Medical Student Perspectives: A Canadian Medical Student’s Perspective on Health Care
As the Canadian Representative to the Council of Student Members, I wanted to share our perspective about health care. Let me start off with a definition of health care that we can use for our discussion: health care is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical and allied health professions (reference). As medical students, we are immersed in the health care environment, constantly learning and serving within it, sometimes even oblivious to what is going on around us. This perspective has allowed me to widen the scope of my vision and has led me to look critically at Canada’s health care system. I want to discuss what a health care system needs, how best to deliver care, and Canada’s current health care system.
Health care needs a delivery system that will reach all of its patients; rich or poor, urban or rural, and of every ethnic origin. Discrimination of access based on any of these aspects is a violation of the very definition of health care. What every citizen of the world needs is a system that provides equality of access and ensures prompt delivery of care. Canada has a system such as this: any Canadian or permanent resident can walk into any clinic in any of Canada’s 9.8 million km2 and receive ‘free’ health care. The system is public with each province providing residents with ‘health cards’ allowing every Canadian to have preventative, diagnostic and treatment services. The system is publicly funded by provincial and federal taxes. Doctors are private entrepreneurs and are generally paid on a fee-for-service basis, with a minority practicing as salaried physicians. While this is what most Canadians will tell you about our health care system, allow me to tell you what I saw as a student doing clinical rotations this past year in my home province. I worked in tertiary care centres, community hospitals, and in rural hospitals. I saw all members of the health care team work together for the best of the individual patient. We were encouraged daily to practice evidence based medicine, being challenged on the spot about new medical literature. Patients in our emergency department had timely access to non-invasive procedures, such as CT scans or MRIs, or invasive procedures, such as angioplasties. I saw a patient with metastatic carcinoma diagnosed in the emergency department go for radiation treatment within 24 hours. Patients were always discharged with the proper input from home care, occupational therapy and physiotherapy services.
Canadian patients can see any primary care physician they choose and request to see specialists at will. Physicians are always empowered to have the entire spectrum of treatment options offered to their patients, so that both patients and physicians can make informed decisions as to what fits their beliefs and objectives. Furthermore, the exaggerated wait-times often cited as an argument against our public health care system are taken out of context. Patients who need lifesaving treatments get those in a timely fashion, while those whose interventions are not as time-sensitive have a lower priority. Contrast this to a health care system based on profit, where individual freedoms of a patient and the medical practitioner are limited, in terms of services, which hospitals an insurance provider will cover and which physicians a provider will allow a patient to see.
It is true that in private health care systems wait times are shorter for non-life saving treatments for some patients, however they are an eternity for the millions of individuals without access to health care. Furthermore, the ability to deny patients access to lifesaving treatments because of their inability to pay or the unwillingness of their insurance company to pay is unethical and a crime against the common good of society. I believe every honest practicing physician, resident, and medical student should reject and work to change such a non-sensical framework. As a Canadian medical student, I realize that my perspective on health care may be somewhat different from my American counterparts, but I believe as a future physician, the majority of us have the same core values and principles that have led us to, and keep us in, this wonderous field of medicine. Like most of my Canadian peers, I am looking forward to becoming a fully established medical practitioner within a system where I can have a rewarding professional life.
Council of Student Members, Canadian Liaison
University of Manitoba Faculty of Medicine, 2008
Note: The views and opinions contained in this article are those of Umjeet Jolly and do not represent an official position of the American College of Physicians (ACP). For more information about ACP's policies about access to care, visit www.acponline.org.
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