Our first experience with the Canadian Healthcare System

So, on December 7, Sarah broke her arm while making a fabulous save as a goalie in our soccer game. Immediately after the game we took off to the Emergency Room at a local hospital to get our first taste of the sometimes praised and often criticized Canadian healthcare system.

It was a Sunday night, and we arrived around 6 pm. Sarah was in some pain, but she was by no means crying nor were there bones sticking out of her skin. In fact, we weren’t sure that her arm was broken, but from the swelling and the pain, we suspected as much. The hospital emergency waiting room was quite full. I had heard stories of long, often eight-hour, waits for treatment. I was expecting the worst.

As soon as we walked in the door, Sarah used a kiosk to sign in and print a number to see the triage nurse. We were there only about five minutes before she was seen by the triage nurse. The nurse took Sarah’s blood pressure, checked her oxygen levels, and said that it would be a fairly long wait but that she would get in for an x-ray right away to save time later.

About twenty minutes after this, Sarah was called into radiology and had her x-rays done. After this, we were sent back to the main waiting room. Then began the long wait. By this time, it was about 7 pm. The waiting room was still quite busy, although there was no one vomiting, bleeding, or otherwise dying. One pregnant woman was clearly in great discomfort and crying and rocking in her seat, and I was happy so see that they came to get her from the waiting room fairly quickly.

In the two hours that followed, we had lots of time to watch “Friends” episodes on the waiting room tv as well as observe the other Canadians (presumably) who were there for treatment. Everyone was very quiet and patient. Most of the people had been there at least as long as us. Not once did I observe anyone go up to the ER desk and complain about the wait or ask for an estimated time frame. A mother and her son worked on crossword puzzles in one corner. In another, couples quietly chatted. One young lady came in and signed in for treatment with her Tim Horton’s take-out in hand. Sarah just cradled her arm and winced occasionally from the pain. I continually braced myself for a rant to the triage nurse or the registration clerks about the long wait, but that didn’t happen.

I was also able to overhear the odd conversation revealing clues to the reasons the others were at the ER. A few were inexplicably dizzy. Another felt she was having an allergic reaction. One other thought she might have a broken collar bone. Despite these complaints, no one was falling on the floor, showing obvious signs of hives or trouble breathing, or convulsing with pain. Around 9 pm, several of us were called into the treatment area where we waited another 20 minutes or so. Eventually, Sarah and were brought into a treatment room where we were immediately seen by a nurse. Shortly thereafter a doctor arrived and let us know that, yes, indeed, Sarah’s arm was broken, or at least cracked. She was given some very strong pain killers and a cast. After another hour or so, she was still in pain and so was given more pain killers. During this time, I was also able to listen in on more conversations about dizziness and “just not feeling right” as well as supposed allergic reactions that did not seem to cause the ER physicians great concern.

A little past midnight, Sarah was sent on her way with a cast, a prescription for pain pills, and a temporary sling. We were also informed that she would have an appointment with an orthopaedic surgeon, and we’d be contacted with the details.

Okay, so that’s not too exciting of a story. But let me draw some comparisons and differentiations between what we experienced here and what we would have experienced in the US. Americans (and Canadians) are quick to point out the problems with the Canadian healthcare system, particularly in terms of wait times—wait times in the ER, wait times for MRIs, wait times to see a specialist, etc. Having been to emergency rooms in several cities in Michigan and Illinois myself, I know that when it’s 5 am and I’m in excruciating pain from a kidney stone, I have usually directed Sarah to take me to, not the closest ER, but the one where I expected the shortest wait. So, even in the healthcare utopia of the United States, ER waiting times were enough of a concern that I would have Sarah drive me an extra fifteen minutes, while I’m almost passing out from pain, to a hospital known to be less busy. Also, I have, on several occasions in the US, gotten through triage, past the waiting room, and into a treatment area, and even to a bed and still waited over a half hour for pain medication and over an hour to see a doctor. The last time I visited a Michigan ER in January of 2008 with a kidney stone, I was in so much pain that I was yelling and crying and rolling around in the hospital bed with no pain medication or visit from a doctor. It went on so long that after about twenty minutes of this, a security guard actually came in to see what the noise was.

