I just wanted to go to the doctor.

Alberta has been suffering from a physician shortage for several years, but it’s become especially keen lately. With Calgary’s population just over 1,070,000 and growing, an estimated 200,000 Calgarians are currently without a family doctor. It’s a complex issue – fewer doctors are going into family practice and foreign doctors have been shut out for a variety of reasons (that’s a whole separate issue), while the constantly expanding population has placed extraordinary stress on established physicians.

I’ve lived in Lethbrige, Nanaimo, and Victoria and had a doctor in all three cities. In Victoria I simply called a clinic and asked if any doctor was taking new patients and, ta da, I had a doctor.

Not so with my first attempt to acquire a Calgary doctor – which consisted of an afternoon spent getting cozy with the yellow pages, racking up a major cellphone bill, and speaking with staff members who were too busy to answer my questions. Eventually I was referred to the Health Link website.

Managed by Alberta Health Services, Health Link provides a list of doctors taking new patients, plus 1-800 access to nurses who can provide medical information and advice on minor health issues. I checked it out, only to find my chances of securing a female doctor anywhere near my home were slim-to-none. There is currently one female doctor in my area, sort of, who is taking new patients – but “neck and back pain only.” And the other female doctors are maternity specialists. Perhaps I shouldn’t be so picky, but I think we all have a right to be selective when it comes to allowing someone access to our bodies.

Instead of despairing, I decided to accept the reality of the situation and learn to deal. I began to trek down to my friendly neighbourhood medical clinic as necessary . . . and bring a book, of course. Typically the wait is two or three hours, but, given how much I love to read in cramped spaces surrounded by sick people, there’s no problem. Twice I have insisted on seeing a female doctor and taken my chances that I’ll get in to see her before the shift changes and a male doctor takes her place. Twice I have waited all afternoon and then gone home when the male doctor arrived.

But as I say, I accepted the situation. Rather than get upset or rant at the clinic staff (there’s a sign . . . no abuse, raised voices, or profanity may be used toward clinic staff . . . that’ll get you barred), I simply gave up and planned to return the next afternoon. The alternative would be to drive all over the city from walk-in to walk-in, which I’ve heard many people do, but I prefer sitting for a few hours in the clinic waiting room to spending those same few hours in the cockpit of my car.

My last visit to the doctor, however, may have marked the end of my role as the patient patient. There was nothing majorly wrong with me . . . I had an inkling that I might have tendonitis (which would render me unable to work), had some unresolved issues with my ability to breathe properly at night, and had two smaller, more private issues, all of which I planned to address with the attending physician, male or female.

A nurse came into the examination room and asked me what I was seeing the doctor for that day. I explained that I had a number of issues to address. Instead of writing said issues down on my chart and leaving the room, the nurse informed me, “The doctor does not have that kind of time. He can deal with your most pressing concern.”

I’m not known for being a pushover, and so I replied, “All my concerns are pressing.”

Not amused, the nurse reminded me that the doctor did not have time to deal with a laundry list of problems and I would have to pick one for him to examine.

“I just sat in the waiting room for three and a half hours,” I said. “I don’t have time for that.”

She did not budge.

Despite my desire to demand compensation for my prolonged wait (compensation being 15 uninterrupted minutes of the doctor’s undivided attention to deal with what I wanted to deal with), I decided to focus on the tendonitis, as it was causing me the most pain, and hope the remaining issues would rectify themselves in time. (They haven’t.) After three or four minutes with the doctor (or was it two?), he assured me I did not have tendonitis and that I was a smidge paranoid. Probably just overexerted myself. Take some ibuprofen. Everything will be fine.

And away he went. So much for that.

For the sake of curiosity, I called the 1-800 number provided on Health Link. I was connected with a nurse who addressed my concerns – all of them. I appreciated the time she took to listen to me describe my symptoms. She asked me questions and explained in moderate detail how the knee joint works, how the nasal passage functions, and so on. Finally, I was getting somewhere.

And then she delivered her advice. It was simple, yet problematic: in regard to all four of my health concerns, she suggested I go see a doctor.

