My patient is shouting—and so should I

I heard him yelling at my office staff. “I am suffering. Doesn’t anyone care? I need a hip replacement. It has been delayed or cancelled again and again. I need more morphine tablets. Why can’t he see me?” The angry patient bellowed at my office administrator in a full waiting room through a COVID screen. “Please sit-down sir. I will ask Dr. Abdulla to discuss it with you but there are many patients waiting so you will have to wait,” the staff placated. “I will not. I am tired of being told what to do. I am tired of waiting. I will not have some Pakistani doctor hold me back from medical care that my taxes pay for. I want to see him now!” the patient insisted. Why has civility been lost? Why can we no longer be patient? Why are doctors to blame? Read: The unintended consequences of Ontario's healthcare policies Before you pass judgment, here is the back story. This 64-year-old man was well prior to COVID. He was active. He was a runner. He started getting hip osteoarthritis in 2018. We changed his physical fitness to biking and swimming, but he did not enjoy that as much, so he exercised less. His hip osteoarthritis got worse. We went through physiotherapy (not covered), medications (not covered), cortisone injections (not covered), and eventually hyaluronic acid injections (not covered) all with temporary relief. Eventually his condition got much worse so he went to the Total Joint Assessment Clinic, which confirmed he would be a candidate for surgery in four to six months. Then COVID-19 hit so he was pushed back another nine to 12 months. He started gaining weight and ended up with early diabetes and hypertension. His pain was much worse, so he needed anti-inflammatory and stronger pain medications. He even needed a few morphine tablets per week. He had a date to get a hip operation, but the lockdowns cancelled this date. He needed more pain medications and his hypertension and diabetes got worse. He ended up with a small heart attack from worry and struggles with unemployment. He patiently got back in line. A date was chosen. He was working hard to manage his osteoarthritis, his diabetes, his hypertension, his heart disease, his cholesterol, his weight, and all while being on Employment Insurance. Read: Improve healthcare: Ensure a team for every family doctor As the date got closer, he worked harder but needed more pain medications. And in the end, they cancelled it again. That is when he burst into my office. I don’t blame my patient. He is struggling like many Canadians. Struggling with delays in health care. Struggling with inconsistency in information. Struggling with policy makers and politicians who point fingers at one another while Canadians suffer. It’s not easy to be civil when you are in pain, when you have lost the quality of your life, when you have lost your job, when you have lost your hope. It’s not easy being patient when your child is sick, when there are no more medications, when your hip replacement operation has been delayed over and over, as your cancer grows, as the “experts” say things are at a breaking point but do nothing to change things. It’s not easy holding back your hurtful words when people act like they care but you still suffer. Even if there is a “plan” to eventually fund more of these procedures in private clinics, we are not managing the present needs of our population without extended suffering now. I can no longer be quiet as I see every patient I look after getting the lowest common denominator of care despite my best efforts. Is this what Canada calls universal health care? I can no longer be civil when I know healthcare is now sick care and it is already broken. Is this the type of health care that Canada is renown for? It is time for my patient and his doctor to start yelling TOGETHER. Who will join us? Dr. Alykhan Abdulla is a comprehensive family doctor working in Manotick, Ontario, member of the Ontario Medical Foundation Board, Bruyere Foundation Board, 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 January 20, 2023.

My patient is shouting—and so should I

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