Life Log

An Unanticipated Personal Encounter with the Canadian Health System

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This weekend, while attending the annual gathering of science fiction and fantasy fans in Montreal for Worldcon, I overdid it a bit.

Well, I lie. I overdid it a lot.

The Worldcon was fantastic. Full of old friends and acquaintances. Montreal has fast become one of my favorite cities from what I saw of it, and everyone was super friendly. More surprising was how family friend Montreal was. People were constantly stopping to talk to the twins, and Emily reported a ton of help with navigating the stroller and babies around from random strangers. The phrase of the week for us is “Deux Bebes!” which we heard over and over again on a daily basis in a variety of locations and situations. The twins were a hit!

But there was a lot of walking. The Palais de Congress was a huge convention center, and several of my panels and lunches required me to walk across the entire thing. At night, the Delta-Centreville (party hotel) was a long hike for me, and then the Hyatt Regency, where we stayed, was a bit of a hike slightly uphill from the Palais. There was a crazy amount of weary, tiring, hiking.

By Sunday morning, I was feeling completely sapped, and not getting enough sleep. I tried to nap before the pre-Hugo ceremony, but felt like I’d hit a brick wall by the time I’d walked over. I had to duck out of the Hugo ceremony briefly to lay down. By the end of the night my pulse was racing a bit, so I went back to the hotel to sleep. When I woke up my pulse was even higher.

After checking it several times, I decided it was high enough that I would follow standing orders to check into an ER when this sort of thing happened. I took a metaprolol a bit early and told Emily we needed to pack and go.

I was a bit nervous, and asked for an ER, but mentioned needing it for my heart. I was taken to the Clinique de Cardiologie de Montreal by a taxi driver.

The biggest barrier was quite simply language. At first they were worried about flu, and had me in a corner for that, but someone with more English ability figured out that I was there for a racing pulse and things got moving. Emily and the twins came with (and throughout all this garnered a fair amount of attention and cries of “deux bebes!” from nurses and people in the waiting area).

Next up was that I didn’t have a health card or was in the system, so they (pretty quickly) created a temporary ID of some sort and took some basic information, then got me into a triage area. After taking my pulse and pulse-ox, blood pressure, and temp, they confirmed my pulse was high and something was up.

After a brief wait they stripped me of my shirt and got me into a booth where they strapped me to an EKG machine and took a look.

At this point, not knowing language, it got a bit hard to understand what was happening. From past ER visits, mostly what happened is that I was x-rayed, sometimes catscanned, and blood was drawn to look for signs of damage to the heart, and if none detected, I was released. This is pretty much what happened here. Once the EKG came back, they had me wait for a bit, then generated an ordered for me to get x-rayed. Unlike in the US, where you are put in a bed the moment you arrive, I walked to the radiology department. Then, since I was a furriner, I had to go downstairs and pay for the visit, which I’d been expecting to come at the end of things. The bill was $480 for the whole ER visit, one lump, with a couple receipts so I could send them to my own insurance agency when I got home.

After that I sat in the waiting room, then was taken in by a nurse to get my blood drawn, again my ER experience let me know despite language barriers with the nurse that this was to look for damage in the heart (it releases certain enzymes if its being damaged, I gather).

After that, things slowed down, and we got our only slightly tough period. I had to sit in the waiting room, with a mask on, with a gown on on top, while I twittered and texted various people to update them. The wait was maybe an hour, and then I got to see the doctor once the results of my bloodwork had come back and he’d looked at my EKG. It seemed longer because I was sitting and waiting.

The doctor talked to me for a while about the past incidences, quizzed me a lot on why the Ohio doctors hadn’t dug deeper to figure out why I’d had a PE instead of just treating it, and had some other questions. In the end, he told me I’d just overdone it. Stress, too much activity, pushing myself, all of which I just shouldn’t be doing. The mild tachycardia resulted.