I’ll go see a doctor, all right. But given the mood Alberta’s sickly health care system has left me in, I’m not so sure that doctor will be happy to see me.

I prefer not to know the finer details of child birth. Instead, I’d rather wait my turn to experience it, and find out the good, the bad, and the ugly of pregnancy and delivery. A pregnant co-worker, however, has been spoiling some of the secrets for me . . . and affirmed my belief that gestation and childbirth aren’t all that glamorous.

I don’t like it when people ask me about me and my husband’s child bearing plans (see this earlier post) and I am almost certain that, when my time comes, I am not going to be overly fond of all the poking and prodding that I will be subject to.

My fear and concern, though, and likely the fears and concerns of many women, has recently been lessened by the government of Alberta’s announcement that, as of April 1, 2009, the costs of midwifery will be covered in the province’s maternity package. A huge sigh of relief for people like me, who are very private about their bodies and bodily functions, and value the personal relationship and trust a midwife has to offer.

My sister-in-law, who is pregnant with her second child and final child, also applauded the decision. “I honestly don’t think the doctor provides enough time in your visit to answer some of your questions. Or some of your questions aren’t questions you would go to a doctor about,” she says. “A doctor often looks at pregnancy [from] a medical standpoint, not so much a hormonal, emotional standpoint.”

Amanda describes her experience with her first pregnancy as a fact finding mission, in which she had to independently research pregnancy itself, as well as “prenatal classes, preregistering at the hospital, classes for infant car seats, etc. None of this information was provided to me by my physician.” She acknowledges that it is likely not part of many doctor’s jobs to fill in all the blanks for expectant mothers, but thinks it would be beneficial for doctors, who have seen a pregnancy or two, to give new mothers suggestions or information they may not think of. “It was never even asked if I wanted support for breast feeding, what my birth plan was, whether I wanted an epidural, none of this was discussed in advance between me and my doctor.”

While the new Alberta benefits won’t arrive in time for Amanda to take advantage of them, she acknowledges the benefits that a midwife could offer. “The biggest thing would be the support during labour. Which if you ask any woman [who has given birth], is the most overwhelming, painful, uncertain event in your entire life. At this time of uncertainty, you are left to manage through on your own with minimal hospital support.”

Enter the midwife . . . and you get an experience like Jennifer Davis, who paid $4000 out of her own pocket for one. “It was worth every penny,” she says. “My midwife was with me from month four of my pregnancy until Donnovan, my son, was five weeks old. I could phone her and ask questions anytime, she would come over and have tea with me and discuss my feelings and my body, she even came to a doctor’s appointment with me when my husband was unable to make it.” Jennifer says that her midwife, Sherry, helped her enroll in prenatal classes, recommended prenatal yoga and swimming, and even helped her pick out a stroller and a car seat.

“Sherry knew all the regulations for things [for cribs, car seats, etc.], and even suggested things I never even thought of. I’d never had a child before, but she was educated on the entire process, and had helped many mothers before me . . . she was a pro.”

Midwives have, of course, been aiding women for centuries. Here in Canada, they were reintroduced as a regulated profession in the early 1900s. While they must undertake training in order to be licensed, they are not permitted to intervene medically, and so are recommended for low-risk pregnancies; higher risk ones are left to doctors.

“My midwife helped me map out a birth plan, make difficult decisions regarding prenatal testing, pain management, and birth setting. She made sure I was informed about every step of the process so that I could make the best decision for me.”

Jennifer’s labour and delivery, like Amanda’s, was in a hospital. But while Amanda was visited by nurses every hour or so “to fill out their forms, and check [my] stats,” Jennifer’s midwife was in the room, at her side, for the entire experience. “She helped both my husband and I get through. She knew when to stand back and let us be, and when to step in and help us out. If I had had a home birth she could have delivered Donnovan, but I chose a doctor, just in case. But my midwife was in charge of checking my cervix, rather than having several different nurses and doctors checking me.”

Post-delivery, both Amanda and Jennifer spent a few days in the hospital and were relieved when they were finally sent home. Jennifer’s midwife was at the house waiting. She helped them to get unpacked and settled in and then took a few moments alone with Jennifer to help her breastfeed Donnovan.

