Sunday, November 13, 2016

Mostly some medical notes................

Blog for Nov 13, 2016

One nice thing about the time change (yes, Canada observes the end of daylight saving's time), we see a beautiful sunrise most mornings. It is a benefit (there are few) of living on the 12th floor of an apartment building. 

This has been another busy week but not much happened that is especially blog-worthy so this may be short, especially if I don’t bore you with things about cars!

Monday Kathy and I made another trip with a missionary who needed to go home because of illness. This trip, however, was only to Vancouver, BC, where the missionary caught an international flight that would go directly to the destination city. For Kathy and I, it was a much less complicated trip as we didn’t have to go through customs. We left in the early afternoon and got back to Calgary before 9:00 p.m.

Kathy and I make these trips (just me if it is a male missionary) as part of my duties as the mission medical advisor. It isn’t always necessary to accompany a missionary, but if the problem is severe enough or the missionary is in need of some form of medical assistance during the flight, then he or she appreciates being accompanied to their home city and turned over to the waiting family. This is always so sad; to have a successful mission for a time and then have it end rather abruptly. Despite an honorable release, these missionaries go home with a sense of having not truly completed their missions, at least in the way they anticipated, and no amount of reassurance or discussion ever seems to help them be relieved of that feeling of having not completed their mission.

We have one missionary of African descent who has Sickle Cell disease. This was known, of course, prior to coming on his mission and has been well managed. He has done rather well up until recently but is having a fair amount of pain, especially at night. He spent the first part of his mission in the Lethbridge area where he was under the care of a hematologist, but he has since been transferred here to the Calgary area and, with the assistance of the Lethbridge hematologist, his care has been transferred to a blood disorders group here at the medical center (Foothills Medical Center) which is associated with the University of Calgary School of Medicine. I accompanied him to his appointment so that I might be clear on what constitutes a need for emergency care and how best to help manage his care with the hope of preventing or avoiding a need for him to be admitted. I was very pleased with the team approach the doctor, the specialty nurse, and the social worker took.

I have been particularly interested in how socialized medicine works here in Canada and it is not without many of the same problems that exist in the U.S. such as, too few providers in some areas, too much demand on a fiscally limited system, limited access or long waiting periods for those without supplemental insurance, and huge demands on the system by immigrants, both legal and illegal. The system here is Canada is, of course, funded by taxes and taxes are substantial. Then there is the problem of having to have an insurance card for the particular province where one lives. One has two months to establish residency in the province to which one has moved. The particular missionary I have described above is from Ontario. A medical card from there does not authorize him for anything other than emergency medical care here in Alberta. As in the U.S., there is that difficult period when one turns 21 years of age (or 25 if a documented student) at which time one no longer is covered under a family insurance umbrella. One must then show proof that he or she is paying taxes and contributing to the cost of medical care, and have a permanent address. Missionaries who are from Canada and are over 21 (fortunately most missionaries are 19-23), who aren’t students, and are not employed and are therefore not paying taxes, and don’t have a permanent address (using the mission office address helps get around this) – these missionaries have a particularly difficult time qualifying for medical cards. And then there is the issue of prescription costs in Canada, - this is not necessarily covered even though one qualifies for medical care. One must have a prescription plan and this is an additional cost beyond taxes and, depending on the prescription plan, it may or may not cover all needed prescriptions. There are special programs for those who are indigent or otherwise have limited income but these programs have a rather limited list of approved medications.  This, too, sounds a lot like U.S. medical care and prescription issues.

Dental care is not covered in Canada by medical coverage, and it is really expensive. We are aware of a couple who annually fly to Arizona for the purpose of getting their dental needs taken care of. They find what they pay in Arizona is about 30% less than what the same care would cost in Canada even after factoring in the cost of the flights.  Fortunately, they stay with family in Arizona so lodging is not factored in.

We see many medical clinics as we drive around Calgary and often see signs stating they are accepting new patients. This has led me to inquire how physicians are paid in Canadian clinics. They are salaried or fee for service physicians and are paid according to their productivity, so this, too, is much like physicians in the U.S.

Nurse Practitioners are somewhat common in Canada but nowhere near the same ratio to physicians as in the U.S.

Physician Assistants have existed in the Canadian military for many years but not so much in the civilian world. That is changing. There are now three PA training programs in Canada and, from my reading on line, they appear to pretty much follow the U.S. model. Only one appears to offer a Masters Degree, which is pretty much the rule now in the U.S. In my experience when people here ask about my background, nearly every one of them have never heard of PAs and don’t understand their role. Fortunately, many are aware of what NPs do so there is a frame of reference they can use when I tell them what I do (did).  :^)

Well, we have all survived the election. Regardless of how we voted, it is time to get behind the new president and pray (FERVENTLY) that he gather good people around him to advise him. If Ronald Regan could do it (gather good people), so can Donald Trump. Otherwise we might be looking at the prophesied time when “the constitution will hang by a thread.”

Have a great week!

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