In Canada, we do not have universal healthcare

If you travel around the world and say you are Canadian, the conversation quickly turns to our Canadian uniqueness. We are known for our hockey superiority, beautiful geography, delicious maple syrup—and universal access to healthcare. The first three are certain but I worry about our universal healthcare. Let me share with you five short vignettes in my local community. These are representative composites but based closely on what I have witnessed: Amber is a 42-year-old mother of four, separated from her husband and living in and out of a women’s shelter. She has struggled to provide a safe, secure home for her children. She is not receiving any spousal or child support. She has lost custody of her children but has access to them on weekends twice a month. She needs to line up in the morning to register for the doctor at the walk-in clinic. She is struggling with mental health challenges but only allowed 15 minutes and one problem per doctor visit. She has a family doctor but cannot drive there easily. Her children are seen by the same family doctor sometimes, but the estranged husband also takes the children to nearby walk-in clinics and the ER to prove he knows better. She cannot afford medications. She cannot access counselling, so her mental health is worsening, as are her chances of getting a job and joint custody of her children. Tariq is a 28-year-old single telecommunications employee with diabetes, living in Gatineau. He has an excellent drug plan. He has no family doctor. He uses online virtual care clinics who prescribe medications. He has not seen a doctor in person for more than eight years. There is limited access to healthcare in Gatineau. He manages his diabetes with his pharmacist, who renews his medications and supports him. He struggles with hemorrhoids, obesity, cold feet, hair loss and skin infections. His blood sugars run high, around 10 to 12 millimoles per litre. He can no longer exercise. Nariyoshi is an 82-year-old retired painter and Ikebana artist living in long-term care in Manotick. He has dementia, atrial fibrillation, congestive heart failure, osteoporosis and frailty. His family doctor visits him in the retirement home, or he can be drive to the doctor’s office nearby. He has access to community care supports. He has daily Tai Chi. He has a geriatrician on his team. He has a DNR order, has updated his will, has power of personal care and power of attorney all organized. Marie-Claude is a 55-year-old alcohol-dependent schizophrenic couch-surfing in Orléans. She is a patient at a community health centre with access to MDs, nurse practitioners, social workers and drug addiction counsellors. However, she struggles with regular compliance with her anti-schizophrenic injections. She slips up often by drinking mouthwash or alcohol hand-sanitizing gel, sleeping at different friends’ and relatives’ homes, and missing her appointments. This has led to her five admissions over the last year: ER, ICU, then in-patient psychiatry. Klaus is a 62-year-old married government employee living in his own home in Kanata. He has had the same family doctor for 30 years. He has access to a gym at work. He has access to a walk-in clinic attached to his family medicine clinic. He gets executive fitness examinations annually. He does his regular cancer-care screening, blood pressure check-ins two or three times per year, and treats injuries quickly with physiotherapy, massage, chiropractic or acupuncture. He gets new orthotics and glasses every two years. He recently had a concussion while playing hockey and purchased an MRI a few days later. His family doctor is retiring and told him to find a new doctor. These five composites, realistic reflections of patient health-care experiences in my community, show that there are multiple tiers of care in Canada. I challenge the notion of universal healthcare that is equitable, accessible and fair to every Canadian; this is not what I encounter. I am proud of being a family doctor in Canada, but I am very concerned about the ongoing degradation of our beloved health-care system by niche politics, inconsequential “improvements” and blatant neglect (or ignorance) by those who are here to guide us. As a wealthy, well-educated and well-meaning country—with largest supply of maple syrup—we can do better, and we must. Dr. Alykhan Abdulla is a comprehensive family doctor working in Manotick; board member of the College of Family Physicians of Canada; and Director for Longitudinal Leadership Curriculum at the University of Ottawa Undergraduate Medical Education. This article first appeared in the Ottawa Citizen on March 1, 2023.

In Canada, we do not have universal healthcare

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