Seek immediate medical attention…and then wait eight hours!

A few weeks ago I was visited by an old friend: a kidney stone. That little sucker, pictured above, was my third experience with one. For those who haven’t had the pleasure, the pain of a kidney stone can best be described as more or less like shoving a crowbar into your scrotum and pulling it out thought your kidney.

Did I say more or less? I meant more.

Of course, pain varies from person to person and will depend on the size and shape of the stone and whether or not is gets lodged causing a build-up of fluid…and ever-increasing pain.

Why do I bring this up? Well, having experienced kidney stones before, I knew the options. A stone smaller than 5 mms should pass on its own if the patient drinks lots of water while managing the pain with meds. The pressure should flush the stone out eventually. Stones over 5mms may get stuck. In such cases the best option is to blast it with ultrasound in hopes of breaking it up.

After my previous stone, the CAT scan revealed a 6mm stone in my left kidney and a number of smaller ones in my right. Since the pain this time was on my right side I figured my best course of action was to drink and take the pills my kids were given following the removal of their wisdom teeth. Yes, I know, I should never take pills prescribed to someone else. But the last time I was at emergency the nurse was only allowed to give me Tylenol while I waited eight hours to be seen. That wasn’t going to happen again!

So I took meds to get through the night. In the morning, I threw up and then briefly felt better so I decided to go to work for an important meeting. By the time the meeting ended I looked like a badly made-up corpse – only less life-like.

I went home and threw up about five more times before I decided it was time to go to emergency. (Of course the trip to emergency would have happened the night before if I knew I’d be seen immediately. Knowing how long I would have to wait was a major deterrent. Instead I did what I assumed they would tell me to do anyway: drink water and take pain medication.) But before I left I decided to lie down for a few minutes. I half dozed off with thoughts of, “Did I remember it properly? Was the big stone really on the left or right?” When I woke up, I actually felt a little better and waited. Soon the pain was gone and I urinated large quantities of fluid – as opposed to the trickles of the previous 24 hours. During the next night, the stone passed! The sun then rose and life was worth living again!

I experienced this after I had written the column published below. The irony was too much to ignore. You (and I) might question my decision not to seek immediate medical advice but the reality is that the anticipated wait time WAS a factor in my decision.

Whether we like to admit it or not, a public health system will always have limited resources (as opposed to the unlimited public desire for health). The only deterrent these days seems to be wait times. It feels almost like the line-ups for bread in the old Soviet Union.

I don’t think a fully private system is any fairer (good luck to those uninsurable people with prior medical conditions!) but I don’t see how how a fully public system can work either unless limits to access are built into it. And people always find ways of getting around such limits when desperate (Hey, I know a doctor at that hospital. I’ll call and see if he’ll see you sooner.) I think some sort of hybrid model is inevitable.

Seek immediate medical attention if…
(Source: Consultez immédiatement un médecin si… Journal Métro, October 10, 2012)
Voir plus bas pour la version Française.

In American TV commercials for the popular erectile dysfunction drugs, Viagra and Cialis, the announcer advises: “To prevent long-term injury, seek immediate medical attention for an erection lasting more than four hours.” The problem is that on a good day in Quebec you will wait eight hours to be seen in a typical emergency room. This means the best strategy is to go to emergency, wait four hours, then take your Viagra. After that, it’s a race against the clock to see if your erection fades before they call your name!

Hopefully, we won’t find ourselves in such a predicament but some other health crisis will likely bring us to an emergency department one day. When we think emergency, we tend to mean ‘I want help NOW’ not in 8 hours. Yet despite public outcry and endless pledges from health ministers to reduce emergency room overcrowding, the waits keep getting longer.

Unless politicians can change human nature, however, I don’t believe our current system will ever succeed in reducing emergency room waits. This is because the long wait is all that keeps many people away. If a shop has popular items for free inside, the only thing stopping people from wandering in is the length of the line-up at the door.

Who can argue with such a basic need as good health? But solving the problem of access to healthcare by making it free for everyone creates a system that is quickly overwhelmed by human emotions. Anxiety over health, sometimes reasonable, sometimes excessive, brings us to seek medical help. If line-ups were short, how many of us would like to ask a doctor a question – just a quick question, Doc – and ask one almost every day? Anxiety will always push us toward extra caution and make us seek medical advice.

Currently, the only disincentive from seeking free services is the waiting time. Since human nature won’t change, how then will times ever shorten? Well, we could appeal to another aspect of human nature: The tendency to want to keep what is ours. We have no trouble spending other people’s money but when it comes to spending our own it’s a whole other ball game; we haggle over price, we talk to competitors, we question our needs.

This is not to suggest we should make everyone pay for health care. I do not want to live in a society where only the rich get treated. But the ideal of universal health care could certainly include a system where a little bit of personal responsibility is built into it, such as a shared cost system or other similar strategy. It is important to preserve access but unless we apply some brakes to the demand, we will soon be bringing roll up mattresses with us to emergency.

_______________________________________________________________

Voici la version Française:

Consultez immédiatement un médecin, si…

Dans les publicités américaines sur les médicaments contre le dysfonctionnement érectile, Viagra et Cialis annoncent : « Pour prévenir les lésions à long terme, consultez immédiatement un médecin si l’érection dure plus de quatre heures. » Au Québec, le problème est qu’il faut au moins huit heures avant d’être examiné par un urgentologue. Cela signifie que la meilleure stratégie serait d’aller à l’urgence, attendre quatre heures, puis prendre le Viagra. Après, c’est une course contre la montre : l’érection se dissipera-t-elle avant que l’on appelle votre nom?

Espérons ne pas nous trouver dans cette situation, mais un jour ou l’autre, on devra probablement se précipiter vers la salle d’urgence. Pour moi  « urgence » signifie aide immédiate… et non dans huit heures. Pourtant, malgré le tollé du public et les promesses des ministres de la Santé, il semble que l’attente ne cesse de s’allonger.

À moins que les politiciens ne puissent changer la nature humaine, je ne crois pas que notre système actuel puisse réduire l’attente dans les salles d’urgence. C’est d’ailleurs ce qui dissuade beaucoup de gens de s’y rendre.

Qui peut s’élever contre un besoin fondamental comme la santé? Mais résoudre le problème de l’accès aux soins en les rendant gratuits pour tous crée un système qui est rapidement submergé par les émotions humaines. L’anxiété relative à la santé, parfois raisonnable, parfois excessive, nous pousse à consulter un médecin. Si l’attente était courte, combien d’entre nous aimeraient poser une question au médecin (juste une petite question, Docteur), pratiquement chaque jour?

À l’heure actuelle, le seul élément de dissuasion est le temps d’attente. Comme la nature humaine ne changera pas, comment raccourcir ce temps? Eh bien, on pourrait faire appel à un autre aspect de la nature humaine : la tendance à vouloir garder ce qui nous appartient. Nous n’avons aucune objection à dépenser l’argent des autres, mais lorsqu’il s’agit du nôtre, c’est une autre histoire : nous marchandons, nous remettons nos besoins en question.

Cela ne veut pas dire de faire payer tout le monde pour les soins médicaux. Je ne veux pas vivre dans une société où seuls les riches sont traités. Mais, idéalement, le système de soins de santé universel pourrait prévoir un peu de responsabilité personnelle, comme des coûts partagés. Il est important de préserver l’accès aux soins de santé, mais à moins de diminuer la demande, nous devrons bientôt apporter notre sac de couchage à la salle d’urgence.

Tagged as health systems, Hospital wait times, kidney stone, private health system, public health system.

Posted in Human nature, Random thoughts.

Posted on 28 May 2013