I’m not saying the treatment in Canadian emergency rooms are better or worse, but I am saying that waiting is an issue in the US as well. You may just wait in a treatment room rather than a waiting room. After all, a common marketing tactic for US hospitals is to brag about their ER waiting times—often they claim that you will not wait more than an hour before receiving treatment. Let me tell you—depending on your emergency, an hour can still be a really long time.

The next day we had a call from the orthopaedic surgeon’s office, and she had an appointment two days after that. The doctor took off her cast, gave her a sling and more pain pills, and sent her on her way with an appointment for two weeks later. Apparently because the bone was not broken too badly, a cast wasn’t necessary.

Taking everything into consideration, our ER visit probably ended up lasting about two hours longer in Canada than it would have in the US. However, when comparing the cost of our time to the monetary cost we would have faced in the US, the two hours was probably worth it.

Here is my estimation of what Sarah’s broken arm would have cost in the US.

ER visit co-pay $100
Pain medication prescription co-payments $15 x 2=$30
Specialist visit co-pay $25 x 4=$100

WAIT—stop adding. This calculation is irrelevant because. . . .
we would have annual coinsurance (deductible) of $1500! So, we’d be paying the whole amount of the ER visit, up to $1500 plus 20% of anything beyond that. Oh, and prescription and doctor visit co-payments don’t count towards the $1500 coinsurance.

Let’s try again.

ER visit $500
Pain medication prescription co-payments $15 x 2=30
Specialist visit co-pay $25 x 4=$100
Arm sling $10
Rehabilitation session co-payments $25 x 6=$125
TOTAL: $765

Of course, this is just an estimate based on my most recent visit to a US ER. And, the number of doctor and rehab visits might be fewer or there might be more. This calculation does not include the $200 per month out of Sarah’s check to pay for this healthcare coverage. Anyway, the out-of-pocket cost to us in Canada was $0. I can wait an extra two hours for $765.

I’m not naïve enough to think that we weren’t paying anything for this healthcare. Clearly, every time we put gas in our cars, get a haircut, go shopping, or go to work to earn money, we’re paying for the healthcare in higher taxes. The difference is that we will never be in a position where we can’t afford necessary healthcare coverage while we’re in Canada. That could happen quite easily in the US.

The evils of co-payments and coinsurance are quite apparent. However, they are also probably directly related to the difference in wait times between US and Canadian healthcare facilities. For example, people who have to pay $50 or more just to walk in the door of an ER won’t go there when they feel dizzy or think they might be having an allergic reaction. In the US, people who feel dizzy will take a nap and see if they still feel dizzy when they wake up. If they do still feel dizzy at that point, they’ll probably go back to bed. Most people won’t cough up the $50 or more to visit the ER until they are certain something is seriously wrong. Also, people who feel well enough to sit quietly and do crossword puzzles or who feel well enough to stop for takeout food on the way to the hospital won’t be in the ER in the US as often, either.

Then again, there are some people who have insurance with no deductibles who abuse the US emergency healthcare system. There are also people in the US who, when seriously ill and in need of emergency healthcare, don’t seek care because they cannot afford or do not want to pay the required co-payments. By the time they do seek care, their condition has worsened.

I’m not sure what the answer is, because I understand the fundamental premise of the Canadian healthcare system is to provide equal healthcare to all. Yet, co-payments can often be a deterrent to keep people who don’t require emergency care from visiting the ER. All I know is that when I was in the US, if I broke a bone or had a kidney stone, I was in too much pain to worry about paying the co-insurance co-payment, and so went to the hospital. I can’t imagine what it would be like to be in the same situation with no insurance at all. Because I’m in Canada, I probably won’t ever be in that situation.

Difficulties Making Friends

If you haven’t figured it out from my previous posts, making friends here has been difficult for Sarah and me. I’m not sure how much of that is just our perception—perhaps everyone finds that it takes a long time to make friends when they move. Or, maybe the difference is so obvious to us because we did have so many friends in West Michigan.