He also wanted to talk to me about the big picture of dealing with my condition, as its something he’s familiar with at the clinic. He told me it’s not necessarily something I’ll get over, but that I’ll probably be managing for a long time (if not life), and that the medicine I was on was for quality of life, not a cure of any sort. He told me it was not dangerous, just annoying, and that I probably needed to adopt a more ‘zen-like’ approach to life in order to fold it into how I approach everything, keeping the fact that I have this thing now. There was a lot of great advice about holistically managing to prevent these episodes, some of it that I’d picked up on from Karl Schroeder (Toronto based, who went through his own experience, as he blogs here), and some much needed reassurance by the doctor about some of the details of these things by the doctor.

He also told me that I should have gone to a nearby ER, I sort of confused the taxi driver when I mentioned needing an ER for my heart, as the Clinic I was in was more of a total care place, even though it did have an ER. This may have explained the more walking about I did. But it also seems they decided pretty quickly on that I wasn’t in danger, which is why I was walked about, as other patients were there in wheelchairs or beds.

Then I was released.

Emily says we were actually in and out faster than we usually are.

I’m also still not sure what the difference would have been had we gone to a regular ER/Hospital.

As for differences between the US and Canada, which everyone right away asked about in my twitter feed and via email, here is what I noticed between this clinic and experiences back home:

-Fewer accountants and a vastly smaller billing department. Lima Memorial has a massive area for billing, this place had admissions, a secretary for handling the medical card (who gave me a temp), and downstairs where I had to pay cash because I wasn’t in the Canadian Health System, there was a small office near the cafeteria with one lady working a window who took my credit card.

-No crazy multiple billing system. The hospital charged me one fee. Hematologists, radiology, EKG reading, the ER doctor, and the hospital didn’t all bill me separately. In the US this visit would generate 6 or so bills from various departments, sent at staggered times. This alone reduced my stress level, as I knew right away what the total cost was and had it on one bill.

-No matter what, in the US I’ve been put in a private room on a bed, then all vital stats taken by people who came to me, or moved the bed around from station to station. The Canadian method of this particular clinic was to triage me, determine whether I was in trouble, then once they knew I was going to make it, dropped me down a notch and had me walking all over the place. This was a bit alien to me. But I don’t even know if this is US vs CA, it may be big city vs rural area, as I live in a much smaller town.

-In both cases nurses and doctors followed the same sequence for my symptoms, US or CA.

-The Canadian doctor seemed far more interested in getting me to understand how to deal with this as a person, not just turfing me back out once they’d dealt with the problem. I spent more face time with him in the office just talking, even if briefly, than with my main Ohio cardiologist who has me in and out in five minutes once he determines my EKG readings are okay once a quarter. The doctors in Columbus, OH, teaching hospital actually spent a similar amount of time, which was nice, but they also didn’t spent as much time talking me down off the ledge or giving me approaches on how to handle this thing as a ‘person.’ I don’t know if I just lucked out on a doctor, but it was very, very welcome this morning and will have implications on how I handle this recurring speeding heart.

Of course, the plural of anecdote is not data.

But, unlike what some people are screaming, I was not marched to a death camp and asked to choose how I wanted to die. I got triaged quickly, they figured out what was going on quickly, and then after a wait for bloodwork, they sat me down and walked me through some stuff I needed to hear that I hadn’t been fully explained before. I paid a single, total bill in one place, quickly. Had I been Canadian, I gather I would have had to just show my card, rather than take the step of sitting down to fill out info for a temporary Health ID.

36 thoughts on “An Unanticipated Personal Encounter with the Canadian Health System”

