Query

Figure. Photo by: Anson Liaw

I'm sick of it. I'm not going to do it any more. I hereby declare that I am never going to defend medicare again.

I've had my last argument with patients in an attempt to explain why they need to wait over a year to have hip surgery, three months for a CT of the spine, six months for a knee MRI, nine months for a cardiology consult.

I used to feel responsible for having that conversation. I used to feel that I was the system representative, the gatekeeper, and that I owed it to the system to defend it. I know better now. From now on, I'll cheerily declare “the system sucks” after I inform my patients of the wait time. I think I'll be much happier that way.

After all, what purpose does it serve if I defend a system that demands patience as the user's primary virtue? Nothing will change. If their own doctors actually say that the system is broken, then perhaps patients will agitate for change.

I used to feel responsible. I used to support patients as they waited, acknowledging that it was a long time to wait but that it was best for everyone involved, that is was the price we pay for the fair distribution of resources. Now I know better. Now I know that patience is not a virtue when it comes to one's health, and that the system I have spent so long defending is indefensible.

I know this from the trenches: a patient of mine died on the angioplasty list, and two with arthritic hips jumped the joint-replacement queue by falling out of sheer pain and consequently breaking their hips. My conversion isn't really a matter of sudden insight; I just got worn down by people griping about how long it took for their investigations or interventions to happen. I said “I'm sorry” so many times that I began to wonder what I was sorry for, and if I should be sorry. Was it really my fault when I apologized to Mrs. Hendrickson after she had broken her hip? Was it really my fault when I paid my condolences to Mr. Clarke's family after he had died suddenly in the night? And was it really my fault even on a smaller scale, when patients complained about having to wait two weeks for their barium enema?

I'm not sorry any more. Nor am I an advocate of private health care; I don't think it's the saviour of the public system. I am of the Something Must Be Done school, although like most members of that school I have few concrete suggestions to offer. I am sorry for that, however.

I've sung my “the system sucks” tune for a few weeks now, and no longer do I get into arguments about whether it's appropriate that someone be made to wait months for a test. Patients for the most part seem resigned; I had expected that they'd be shocked, but it appears that they aren't fools and so are not surprised by my little ditty. But a few of them, the more tenacious ones, say, “But I could be dead by then.”

“Well, I certainly hope not,” I warble. And I add, for effect, “The system really sucks.”

We're both right.

— Dr. Ursus