By Dr. Michael Moreton

After years of practicing medicine in Canada and the United States I left for China to work for 10 years there, and then another seven years in Thailand and Cambodia. Just four years ago I returned to Canada. There are significant differences in the structure of how health care is provided in different countries, and I am now more appreciative of the Canadian system.

The structure of medicine, as pioneered in Britain and adopted in other countries of the Commonwealth (Canada, Australia, New Zealand, Malaysia, the Caribbean countries) and much of Europe, is the pattern that I have experienced, and for me seems ideal. 

It is pyramidal, with three elements. First is primary care, a network of family doctors living in the community and delivering everyday advice and treatment of everyday complaints. If the problem needs more expert advice, they refer the patient to their specialist colleague who is able to provide secondary care.

This specialist may refer the patient on to a super-specialist — neurosurgeon, cardiac surgeon or cancer specialist, for example, for tertiary care. The primary care doctor, family doctor or pediatrician, has an essential role in this system. In ideal situations they have known the patient for years and have guided them through various misfortunes. They know the family and understand the patient's attitudes to treatment and compliance with recommended treatment.

The primary care doctor is also the quarterback, coordinating care by more than one specialist that might conflict. The specialist doctors communicate with the primary care doctor and inform them of any investigations or procedures performed. The primary care doctors are the foundation on which the specialists stand. They are ably assisted by well-trained nurse practitioners who provide a similar service. When the system works well it is excellent for both doctor and patient. Each doctor is providing the level of service they are best capable of offering.

The striking thing when I went to China in the 1990s was that there were essentially no primary care professionals outside the hospitals. Everybody went to the hospital for everything. Patients choose which kind of doctor they wished to see, thus self-diagnosing their condition, which can lead to unfortunate results. It was enormously inefficient; a visit for a minor complaint such as a sore throat or urinary tract infection could take all day.

In my area of medicine, obstetrics, cultural traditions established over centuries were present and compromises had to be made for me to fit in and not offend. I also helped arrange visits for Chinese health professionals to Canada, the U.S. and Australia. They were not exposed to family doctors and could not see how useful a system this could be in their own country. In recent years efforts have been made to provide primary care in community clinics, but in a country with a population 38 times that of Canada this is a formidable task and historical and cultural barriers must be overcome. 

The Canadian health care system is not perfect but by comparison, it is excellent. Waiting times are sometimes longer than they should be. Overworked staff can be brusque and apparently uncaring but in the main it is a system that we have many reasons to be proud of. I cringe when I hear Canadians criticize the system.

It is also natural to dread illness, but to feel it may be a financial — in addition to a medical — disaster is unconscionable. Canadians are luckily free from this concern unlike some nearby neighbours we know.

--Dr. Michael Moreton is a retired physician living in Lindsay.