  1. For some odd reason, I’ve had experience with a number of different hospitals and ED’s regionally (I think I counted eight, including Cleveland Clinic, UM, Beaumont, and many other hospitals around Michigan). I’ve thought about writing up my observations as an article, but haven’t had a chance to do so. One of the things I’ve decided is that perceptions of the quality of health care one receives often have very little to do with the actual quality. It’s very difficult for a layperson to understand what constitutes the highest standards of care and whether doctors are sticking to it. It’s mostly a matter of trust. What most of us perceive is customer service, which matters a lot, and that varies quite a bit, and can be surprisingly bad even at very reputable hospitals.
    I think the way they had you walking around for tests without a room as a “home base” is rather odd. Most ED’s do allow patients who are ambulatory to walk where they need to go, but then they go back to some place where the doctor can find them–usually a room or a bay or maybe a stretcher in the hallway if things are really busy. I wonder if you ended up at more of an outpatient center than a true emergency hospital…
    Personally, I’ve rarely been asked to pay a bill right at the hospital. Almost always the bill has been mailed to us. I think maybe once or twice we’ve paid a copayment upon leaving, but generally they just send us a bill and it includes invoices from various departments. The doctor’s office does ask us to pay at the time of service.
    I’m glad you got some good care for the “whole person.” It’s quite interesting to hear that your condition is not considered dangerous…? Perhaps this is something to discuss more with your cardiologist. (Demand your full fifteen minutes!)

  2. Hey Toby–
    Glad everything was treated promptly and worked out well for you. I imagine it was stressful, especially at the beginning, being a furriner and all in a city that doesn’t speak a lot of English. But yeah, that is the classic approach in a Canadian ER, which is to triage triage triage and do a bit more triage. That way, like they did with you, the non-life threatening cases are bumped down in priority, and the life threatening cases are catapulted up in priority.
    I guarantee you’d be whisked away on a bed if you were in bad shape.
    And yeah, if you were Canadian, you’d simply give them your health card and then that’s it. No bill(s). Nothing. You just leave when you’re done.
    Anyway, it was awesome to finally meet you in person and hang at worldcon. Friday night dinner at Le Quartier with the girls was a highlight of the con for me. You’ve got a lovely family.
    Cheers man!

  3. Datapoint: in our NYC neighborhood hospital, when my partner was mugged and got a knock on the head, once they knew he was mostly okay we walked ourselves up to radiology and back for his CT scan.
    I’m really glad you’re okay, and extra glad you got such good care.

  4. Toby, I am so glad everything worked out so well for you, being sick away from home is bad enough, not that I could imagine having to deal with a foreign language on top of it, but I had three years of French in High School, so perhaps I could have muddled through it a bit easier…
    Anyway, I sent a link of this blog page to a good friend of mine with a more than moderate conservative bent for her perusal…I doubt it will convince them, but I ‘d like to think that I have tried.
    Deux bebes! Tres magnifique!

  5. Catherine, yeah, if you follow the link I gave you’ll see I was at a heart clinic for analysis and testing, not an ER as such. Which is why the doctor said I kinda went to the wrong place.

  6. I am relieved you took initial advice and went in to the ER. I am also glad that you are doing better!
    I would definitely agree that the convention center layout was a bit hellish. After four days, muscles I didn’t know I had, ache and my feet are filing a restraining order.
    As far as your experience with the Canadian Health System, I am happy it went well. I would think if multitudes of Canadians were dying at the hands of shoddy care — there would be a complete lack of any scary security guards at the Convention center, telling you that the floor was not for sitting!

  7. I live in the Twin Cities, and when I visit the doctor, I often have to run around to get all of my tests done. I don’t go in via the ER, however, so I’m not sure how that is done.
    I think the most important issue is that you’re ok. But I think it’s also good to note that the doctor you visited was interested in you as a person — the total care route. That’s a great type of medical facility; treat the person, not the symptom. That’s why we should have more well person access here in the states.
    Without getting into medical care issues, really I’m glad that you’re ok.
    And, btw, I did vote for y’all in the Hugos. I’m just happy that I could — and don’t consider you losers at all. 🙂

  8. Was that the “uninsured” cost? Or how does it work in Canada?
    I ask, because my wife visited the ER twice for Wolff Parkinson White syndrome, something not identical to what you have but maybe similar to scope (basically a heart arrhythmia that won’t stop) and I found the rate the hospital charged before “discounts” (i.e. what the uninsured would pay) pretty appalling. It was sure a hell of a lot more than $480!
    Anyway, glad you’re all right! Some of the differences in care may just be random chance. It took me years to find a really good doctor but I have one now who actually listens and thinks beyond the “shuffle the patient out the door” quick reactions.

