Like most Quebecers, I’m worried about our failing health-care system. As I write this, the Fédération interprofessionnelle de la santé (FIQ), representing more than 80,000 health-care professionals including nurses and respiratory therapists, is joining the largest public sector strike in more than 40 years, fighting for pay that keeps up with inflation and improved working conditions.
In December, the Coalition Avenir Québec (CAQ) has invoked closure to push through Bill 15, a sweeping health-care reform that essentially centralizes much of the health-care system’s decision making within a new entity, Santé Québec.
Meanwhile, two more people died while waiting for help in an emergency department in the province. Sadly, it feels like an endless cycle of history repeating itself. Nurses have been forced into striking before, and previous governments have passed expensive reforms meant to “fix” the problem, but we haven’t added the one thing we desperately need – more medical professionals.
All this means we the patients are left feeling frustrated and afraid of what is to come.
Last May, Tara Kiran and her OurCare research group brought together a diverse group of 31 people from every corner of Quebec to learn more about the problems in primary care and give us a voice in finding solutions. Like many, I jumped at the chance to volunteer. We learned about social determinants of health, underserved communities, Canada’s standing among the Organization for Economic Cooperation and Development countries and Quebec’s poor standing within Canada, the effects of for-profit medicine in Quebec, and how and where moneys are applied. You can find our recommendations for the province’s health-care system here.
A few things stood out to me, the first of which is the fact that 50 per cent of our provincial budget goes toward health care but only five per cent of that goes into primary care (compared with eight per cent in other provinces). Without a primary care physician or nurse practitioner, Quebecers have no way into the system – the door is closed, and the wait list is years long.
Secondly, our system is built around doctor entrepreneurs. Doctors are the second largest budgetary expense after hospitals. While our nurses’ contracts mean they must work double shifts when required, doctors are paid incentives to do their already highly paid jobs, for example, an extra $7,500 per year if they enroll 750 patients and $15,000 for 1,000 patients. We also learned that privatization is more pronounced in Quebec than in the rest of Canada and that it is eroding our public system by draining resources, dumping those with higher-risk, more complicated health problems on the depleted public system.
As if to bring home the importance of what our group had just discussed, a week after I met everyone passionate about helping our medical system through OurCare, I found a lump under my right arm. It took several weeks to get an appointment for a mammogram, longer than usual because most clinics are not wheelchair accessible. Even though I’m over 50 and had a referral sent in the mail through a government program – no need to wait just to get a family doctor’s permission – it took several more weeks to get an appointment for a biopsy.
I was left in limbo for more than two months to find out if I not only had breast cancer, but also tuberculosis.
Then came the worst part: They told me they’d have my results from the central lab in three weeks, leaving me in limbo for more than two months in all to find out if I not only had breast cancer, but also tuberculosis. I am grateful that my cancer results were negative this time, though I do have tuberculosis. Treatment and surgery have been far less arduous. However, it has been an unnecessarily frustrating and frightening experience.
I found another lump recently, and I can’t help but think of the recommendations we came up with. To be honest, I could go through our recommendations one by one to show how they could have helped prevent having to go through this again, and I am frustrated. Our first recommendation, for good reason, is the recognition of systemic issues affecting health, because health doesn’t happen in a vacuum and my disability, and all that comes with it, is relevant to my health. Blaming me isn’t helpful. What I really needed was information, better communication from my doctors about what to expect, how my disability might affect treatments and outcomes and what we could do about that.
One of the things our group agreed on was improving the recognition of diplomas acquired outside of Quebec and Canada. In my case, tuberculosis is almost unheard of in most parts of Canada, however given vaccine resistance and other factors, diseases are returning, and we need doctors who have experience treating them.
Finally, I am one of the lucky three in five Quebecers (one in three for most of Canada) who does have a primary care doctor. However, she works six days a week already, so I haven’t had more than a phone appointment since before COVID. Understandably, she doesn’t have the time to learn about my disability; that’s my job, so having access to my medical records would be incredibly helpful.