Almost a decade ago, in my mid thirties, a routine physical showed elevated liver enzymes. Follow-up tests three months later showed them rising. My doctor was diligent, and referred me to the liver clinic at Toronto Western Hospital. What followed was a year-long series of interventions, which at first were benign – lose ten pounds and give up the couple glasses of wine on weekends – but progressed to ultrasounds and biopsies.
As the mounting tests could find nothing wrong, I became more medically interesting. More specialists became involved, though I rarely the saw the same one twice. Further tests ordered, including a MRI that broke down while I was strapped inside, invoking a fear of enclosed spaces that remains with me today.
Finally, after more invasive tests were recommended and I was rebuked for questioning the need, I balked and walked away from the medical system. And, except for my annual physical, I have stayed away.
Instead, I’ve voted with my wallet as I’ve built my health care team. This includes a monthly visit to my naturopath, who brought my liver enzymes down to normal within two months, where they’ve stayed. It involves semi-regular visits to the traditional Chinese medicine/acupuncture clinic and as regular massages as I can afford. Along the way, a life-long battle with migraines has been tamed, digestive problems cleared up and allergies disappeared. I feel healthier than I did twenty years ago.
I am one of the increasing number of Canadians who does not have an employer-paid benefits plan. Since I am in the ninety-nine percent, I have to make very real choices as to which health treatments I invest in, and what I am willing to give up in order to do so.
Our government funded health care system faces similar choices, as it invests our hard-earned tax dollars in a system that has voracious demand. It currently funds a very narrow slice of the health-care pie, lobbied on all sides by individuals who want their particular priorities funded, and by medical unions and lobbyists who have their own interests at play.
We hear increasingly about the need to fund health promotion and disease prevention. How best to do this? As a tax-payer I don’t want to see heath promotion reduced to health education and marketing focused on changing behavioral risk factors, delivered by harried doctors on a fee-for-service schedule. Especially when my trust in the efficacy of the “public” system is shaken by stories of greed and poor oversight like ORNGE, or efforts by the OMA to avoid disclosure of doctors’ salaries while they buy advertising claiming they are ‘saving’ money for the health care system.
I am cognizant of the costs and logistics involved in adding ‘alternative’ practitioners to the public system. But if we are serious about prevention and not just intervention, we need to open up the discussion about what prevention looks like, what reasonable outcomes can be agreed upon in terms of health promotion, and how and by whom they can best be delivered. In my next few posts, I will explore some of these prevention options.
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Very interesting piece, Helen. Leaving aside the specific issue of alternative medicine, I think it’s important to expand on what you said about the parts of healthcare that are public being limited relative to what they could be. In Canada, only 70% of total health expenditures are public. We have a healthcare system where hospitals and physicians are covered but drugs, dental and physio often aren’t. These too are means of prevention. When I can’t offer my patient with chronic rotator cuff tendonitis physiotherapy (an excellent option in between taking Advil and surgery), this sets up a situation where he/she is unable to work, ends up on disability and eventually needs a surgery when perhaps he/she could have been healed with physio. Such issues are rampant in our system, and will not be resolved until we look at bringing more services under the publicly funded system – the best, most efficient way to pool resources, spread risk and decrease overall costs to the average Canadian while also keeping them healthier.
I agree with you about the need for an evidence-based approach to health care – but perhaps you have a better faith than I do that medicare always takes an evidence-based approach. Seems to me that values, beliefs and self-interest play a rather influential role in the ongoing construction of medicare – not to mention political reaction to what appears above the fold of the Toronto Star.
H.
I think there’s a lot of benefit to having alternate providers of health care, as long as there is evidence to support it works. Dietary advice from a naturopath is very beneficial and likely cost effective if actually followed, but are unproven herbal remedies the same? There’s good data for some herbals, and no data or data showing no effect for others. Acupuncture and massage is also something where the jury is still out for specific indications, although I don’t doubt both make people feel better simply by making them focus on their health and relaxing. But as a taxpayer, I only want government dollars to fund what is evidence-based and specific – if people need a massage to feel better and relax, then it’s equivalent to a spa day- fund it yourself.