me when the last foot check/eye exam was.

However, seeing him that often means I can get renewal prescriptions when the expiry date is approaching, saving an appointment just for that reason.





I've had an annual and thorough eye check (not just the normal optician thing) and regular(ish) foot checks.

How do you mean "not the normal optician thing"
Optometrists if they are any good do incredibly detailed diabetic eye exams/ screening- if the patients show significant retinopathy then they will refer to an ophthalmic surgeon for laser Rx

I believe there's a charge at the optometrist if it's not a doctor referral. An ordinary eye exam is $90. I think the free test and $50 taxi ride is cheaper.

There are certainly tests done at my annual check that are not done at the optometrist. But at my last optometrist eyesight check, she did pick up on something which she was going to pass on to the eye doc (to keep an eye on ) who I was seeing only a couple of weeks later.

I don't believe anyone has yet pointed out to the OP that they will have to pay the full costs of their meds. - rather than a flat cost as in the UK - unless and until they have extended medical insurance through an employer to cover. No idea how much these particular meds cost but it's surely worth investigating before you land here.

Just to add to the above post. My repeat schedule for my crazy pills is dictated by my insurance.
My doctor is happy to give my 3 months at a time with one repeat but my insurance will only pay for two months at a time

There's an MRI place here where people can pay and go privately.

When it was originally announced they said there was no queue jumping involved.

So if there's normally a 6 month wait and you pay and have it done next week, they're going to sit on the results for six months so you won't have queue jumped? Yeah right.

We dont have private insurance, but we do get prescription coverage from the province and they will cover my ongoing meds for 3 months at a time. Doctor usually gives me 6 months worth so turned into 1 fill plus 1 refill.

For my wifes meds the doc does 6 months at once but one pill the province will only cover 1 month at a time so hers is 1 month plus 5 refills.

I have had a couple doctors who want monthly visits.