However, being the astute observer of cultural behaviours that I am, I have been making mental notes of some of the differences between Canadians and Americans that I’ve noticed. I also realize that even with in the United States, there are major cultural differences from region to region, but saying that, I don’t know if I would have encountered as many differences if I would have moved five hours in any direction from Grand Rapids within the US. Much has been written and observed regarding the cultural and behavioural nuances between Canadians and Americans, and I’ve read as much on this as I’ve had time to over the past five years. But, my experiences and my own observations, though much similar to what I’d read, reflect my day-to-day reality.

And, yes, I know I’m generalizing, but this is my experience. If I’m experiencing something that isn’t the norm, it’s still what I’ve encountered.

In the Midwestern United States, and particularly where I’m from, people go out of their way to make visitors and newcomers feel welcomed (especially if those visitors and newcomers are white and Christian.) It’s almost a kind of customer-service mentality that carries on throughout people’s personal lives.

What do I mean by a “customer-service” mentality? Well, here’s an example. If I go to a hardware store in West Michigan and ask the store clerk for help finding something to repair my door, that clerk will show me where every possible tool and remedy is located, tell me what has worked for her in the past, ask me questions to determine the root cause of the problem, and stop just short of volunteering to come to my house to help me fix it. If the store did not have exactly what I needed, she would 1) call other store locations to see if they have what I need, 2) offer to special order it for me, or 3) give me a detailed list of other stores in the area to check, along with detailed directions and possibly maps. In the same situation in Canada, the store clerk would tell me what aisle to look in, and if the store didn’t have what I needed, I would get a “sorrey.”

In the Midwest, people will go out of their way to help you. And, if you actually ask for help, they will go even further out of their way to help you. In Canada, the response is a little more limited. I’m used to not having to ask for help to get it. Here, you need to make your needs clear and ask for help explicitly, and even then, the response you get will be only exactly what you asked for.

Does this mean Canadians are less caring or less helpful? Certainly not. It appears to me to just be a different mindset. Canadians keep their distance because they don’t want to seem too overbearing or intrusive. Canadians maintain a degree of formality in their interactions that conforms to their paradigm of politeness. Canadians as a whole are reluctant to interfere without being asked, and even if they are asked, they try to help without risking the possibility of being perceived as meddlers. You only need to look at the Canadian and the US foreign policies to note this differentiation—and that mentality is exhibited in individuals, as well.

I can remember times, when I lived in Michigan, when someone new started at work or moved into the neighbourhood. Everyone would go to great lengths to learn about this person and where he was from and why he had moved homes or jobs. If he was from a different state, the onslaught of questions from curious minds would be relentless. If he was from a different country, the degree of interest in this new person would be exponentially greater (even if he was from Canada). One only has to ask Sarah about her experience with Midwesterners when she moved to Michigan from England to confirm this.

I was in disbelief in the lack of apparent interest shown to my situation when I moved to Ontario. Usually the questions I got from new co-workers or soccer or hockey teammates were limited to “What state are you from?” and “Where do you live now?” Once, much to my surprised, I was asked, “So why did you move to Canada?” I replied, “Well, my spouse was having visa problems in the US.” My response was met with silence. No follow-up questions, no comments.

Midwesterners show they are interested in you by asking you questions. They want to know about your family, where you’re from, what sports you play, where you go to church, what medications you take, etc. They want you to know that they want to get to know you as a person. These questions demonstrate this. Midwesterners aren’t afraid to ask anything. Sarah can tell some pretty funny stories about questions she was asked when she moved to the US. “Is Nottingham a real place?” and “Have you ever met the queen?” are just a couple of examples.

Canadians, on the other hand, are likely just as interested, but are very conscious of appearing nosy. Once you get to know people, they will gradually start asking you more personal questions. But, they feel that it is impolite to interrogate someone they don’t know. So, to a Midwesterner like me, used to questions as a show of care and interest, I felt that the Canadians did not care to get to know me. Likewise, a Canadian moving to the Midwest might feel intimidated and badgered by the barrage of questions.