  9. Glad you are doing fine and things worked out for you. The only thing I’m surprised about is the cost you paid for the services rendered to you. $480 for the total visit is pocket change compared to what you would have had to pay in the states. The x-ray alone would have been more than that! Interesting indeed.

  10. I’m so sorry that you had to seek medical care, glad that it turned out OK. I too love Montreal, but didn’t love the convention set-up At All.
    I’m also sorry I didn’t get to meet Emily and the girls, and only saw you once in passing (see nonlove for Convention set-up.)

  11. That sounds a lot like my ER visit in Calgary last year during World Fantasy Con. Because I wasn’t a Canadian citizen, I paid a quick $300-400 (don’t remember exactly), received receipts for my insurance company (I didn’t even have my insurance card on me), and was taken care of in about the same amount of time as an American ER. I did get put on a bed and was there for a couple of hours. And they came and checked on me a lot and made me stay there until they were happy I was okay. And they let my friend stay with me the whole time.
    While in the waiting room, my awesome friend was able to ask for heated blankets, and she constantly buried me in them, all freshly heated. And they fed me sandwiches and juice. Mmm, sandwiches and juice. It was almost like being in kindergarten again. Heh.
    Having to go to the ER sucked, but the actual experience worked out pretty well.

  12. I’m really glad that everything is okay.
    And $480 for the whole visit? Wow. I’ve paid more than that for one blood test, with insurance.

  13. Very glad you’re doing okay, Dude. And, hey, Toby, your body is trying to send you a message. That message is you can quit stressing it out or it’s going to hurt you. Bad.
    It Teh Sucks to get old. But we all do it, and it’s better than the alternative. So take the Go Go Go of your nature and tamp it down to just two-and-a-half “Go”s. Okay? So not sedentary, but stop burning the candle in the middle as well as both ends.

  14. I ended up in the hospital the weekend before Christmas with stomach problems that turned out to be a gallbladder attack. After a CT scan and blood tests, they kept me for three nights, with morphine shots for the pain, until the inflamation went down, then sent me home with dietary restrictions to keep to until it could be removed (standard – six weeks after the inflamation goes down) – presented health card on arrival at the ER, total cost: $15 for one day of television when I got bored.
    One month later I had a follow-up appointment with the surgeon to set the date for my surgery – total cost: $7.50 for parking.
    The end of February, my surgery – total cost: $40 for the portion of the prescription drugs not covered by work (would have been about $200 without coverage) and the gauze and tape to change the dressings.
    My father was in the military and we were stationed in the US back in the very early seventies (he was a liaison officer at Fort Huachuca, Arizon), and my mother still shakes her head over a hospital visit for a sinus infection while traveling, and the number of bills they found waiting in the mailbox when they got home.
    Despite the morons protesting at townhalls down in the states on the news, I think I’ll stick with my Canadian system.

  15. Very glad you are ok, sorry I wasn’t there to walk you through the system. Glad you had an overall good experience (and yes that’s typical for our billing system).

  16. All I heard was that you had gone to the hospital. Had I known I might have been able to send a native Montrealler to help you out.
    I am very glad everything went well.
    I took the train too for pretty much the same reasons.

  17. *sigh*
    I miss Montreal.
    Glad you did well. It may have taken more time overall at a real ED in Montreal.
    As an English speaker, and where you were located and the problem you had, the Royal Victoria Hospital would have been the likeliest place to wind up: it’s the huge black victorian block of buildings visible at the top of the mountain. The doctors and most of the staff there speak English as it is a part of an English-speaking university hospital system (McGill).
    In a normal ED, you would indeed have been put in a bed in a room, and everyone would have come to you. It would have cost about $200 more. And you may or may not have gotten the chat at the end.
    I’m glad you had a good experience, though. It’s hard to be ill away from home.

