The Métropolitain

Honest talk and mutual respect can make our health services tolerable

By Rouba al-Fattal on May 18, 2012

 

“Bring a pillow, a lunch box, and a book to read for your next visit”. This was my gynecologist’s advice to me last week when I complained about waiting three hours to see her despite making an appointment beforehand.

Having spent the last five years in Belgium doing doctoral research before returning to Quebec, I did not realize that going to the doctor nowadays is as challenging as going camping. As I was waiting in my silence for three hours, looking around me at the grim faces of the other tired expectant mothers, I could not help but think about how the natives of this country must have waited for hours to see the only doctor in the village.

During the period of my settling at the clinic, my mind wandered back to an experience I hadwhile still residing in Belgium when my husband, a Belgian, got so upset for waiting only twenty minutes at the hospital, apparently an occurrence which is unprecedented. I truly wonder what he would have done if he had been in my shoes, eight months pregnant, glued tothe chair at the Polyclinique of l'Île-des-Soeurs (Nun's Island), waiting for three hours, not having had lunch since I expected to be back home in an hour.

I wish this was a personal experience of no systemic significance; unfortunately, for Quebecers this is a common phenomenon. After sharing my experience with others, I realized that each one of my family members and my male and female friends has had a similar story to share from the past year alone. What shocked me is that when I asked them about what they did about it, they all answered with a defeated shrug, “What can we do about it, we shut up and waited”. I was then told that if they would have complained the nurses would become very rude to them. Some even feared their retaliation, like what happened to me when the secretary decided to allow two women who came after me to go before me just to humiliate and to teach me a lesson in compliance.

At this point, however, I understand why the nurse, the secretary and my obstetrician were so annoyed about my inquiry: “Why do we bother making appointments if we have to wait three hours for our turn anyway, could not I just make an appointment and come a couple of hours later?” At first, I thought they did not understand my question but instead thought I wasattacking them, but I now realize I was swimming against the current by questioning the system and by not accepting my fate like everyone else in that room.

The reader might ask why I stay with this clinic or with this doctor despite these problems. The reason is simply I have no other choice. For one, it is the clinic of my community where I reside; and from what I have been told by others I do not think it is any better in other clinics across Montreal, where most medical secretaries seem overly stressed and aggressive toward patients. Besides, when I returned from Belgium I was already four months pregnant, and many considered me very lucky to even find a doctor who will accept me without a six-month waiting period. 

So far, all we hear from our politicians is that the medical system of Canada is broken; we cannot do anything because the federal government is not giving enough funds; there is mismanagement of resources at the provincial level; we need to privatize our clinics; and there is a shortage of doctors.

‚ÄčIt is true that these problems do exist and perhaps to fix Canada’s medical situation all these issues need to be addressed, but realistically it is impossible – at least not without changing our complete medical and political culture towards universal healthcare which is unlikely to happen in the near future. Therefore, what I am suggesting is to break the problem into smaller manageable pieces, and from there see what we can do together as citizens and as medical staff (doctors, nurses, secretaries, and administration) to improve the situation locally.

Doctors with years of experience who know that they spend more than fifteen minutes with each patient should not double book. But since it is the secretary who books, not the doctor. the secretary needs to understand this. It is not so much the doctor’s fault, but from my experience there was a shift in blame between the secretary and the doctor, where the secretary told me to talk to the doctor and the doctor rightfully said talk to my secretary. When a doctor, like mine, supposedly starts at seven in the morning to see patients who are scheduled every fifteen minutes, if then she/he is an hour late to come to work that already sets everyone an hour later. Now, combine that with having most patients taking five minutes more than the fifteen minutes, by midday each patient will have to wait two and a half hours extra for his/her turn.

‚ÄčAssuming that for unforeseeable reasons the doctor was called for an emergency at the hospital, transparency then is the key to deal with patients. The secretary here has to directly inform patients of the delay and how long it is expected to be. This allows patients to make an informed decision such as: reschedule their appointments, go for a walk if it is needed for their blood circulation, to go back home if they live close by, to pick their children from daycare if that is needed, to grab something to eat if they have not yet, or to go back a couple of hours to work if they had taken an hour only for this visit.  

Time is relative. While a doctor performing an operation at the hospital does not notice the time passing - or does not even want to be aware of the time to remain relaxed - a patient who is waiting that same period feels the time passing very slowly to the point that the waiting becomes an aggravating experience that pollutes his/her mood and causes him/her stress. So, it is important to have a staff at the clinics who are aware of this problem, and who are trained in dealing with stressand with people at a humanitarian level. 

The local medical administration needs to provide civic-medical-education to both patients and the medical staff. Both groups need to have mutual respect for each other’s time. The notion that some doctors have of “my time is more precious than yours” should no longer be tolerated or accepted. For example, when one of my family members made anappointment and went to Verdun Radiology Clinic, he was asked to wait an hour and a halffor the doctor. However, ironically, when another family member was fifteen minutes late for her appointment they told her that they can’t accept her and that she needs to reschedule for a month later because, according to the secretary who was in charge at the time, she “should have respect for the doctor’s time”.

Another technical solution is to digitalize all patients’ files. In Belgium, for instance, all hospitals and clinics use special software to store patients’ information in a central system(including blood tests and medical history) in order to be accessed by various doctors/hospitals who deal with the same patient on different issues. Currently, every time we go to a different doctor for a medical issue in a different hospital or clinic, we either have to have a copy at hand of our laboratory results which is not always possible to obtain, or we need to take another test by that specific hospital/clinic. I was indeed shocked to notice that at my clinic in Nun’s Island they do not have that system and that all information is stored still in paper files. 

Although some family members warned me not to publish this article until I give birth to avoid problems at the Polyclinic (which is a reflection on part of the problem and the culture of fear between patients-doctors in which we live), I believe in open communication and participatory democracy as a solution to our social problems. True, I was not pleased with the condescending manner I was treated with at the clinic by the secretary and the nurse. And I also did not appreciate the doctor’s suggestion to “just forget about what happened and focus on the baby”, nor her analysis that because I’m “a woman and pregnant and passing prenatal depression” I was more sensitive to waiting for three hours. But my sex, mood, and hormones are not what triggered writing this article. It is all the problems that I observed around me about our medical system (especially since I had more than enough time at the clinic to reflect on them), and believing that we can do something about these issues is what triggered me to write this piece with the hope that it will reach our decision-makers and medical administrators.