Conversely, Canadians are less willing to share information about themselves with those they don’t know very well. You can ask Midwesterners almost anything personal, and they will answer your question and add their life histories. I have found that I really have to ask a lot of pointed questions to people I meet to learn anything about them here, but I also have to be especially aware of irritating them by appearing too nosy. To Midwesterners, sharing information about yourself provides a way of finding common ground. To Canadians, sharing knowledge about yourself is not only inappropriate and breaches the level of formality they wish to maintain, but it makes them feel exposed and vulnerable.

Where this difference in self-disclosure is most evident is in the sharing of personal health information. Most Midwesterners will tell you, at great length, about their and their family members’ medical histories, surgeries, emergencies, medications, allergies, etc. I think this is yet another way that they are trying to give information that allows them to eventually find common ground with others. Go through a lengthy enough list of medical conditions, and the person you’re talking to is bound to eventually have experienced the same malady. The Canadians couldn’t be more opposite in their approach to sharing the personal health history. Shortly after I started at my job here in Canada, a co-worker was telling me how she had recently had an extended time off work. I asked if she had been on vacation. She replied that, no, she had been in the hospital for a major surgery. I waited for her to continue, expecting all the gory details. All that followed was silence. I felt the urge to ask her what the surgery was for, but I could tell that she didn’t want to reveal the details. So, the conversation ended there. Had this occurred in the Midwest, I wouldn’t have had to ask to get the details. And, if I didn’t ask any follow-up questions, it would be seen as though I wasn’t interested in the person’s struggles.

If I am speaking with a Canadian and start talking about any health issue I have, for example, how I broke my fingers two years ago, as soon as I give any information other than the fact that they were broken, I can sense their discomfort—they’ll shift their eyes away from me and look like they are thinking of a way to change the subject.

Okay, so even some Midwesterners don’t like to talk about their health conditions. Granted. But, here’s another example of the Canadian reluctance to self-disclose. I was speaking with a co-worker who was telling me about his mother’s commute to work. I said, “So, what does your mom do for a living?” You would have thought I asked him to confess his sins. His face turned bright red and he looked at the floor and shifted uncomfortably in his seat before saying, “She works” in a tone that said “none of your business.” In my mind, I was trying to show interest and maybe even find a common link between him and me. His response to my question made me wonder if his mother was a lady of the night. Then I remembered that he was just acting Canadian.

Canadian Thanksgiving is in October. Sarah and I had been living here less than two months. Everyone we knew from work, hockey, and soccer knew that we were new here and had no family here. Many people asked us what we were doing for the holiday. We told them that we weren’t doing anything. Had we been new to the US at US Thanksgiving, we would have had more invitations to a holiday get-together than we could believe. We didn’t have a single offer here. I wasn’t hurt or offended, I just realized it was a difference.

Of course, it’s important to point out that when Midwesterners ask you about your personal life, they may just be feigning interest. I have certainly experienced my share of people, especially colleagues in management, who pretended to be interested in me for appearance’s sake. The majority of the time, the interest shown by Midwesterners is genuine. What I do know is that if a Canadian asks you about your personal life, most likely, they really are interested.

Hopefully the observations and experiences I’ve shared here have helped to explain why Sarah and I have had such a difficult time making friends. A couple of weeks ago, one of our teammates from hockey invited us over to her house for dinner. When I got her e-mail invitation, I cried. I still don’t know why I cried. Was it because I was so happy that someone had finally reached out to us? Or was it because I realized how much my social situation had changed in that I had been here in Canada for three months with no real friends?

At this point, things are changing gradually. We feel a lot closer to many of our soccer and hockey teammates. Part of the problem may be our age. The fact that we’re in our thirties means that most other people our age are in the midst of child-rearing and have all their time consumed with family responsibilities that Sarah and I don’t have.

All I can hope is that a few months from now, I’ll be writing a blog entry about Sarah’s and my booming social lives.

Meanwhile, I’ll continue my cultural observations.