For Amanda, it was a different. “[I received] very little support for nursing. I managed fine, but many new moms [get] frustrated and throw in the towel very quickly. There is almost no support for learning to breastfeed while in the hospital.” When she had questions, Amanda called a healthlink number and was put in touch with community nurses. “They are very helpful,” she says. “I still call them to this day.”

Similarly, Jennifer still calls her midwife with questions. “She came and checked up on me a couple of times a week for five weeks. I could call her and if she would answer my questions, explain things to me, and if I needed, come over and help me out. She is amazing . . . I know I paid her to hang around me, but it was like having a really good friend by my side every step of the way. And she is so knowledgeable about everything to do with babies and pregnancy, that she was able to educate my husband and I where we were clueless.”

So hats off to Alberta for joining British Columbia, Saskatchewan, Manitoba, Ontario, Quebec, and the Northwest Territories, in covering the costs of midwives. It won’t remove the good and the bad of pregnancy, but it might deal with some of the ugly.

So I support the efforts being made by BC schools and think they’ve tapped into the right source: the kids. Teach them to eat healthy, exercise, and understand their bodies so that future obesity can be prevented — yes!

Recently, though, I heard from a teacher in Nanaimo about a new plan being implemented in some schools. Essentially, all “bad foods” are being banished from the schools — that’s right, no Oreos in your lunch, no Halloween candy on campus, and remember those cool bake sales for fundraising? Well, they are no more. I’m not aware of all the details of the new initiative, but really? No more bake sales?

I agree with no pop, no processed foods, no mass produced cookies filled with preservatives . . . but is it really necessary to ban everything with sugar in it? I’m not a nutritionist or a scientist, but I feel pretty confident in saying that homemade cookies, cupcakes, and banana breads are far healthier than their store bought counterparts. How about keeping the bake sales but not allowing for store-bought contributions, and setting some healthier guidelines for what can be donated?

The mantra of many diet experts and nutritionists is: moderation, moderation, moderation. If you banish all foods that aren’t perfectly healthy, how are kids going to learn you can eat cookies, but that some are healthier than others, and that eating in moderation is key?

Teaching kids to abstain from whole categories of food is, to me, the same as teaching abstinence from sex and omitting any discussion of safe sex. And then people are surprised when hormonal teenagers “treat” themselves, end up pregnant or infected with an STD, and are surprised to learn (after the fact) that contraception was an option, but in ordinance with the abstinence program, no one thought to teach them about birth control and safe sex.

Removing problematic foods from schools is not, I say, an adequate or sustainable solution. It’s a big world out there and when kids leave their elementary school campus for the day and head home, they are going to stop at the corner store and buy a chocolate bar or a can of pop. I would like to see kids being taught about alternatives to store-bought snack food (homemade cake made with applesauce instead of oil is healthier and tastes just as good), portion control, and moderation. In doing so, they’ll learn to incorporate “junk” food into their diet without becoming unhealthy — and without having to give up cookies entirely.

One week ago, I sat in a packed walk-in medical centre with my child, waiting restlessly to see a doctor on a Sunday. I had hoped the clinic would be faster than the nearest hospital, and while our visit was urgent and could not wait until a weekday, it was not a life or death emergency. I watched a steady stream of sick grownups as they wandered in to sign the waiting list and claim a chair, only to cough, sneeze, and sputter back out the door to brave the frigid minus 20C winter to have a cigarette.

Over the course of two hours in the waiting room, people showed up to see the doctor, and while they waited, bought candy, potato chips, chocolate bars, and of course, cigarettes from the adjoining pharmacy. In between bouts of respiratory distress, these sick adults ate candy, devoured bags of chips, blew their noses, then huddled outside against the glass windows to take long drags of their smokes.

