Tales of the Grim Reaper from Montreal

I go to Canada fairly frequently. Whenever I’m in a social gathering and people find out I work in health care, they have something to say. It’s usually something good or bad about the US or Canadian health care system. Occasionally they ask for my view.

This weekend in Montreal I was speaking to an acquaintance (“Jim”) whose 87 year old father is in the hospital with advanced cancer. Jim told me that whenever he goes to the hospital doctors and other staff pressure him to sign papers indicating he does not want heroic measures. According to Jim the doctors feel his dad’s case is hopeless and want him to die soon.

Jim described his dad as a “young 87,” who was living on his own and driving until 2 months ago.

Jim said that the doctors frequently tell his father, “Do you realize how sick you are?” Jim is very angry about this and keeps telling the staff not to harangue his father with this profound insight. (His dad knows what’s going on but doesn’t want to hear about it constantly.) Meanwhile, Jim says his dad is receiving treatment and responding to it, which is a real nuisance from the hospital’s perspective.

Apparently the hospital wanted to discharge Jim’s dad, which Jim said was completely infeasible since his dad needs 24 hour care. So the hospital said they’d have to start charging Jim, figuring that would shake him loose for sure. But according to Jim, he surprised the hospital by agreeing to pay.

Jim’s take on this is that there should be a national policy in place that explicitly states under what circumstances care is to be given and in which cases it is to be withheld. That he could live with, he says, rather than being pressured at this difficult time and having his dad harrassed.

I don’t contend that this is an objective account. I was mainly trying to be a sympathetic listener, so didn’t really ask Jim to clarify his points. Still, it’s an interesting portrait.

At the same social gathering I ran into another Canadian who told me she was afraid to live in the States, where health care is such a problem, while in Canada everything is taken care of.

Interesting contrast.

November 23, 2009

2 thoughts on “Tales of the Grim Reaper from Montreal”

  1. My boyfriend is Canadian and lives in the Boston-area. If he ever gets a really bad illness that will require him to go on disability he fully intends to go back to Canada, buy a 3-month Blue Cross policy and then get on OHIP.

    And I also think that it’s worth pointing out that there’s considerable variation among provinces. The anecdotes that I hear from someone who used to sell sutures and gloves to hospitals is that Alberta’s system is fabulous, better than Ontario’s. Parts of Quebec’s, he considered subpar for trauma, because they had no air ambulances. But in a lot of ways Quebec is an outlier, since they don’t have reciprocal agreements with other provinces, so if you’re a Canadian travelling in Quebec from another province, you might want to buy travel insurance.

  2. Yes, National policies might define the care that may or may not be given, however no one’s prescient. When I was a resident (in pediatrics), treating a 28 weeker infant was radical–no longer. What about the 4 vessel heart attack? Childhood leukemia? Hodgkin’s disease?

    I see variation in quality, cost and access to be problematic, but at the same time, I don’t want cookbook medicine, nor rationing–please see http://managingmanagedcare.com/content/opportunity-reform.

    Are our (collective) resources unlimited?

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