Feelings of Lonliness at the Canada Post Office

So, tonight I went to the Canada Post office to buy some stamps for our Christmas cards. I told the clerk I wanted two books of stamps for postage to the US and one book for international overseas. I mentioned that I needed them to send Christmas cards. As she started pulling the stamps out of the drawer, she paused and looked at me and said, "Don't you need any stamps for Canada?"

I replied, "No! I don't know anyone in Canada." As I heard myself say those words, I felt very bad that I have been here over three months and still don't know anyone here well enough to want to send them a Christmas card. That made me so sad and feel so lonely.

I muttered something about just having moved here, and left. On the way back to my car, I wondered if there were any other immigrants who were only sending Christmas cards out of the country and none within.

Now I am wondering what I'll be writing at this time next year. I hope I will be able to report that I needed to buy many stamps to send cards to all my friends in Canada. Actually, I'd be happy if I even had one or two to send because that's one or two more friends here than I have now.

Why is it so hard to make friends here? I don't know for sure, but I'll be writing about that soon as I have some theories.

Election Elation and Dejection

It’s been a long time since I’ve added an entry, but that doesn’t mean I haven’t had anything to say. I really just don’t feel like getting on the computer when I get home from work at night. But, I’ve been writing entries in my head, and now it’s time to put them here.

So, the biggest news since my last entry has been the US election. I will never forget the pain I felt during the last two elections (2000 & 2004) as I watched the results come in. Both times, I was confident Bush would lose, and he didn’t. This time, even though I felt Obama would win, I learned not to believe anything until the results were in.

When the results did come in and they showed Obama to be the winner, I was very happy, but I didn’t have the sense of elation that I expected. I guess I felt that it was a nice change and something in the best interest of the US, but since I am in Canada now, I kind of feel that it’s too late for me to see or experience the benefits of the coming changes.

Regardless, I called many of my friends and family in Michigan and Illinois to congratulate them and to share in their joy. The liberal turnout of the election was amazing—stem cell research and medical marijuana use passed in Michigan. Even my uptight Dutch religious conservative county of Ottawa repealed its ban on Sunday liquor and beer sales.

I was especially pleased to see the bill in California to improve the treatment of farm animals had passed. But that’s where my happiness at the result of the California election stopped. It took two more days after the election, but finally it was announced that the state overturned the gay marriage law that the courts there had passed earlier in the year.

Putting aside my anger at the people who voted to revoke equal rights for a minute, let me ask, when did the US become a country ruled by referendum?? One of the most fundamental tenets of democracy is that the majority rules BUT the minority is protected. Alexis de Tocqueville in his Democracy in America wrote of the dangers in a democracy of the majority’s power to opress, regulate, or infringe on the rights of the minority. As he points out, this is the function of the courts—to prevent the tyranny of the majority.

The apparent trend in the US today, especially as it pertains to gay rights, is label court judges as “activist” when they make decisions that promote equality for those in the minority. (Interesting how conservative judges on a mission to ban abortion or to remove gun control laws aren’t labelled as “activist.” ) Then, if the majority (heterosexuals) don’t like the decision the “activist” judges have made, they organize a referendum, get signatures, raise obscene amounts of money, and wage a campaign of misinformation and hate to get the rest of those in the majority to vote to overturn the court’s decisions.

While it is within the power of the people to organize and conduct a referendum, let’s not forget the court’s obligation to prevent tyranny of the majority. To put this in perspective, let’s pretend for a minute that people were less embarrassed to be racist than they are to be gay-haters. In that case, the wise majority would have certainly put the 1954 Brown vs. Board of Education court decision up for a referendum. And what would have been the result? The majority of voters being white, and many of those being outwardly racist, and others happy to let theirs show only while behind the voting curtain, certainly would have resulted in an overturn of the court decision—tyranny of the majority. This is, essentially, what happened in California.

Ironically, polls seem to indicate that it was visible minorities who turned the vote against equal marriage.

If the well-known saying, “As goes California, so goes the rest of the country” really is true, than I guess it’s a good thing I’m already in Canada.