Meanwhile, at least six infants under the age of one waited with varying degrees of illness, one coughing so badly the indifferent receptionist finally noticed the child needed urgent medical attention, and ushered mom and babe into an examination room. Either that, or she was worried she’d get whatever the baby had. This particular clinic does not triage, meaning to assess patients for their level of emergency and slot them in accordingly. Excepting clear life or death emergencies, everyone signs the sheet, and waits their turn, regardless of age, so a child with a broken bone waits as long as a grownup with a sore throat. That visit there were 30 people in the waiting room, and the entire ordeal took three hours. On a return follow-up visit, there were 10 people in the waiting room, and it still took two and a half hours.

This is not unique to my province. In a 2004 international survey, 48% of Canadians asked said they waited two or more hours to see a doctor on their last visit to an emergency department. Last year, a Fraser Institute study found there were only 2.3 doctors for every 1000 Canadians. There is no question that doctors are struggling under a rising workload. Many doctors aren’t taking new patients, because they can barely fit in the patients they have. It has become the norm for someone sick to wait an hour or even two hours, just to see their family doctor for five minutes.

However, much of the problem remains people overtaxing our health care system with frivolous visits, the kind of people who run to the doctor for every sniffle and sore throat. Doctors universally agree that viruses like the cold and flu can’t be treated with antibiotics. The only thing that works is time, rest, and letting nature take its course. If you’re sick, you should stay home so you don’t spread your germs, just like your mother always told you. And you should probably have some homemade chicken soup with plenty of green vegetables and skip the Doritos.

Precious medical resources are also used up by people on a self-induced slow suicide via tobacco, poor diet, lack of exercise, and a general apathy and lack of responsibility for their own health. Grownups with coughs who feel well enough to go outside and pollute their lungs with carcinogens should be a lower priority than kids who need doctors. And, while all citizens deserve medical care, it’s hard to have much sympathy for adults who fill their sick body with junk food, sugar, and candy when their immune system is already compromised, and then gripe about waiting two hours to see a doctor in an emergency clinic. Meanwhile, someone else’s sick child has to wait that much longer for antibiotics for strep throat, or a cast on a broken bone.

We live in one of the most advanced countries in the world. We have a health care system that many Americans believe is wonderful, because it’s free. Except, our neighbors south of the border are attracting the top talent among Canadian-educated doctors, because of lower taxes, higher salaries, and most of all, innovation.

For example, in the US, medical care customer service is a top priority. Medical care is either covered by employer insurance, directly purchased private insurance, and certain public insurance for low income, elderly, disabled, and poor citizens. Having a system where people pay for treatment also means they expect quality and promptness, and in most cases, Americans get it.

Take Oakwood, Michigan for example. Hospitals promise patients they will see a doctor within 30 minutes or receive free movie tickets and a written apology. During the hectic flu season, patients receive same-day or next-business-day appointments with doctors. Northern Nevada Medical Centre, in Sparks, Nevada, promises patients a nurse will see them within 15 minutes or their visit to the emergency room is free. Other hospitals offer a guarantee of a nurse visit within 15 minutes and a doctor visit within 30 minutes of arrival. In the States, because health care is private, competition is fierce. Many states have four hospitals all within 30 minutes of one another. The result? After Oakwood started their 30-minute guarantee, Sinai-Grace Hospital in Detroit started a 29-minute wait time guarantee. So did its sister hospitals Detroit Medical Center, Huron Valley-Sinai Hospital, and Michigan Orthopaedic Specialty Hospital. Patients who are kept waiting past the guaranteed time receive tickets to the New Detroit Science Center, the Charles H. Wright Museum of African American History, or a Detroit Tigers game.

Who knows if a strategy like this will work in Canada? Years of poor management cannot be solved simply. But either way, it’s time for new strategies and a fresh approach. With the average family losing 50% of yearly income to taxes, including a 65% to 70% publicly funded health care system, sick kids should not have to wait three hours for medical treatment.

Incidentally, in Alberta, health care insurance premiums are mandatory, which means, essentially, if you live in cow country, you don’t get free health care. Surely a little of this money could be diverted to medical clinics strictly devoted to meeting the needs of children 18 years and under, with less than an hour wait time. Let the grownups have their own clinic. Just please, don’t promise them a free pack of smokes if they have to wait more than three hours.