  18. FWIW, what you probably got at the beginning was not a temporary health card, but a hospital card. Everyone gets one — it’s sort of an internal hospital ID and is mostly useful if you have to return for multiple visits.
    Glad your stay in our hospital went well, both outcome-wise and in terms of the health care experience. I am a Montrealer, and a few days ago I had to go down to the Quebec health ministry office to renew my health insurance card for another five years. Total time in the office, including photo: 18 minutes. Oh, for the streamlined efficiency of the free market!
    Steve: yes, that would have been the uninsured cost. A Canadian with a valid health card would have owed nothing for such a visit.

  19. I had heard about the party troubles. I glad I didn’t hear about your health episode until now. I would have been really stressed out more than I am. Get better. Take it easy. We want you to be around for Emily and “Deux Bebes!”

  20. I think there was a bit of difference because you were at the special clinic, which as you said has more of a long-term care orientation. What we found from going to a regular Emergency in Montreal for a back problem before my wife had her permanent residency (and Canadian health card) yet:
    [i]No crazy multiple billing system. The hospital charged me one fee. Hematologists, radiology, EKG reading, the ER doctor, and the hospital didn’t all bill me separately. In the US this visit would generate 6 or so bills from various departments, sent at staggered times. This alone reduced my stress level, as I knew right away what the total cost was and had it on one bill.[/i]
    We did get multiple bills – one from the ambulance (which obviously you didn’t have), a flat-rate ER fee (which was mentioned up-front), one from the dispensary for the cost of the drugs dispensed while we were there, and – which surprised us – one from the doctor who attended us, which seemed to come from the doctor’s personal practice and not from the hospital itself. I phoned the hospital to ask if there would be any more bills coming and was told there would be one for the X-ray itself, but it never arrived. They also sounded very confused about billing on the phone – I suspect this particular hospital just didn’t deal with many non-Canadians and were used to bundling all their bills up for the government rather than having to itemize them individually to somebody.
    That said, the final cost wasn’t as bad as I was expecting, although I forget what it was now. (As a Canadian, this was the first time I’d ever had to pay for medical care, although we still have to pay for prescription drugs, so I had no idea what to expect.)
    One more anecdote while we’re on the subject of payment: when I moved to Quebec (from another province) I put off going to the doctors for quite a while until I got my provincial health card – my out-of-province one wouldn’t be accepted because I was no longer a resident of that province, but I wasn’t eligible for a Quebec one since I hadn’t lived there for 6 months (IIRC – may have been 3 months). It turned out when I finally got the card that coverage was retroactive and I could have sent in all my receipts if I’d visited the doctor during that time and been reimbursed. So even if you’re caught without a valid health card, you’re not stuck with the bill. (Unless you’re homeless and can never prove you lived here for 6 months, I suppose. Not sure how that works.)
    [i]The Canadian doctor seemed far more interested in getting me to understand how to deal with this as a person, not just turfing me back out once they’d dealt with the problem. I spent more face time with him in the office just talking, even if briefly, than with my main Ohio cardiologist who has me in and out in five minutes once he determines my EKG readings are okay once a quarter. The doctors in Columbus, OH, teaching hospital actually spent a similar amount of time, which was nice, but they also didn’t spent as much time talking me down off the ledge or giving me approaches on how to handle this thing as a “˜person.’ I don’t know if I just lucked out on a doctor, but it was very, very welcome this morning and will have implications on how I handle this recurring speeding heart.[/i]
    Either you lucked out on a doctor, or this was because you were at a specialty clinic which focuses more on long-term care (I suspect the latter). In all my visits to the doctor, I’ve rarely had any complaints about the on-the-spot treatment, but I’ve found the level of follow-up pretty variable. I’ve never had to go in for anything really serious, though, and I did get a pretty good lifestyle talk the first time I went in for the one thing that turned out to be chronic – so maybe it’s something they only do when you’re first diagnosed with a chronic illness, or maybe it’s just coincidence that I also got a good doctor that one time.
    (It’s possible that if you’d gone to a regular Emergency and not been obviously in the city just temporarily, you’d have been referred to the clinic you ended up at as a matter of course, and gotten that advice anyway. But it’s not usual for a drop-in.)

