More than six million Canadians are without a family doctor, forcing many to get basic care from walk-in clinics or emergency rooms or only after extended waits.
In response, two experts have developed a guide to help Canadians navigate the health-care system. Their book, The Canadian Health Care Guerrilla Handbook: How to Fight for What You Need (Sutherland House), was released May 12.
“This is a book about fighting for care,” write authors Michael Decter and Mike McCarthy.
Decter is Ontario’s former deputy minister of health and a longtime health‑care executive and policy advisor.
McCarthy is a former nurse, senior adviser in Ontario’s health ministry and patient advocate.
Canadian Affairs reporter Alexandra Keeler spoke with both authors about how Canadians can fight for their own care in an imperfect health system.
This interview has been edited and condensed for clarity.
AK: Canada is often praised for its universal coverage, but criticized for access problems. Where do you think the system is most broken today?
MD: Hospital services and physician services are the two foundational pieces of Canada’s health-care system, and I think the biggest problem is neither of them are working very well.
The family doctor is the gatekeeper, so if you don’t have a family doctor, it’s hard to get a prescription, it’s very hard to get a diagnostic service, and it’s very hard to get to a specialist.
Then on the hospital side, you can get extremely good specialist care in our teaching hospitals, but as you move out from the big urban areas, there isn’t really a great referral system.
Home care and mental health are also the poor stepchildren of the system.
MM: We have a crisis with youth mental health, where there’s 15 beds in the entire province for thousands of kids that suffer from suicidal idealization, onset of mental illness with schizophrenia, bipolar, what have you.
We also spend a lot more money on health care than many other countries that have better outcomes, but most of our money goes to wages. There’s nothing wrong with that, but if you’re going to pay people well, you’re going to need other money to pay for the services.
When it comes to system integration, there’s still many communities that are using fax machines for doctors’ offices. There’s still many facilities that, after hours, send their patients to the ER to get services there, or the record doesn’t follow you to the specialist from your family physician.
AK: What are Canadians consistently getting wrong when they try to navigate the system on their own?
MD: Well, a huge number of them end up in the emergency room who shouldn’t be there, but we don’t help them with alternatives. … If they haven’t got an alternative, then it’s a rational thing for them to sit in an emergency room.
Also, the Canadian Medical Association has a very good statement … that says every patient with a serious condition is entitled to a second opinion. … Canadians are unreasonably nervous about asking for a second opinion.
MM: Canadians are often too stoic. We need to be a little more forthright with our health-care providers.
AK: With more than six million Canadians without a family doctor, what are the most effective ‘first moves’ for someone trying to find care without a family doctor?
MD: The first step you should take when you’re healthy is to start to build a health team. … Instead of just going randomly to a pharmacy when you’ve got a prescription, pick a pharmacy, go, and get to know the pharmacist. Pharmacies are an amazing resource.
MM: When it’s about finding a family doctor, we also talk about … your visiting practices — putting your name in and being polite to the receptionist, because that person has a great deal of power.
We also urge people to have a fellow advocate with you, whether it’s a loved one or a friend … so that they go with you along your patient journey.
AK: In the book, you discuss nurse practitioners as part of the solution to the family doctor shortage. How can Canadians access primary care through a nurse practitioner?
MD: In some areas, like Ontario, you just need to go and enroll if you’re in the catchment area of the family health team.
In some other places, you have nurse practitioners in private practice, which means you can just go, but you will get charged. There’s some effort to bring private nurse practitioners under the Canada Health Act, but that’s going to be a slow process.
MM: I had the file for nurse practitioners when I was in Ontario, and we set up 50 standalone nurse practitioner clinics for rural, remote areas. … While it’s not an optimal model, for people that are limited in those areas where they have no primary care — they’re quite satisfied, there’s a high satisfaction rate.
AK: What are patients still missing out on if they patch together care through pharmacists, walk-ins and virtual services, but never secure a family doctor?
MD: Someone who knows their history and their family history.
MM: And it’s the relationship that people miss out on. If you get a family doctor, your wife, or your husband, your kids — they all get rostered in. And that relationship … is a well of information of your entire family.
If you don’t have that, and you have to go to the ER every time you need to get something for primary care, you never get the same person, so you never get someone who says, ‘I remember you from two years ago, and you responded to this medication pretty good, let’s try that again.’
AK: When should a patient stop waiting for the system and seek alternative paid care?
MM: While it’s not equitable and it’s not fair, if you have the ability to pay for primary health care, and you feel you need it, and your health is deteriorating, you need to consider paying for it. There’s a number of models in Canada that … provide primary care services that we suggest.
You can die if you don’t have stuff looked at eventually.
AK: You both brought two different perspectives to this book, and obviously you are aligned on many things. I’m interested to know where you disagreed while writing this.
MD: There’s still a part of me that drifts towards defending the system.
MM: Canadians need to wake up and recapture that dream of what it meant to have a great health system. We don’t. And we’ve got to stop paying lip service to the fact that it’s so great.
