In the Dark: What I Learned About Our Healthcare System on My Way to the Operating Room

by Nadine Morris Graeme Wilkes, Senior Director | 03 May, 2018 | 03 May, 2018

My recent journey into the Canadian healthcare system started with a “pop.” I was walking down the street when I felt a snapping in the back of my ankle and a searing pain. It wasn’t long before I learned that I had ruptured my Achilles tendon. Surgical repair was in my future.

As someone working in a healthcare improvement organization, it’s always fascinating to see healthcare up close. What I saw confirmed my belief that, while the foundation of our system is solid, there’s plenty of room for improvement. And this improvement is particularly important for others in our country who just don’t have the advantages that helped me navigate my way back to health.

First, the positive:

Great providers and care: Every healthcare provider I met was kind, caring and professional. The volunteers who roamed the wards telling corny jokes and playing beautiful music truly lifted my spirits. And I have no doubt that I received world class clinical care.

No money, no problem. . . for me at least: Thanks to our taxpayer funded hospital and physician system, money never crossed my mind. Not when I went to the emergency department (ED). Not when I was in hospital for my procedure or during follow-up care. It helped that my employer-sponsored insurance covered the cost of a semi-private room, medications and some physiotherapy – important health services that many Canadians may have difficulty accessing.

But there were definitely aspects of my experience that could be improved:

Waiting and the unknown: I was initially told to arrive at 9:30 a.m. on a Thursday for day surgery. As the day wore on I started to have my doubts. There was a glimmer of hope at 3 p.m. when an anesthesiologist began to discuss my options, but soon I was told they couldn’t fit me in. My surgeon said they would re-schedule over the weekend. No problem. I was nervous and this felt like a stay of execution.

My surgeon’s office told me to show up at the ED Saturday at 7 a.m. They inserted an IV, took some blood, my history (again), and my insurance information. That afternoon I was transferred to the orthopaedics floor - my new home away from home.

Each day in hospital was similar. I would fast all day until I knew that the window for surgery was closed. Then I’d feast on hospital food or takeout before starting my fast again at midnight. My days were mostly spent probing for more information from nursing staff, other patients and their families, and the surgeons.

I learned I was low priority and they couldn’t say when my surgery would take place. I couldn’t go home, sleep in my own bed, and come back the next day or I’d lose my place in line. An appointment, instead of standby, wasn’t an option as every surgery was based on triage. How long might I wait? No one knew. Maybe a delusion from lack of food, but I pictured myself marooned and growing old in the hospital.

My number was finally called Tuesday morning. It felt like I had won the lottery and I’ll admit to high-fiving a few staff. I’m pretty sure I gave a few more as I regained consciousness.

I have no doubt others before me needed surgery more than me or had waited longer — but clear communication from hospital staff would have really improved my experience. I understand they didn’t know when I would have surgery, but they knew the system by which those decisions were made. They knew I was on a standby list. They knew their policy on surgical wait times for admitted patients. They knew how many were on their list each day. I would have loved to know those things. And someone who needed to make childcare arrangements or deal with a demanding employer would have needed that information even more.

Discharge: The morning of my discharge from hospital, the surgeon and team stopped by my bed. I know discharge and other transitions in care are really important. Could I move my leg I asked? Yes, but not too much was the reply. I was told that other instructions would be found in my discharge summary.

The summary was clear on which surgery I had, who had performed it, and who the most responsible physician was. Otherwise, my instructions were to call my family physician if I had an issue and to schedule a follow-up appointment in two weeks.

This wasn’t at all helpful in preparing me for my recovery. To supplement this lack of information I went online and found amazing resources like this myhealth.alberta.ca guide with instructions for wound care, non-medication pain management and more. Innovations like patient oriented discharge summaries can’t come soon enough!

I don’t mean to complain. . .

This isn’t about complaining, but about sharing my experience and asking how we can do better. How can patients have better experiences of care? How can we ensure they feel confident and safe transitioning home? I have to admit that I feel a twinge of guilt: will my kind and competent surgeon find out and hold it against me? Will people just see this as whining about my healthcare when so many people have more serious medical issues?

Maybe my reticence reflects a stereotypical Canadian politeness. Or perhaps it stems from our collective exaltation of our publicly funded healthcare system — an affection that I share and that drove me to work in this sector. As Canadians we accept healthcare that is middle of the pack – at best. As CFHI President Maureen O’Neil has asked, “Do we love our healthcare system too much?

Improvement starts by recognizing that we can and need to do better. While my wait for care was merely an inconvenience, I can’t picture what someone with less advantages than me would have done: a single parent; someone who didn’t have an understanding employer; or someone who didn’t speak the language. And imagine if I hadn’t found those online resources and suffered a blood clot – how would I have even known the symptoms? Or where to go?

What do you think? Have an experience you’d like to share? Or a suggestion for ways to improve our system? Let us know…

Graeme Wilkes

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