  21. I have a long-standing heart condition, and I’m in Canada.
    The way it works out when I go in to ER is usually that the ambulance people take my vitals, give me oxygen, then ask for my medical card and meds and put me on a stretcher. There is no more paperwork once we get to the hospital.
    Then, it’s triage. Since it’s cardiac symptoms, I’m ahead of the bulk of the patients (triage, step 1). Usually, once I’ve been checked out by intake staff, I’m put on a collection of machines and left on the stretcher while the bloodwork / EKG is done. Nurses, and occasionally a doctor, check on me frequently during this time.
    Once (but this time, I walked in off the street) I was whisked away directly to ICU, where I stayed for several days.
    Afterwards, once I’m stabilized, consultation, maybe a prescription, referrals, more consultation, a final check-over. Then home.
    After a few weeks, a small bill comes for ambulance services. That’s it.

  22. @ Chris Gerrib
    Personally I think health care systems should be “socialist”, or to put it a bit more politely “free at point of access”. For all its faults I think that a nationalised system is better.
    As for being ill in a foreign country, that happened to my brother whilst we were in France, not good, but hospitals were great…. again, only issue was language, care itself was very good. Just got lucky in that we were near a major hospital when dissaster struck.

  23. Before I moved to Canada, I worked here for a year or two. I once had to see a doctor for an ear infection. I was scheduled to fly in a couple of days and needed a letter to be able to change my flight with no extra charge (airlines don’t do this any more).
    So I went to a clinic, saw a doctor on a Sunday afternoon. He prescribed some antibiotics and wrote a letter. When it came time to pay, no one really knew what to charge me. They finally decided that $25 was good. Then they all (doctor, receptionists, techs) all apologized for having to charge for healthcare. The doctor said that he really wanted not to charge, but figured he had to charge something. The antibiotics were less than $1.
    My insurance company in the states paid only 75% of the total bill since it was in a foreign country. They even sent me a check for 75% of what was the equivalent of 50 cents. Figured it cost them $10 to process the drug claim and send the check.
    When I moved here permanently a year later, I chose him as my family doctor.
    I can’t imagine having to live under the US healthcare insurance system ever again.

  24. I’m glad to hear you are okay and that you were well treated while in Canada. I am Canadian born and bred, and to me, the notion of paying for medical services is just bizarre. I never have! As others have said, whenever I needed a doctor or any tests, I just show my provincial health card and that’s it.
    I don’t know the data on this but I am told that our income tax is not even much more than yours – in most brackets it is nearly the same. In any case the US already spends more per capita than we do.
    And I have never had to get approval for a medical treatment or test. If my doctor says I need it, I get it. This whole idea of approval panels just doesn’t exist. Well, not in Canada – I hear the insurance system in the US is basically just that. So death panels are not something to be afraid of but something to deal with right now!
    In any case, again, I am glad things went well for you and you weren’t harmed.

  25. Further anecdotes/information: Ambulance service is generally not part of the national service, and has to be paid for. Most doctors/hospitals don’t generally know what things cost to an external patient so billing will vary widely.
    Urologist friend of mine says staff are always embarrased at having to ask for money – often end up charging less than the deductible would have been in the states.
    Pharamcy costs are a provincial thing (though generally not the stuff you get while in hospital, though that might just be because the two systems are integrated there, i dunno), so that may explain the multiple bills.

  26. My granddaughter from Hamilton took a spill while biking and separated her shoulder — painful but much less than a dislocation. We were able to quote her health card number and the name & number of her regular doctor, for follow-up–he would get a report. Aside from several hours waiting in the hospital (low on the triage scale), she got antibiotics for a scrape, X-rays, and a sling for her arm. They should have charged us for the sling but since she was from out of town, they waived the charge.
    People from out-of-province have to pay for the ambulance immediately or they’ll skip town and not pay.

  27. About the cost you are charged as a non-resident. Friends I have in the medical profession say that is the amount that would be billed to the province by the doctor. Since the province can’t be billed for your visit, you have to pay it.

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