Chapter 4


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Chapter 4 – Diagnostic Ontarios Plan & Practice

Diagnostic tests are a complex and necessary component of managing life with Chronic Illness. In Ontario,  wait times are long and getting Doctors to order them is challenging. To keep Health Care costs down, the Ministry of Health and Long Term Care does not want unnecessary tests ordered.  Fair enough, however this presents problems for Chronic Pain Patients. We need to rule out certain things, look for others and generally monitor our condition. This chapter discusses the various factors that impact the ordering, interpretation and use of Diagnostics in our “Free” Health Care System.  

Finding the source of Chronic Pain is very difficult. Our bodies are complex, remarkable and changeable. Many Chronic Pain patients start with one issue, that leads to secondary and possibly tertiary conditions; without rhyme or reason. It is an elusive condition, many Doctors do not want to deal with. It is a challenge to get a Dr. to order a Diagnostic test, as it seems there is pressure from the Government to keep costs down. If in any of the tests ordered nothing solid is found, that condition/issue is then ruled out. The patient may be passed to another specialist or back to their General Practitioner.   The process can go on and on, leaving the patient sad, depressed, confused, angry and lost. The content of this article may provide some insight into our “Free” Healthcare system in regards to Diagnostic Tests.

Factors to Consider With Diagnostic Imaging

Specific CriteriaEach test ordered looks for specific issues at the request of the ordering Physician. They may request a general scan to look for anything abnormal, or for a specific thing. There may be something else there, not caught by the Technician or Radiologist. Therefore, one test may prove one condition is NOT there, but another MAY be there.

The ranges of normal results –  The Technician or Radiologist interprets the tests based on the general ranges of what is “Normal” or “Abnormal”. Here is an example. I have a family member who had a mammogram a few years ago. They were able to spot a very small lump in her breast. If she had the test in another facility they probably would not have flagged this lump. For illustrative purposes let’s say the lump was a “3” and the Cancerous” range is “5-10”. The Radiologist and Technician, decided to flag that lump. The Oncologist performed a biopsy based on the Mammogram and she was diagnosed with Breast Cancer.

If the Technician/Radiologist had not flagged this lump, it may have grown by the time her 2 year Mammogram would have been done. However, they did and she is now cancer free.

If an X-Ray is done in year 1 of an illness, there may be a trace of something wrong. Or.  The results may fall into the “Normal” range, even though they are just at the edge. After a few years or months, the undiagnosed abnormality may grow, change or morph into something more. If the symptoms are consistent or worsening, why shouldn’t there be a subsequent diagnostic test?

The Technicians/Radiologists These people are looking at the images from an emotionally distant place as they don’t usually have significant interaction with the patient. They may have a bad day, be distracted by something or just not very good at their job. Each Technician and Radiologist is a different person and HUMAN, which means subject to error. One Radiologist may see something another does not. Different sets of eyes may offer different opinions. Therefore, who is to say that one test was done accurately? Isn’t is possible an error was made and ordering another test, if symptoms persist and no other solution is found,  might be of value?

Movement during tests  Going into that MRI Tunnel is BRUTAL. The patient is not allowed to move, breathe or swallow. For some, this is a very stressful ordeal and can cause panic attacks. If the patient moves at all during the course of the test, it must be run all over again – from start to finish.  The slightest movement may cause a blur on the MRI, which will lead to an inaccurate result.

Different tests look for different thingsHere are some links and explanations for different Diagnostic Tests, used for Chronic Neuropathic Pain. Please note these are not the only diagnostics used.  It is important to note one test may not find a result, while another might. When having multiple tests, this increases the wait time, co-ordination, administration and communication/analysis of the findings. For example, an X-ray may show something, but it is not conclusive so an MRI is ordered. The whole time for this process can be anywhere from 2 to 12 months. For someone in pain, this is an eternity.

Neuropathic Pain does not show up on any of these tests Solid things like a herniated, bulging or degenerated disc will show up in at least one of these tests. Neuropathic pain, like Fibromyalgia will not show in these tests.

Another condition may develop over timeour bodies are changeable and sometimes mercurial, additional issues may appear.

Normal becomes abnormal at the beginning of the illness something may have occurred that did not show up in previous tests, or fell in the “Normal” range. That condition may change over time. The result may then  fall into the “Abnormal” category. If the condition persists or worsens, it is reasonable to request repeat tests.

Wait Times For Tests

Once the tests are ordered, it can take a couple of weeks before you even get BOOKED for the test. The actual appointment may be booked anywhere from 24 hours to 6 months. Ontario is planning to reduce wait times for diagnostics and have put up a web page indicating  approximate wait times. Just place the City or Postal Code, type of test and several different facilities will appear. There is a section for both the general public and Health Care Professionals. The following links will take you right into the Ministry of Health and Long Term Care‘s Wait time website.

Ontario On Target for Surgical Wait Times
Wait Time Reporting Most Comprehensive In Canada
June 17, 2010
http://www.health.gov.on.ca/en/news/release/2010/jun/nr_20100617.aspx

Ontario Wait Times Strategy
http://www.health.gov.on.ca/en/public/programs/waittimes/

Ontario Wait TImes for Surgery & Diagnostic Imaging Tests – main page
http://www.health.gov.on.ca/en/public/programs/waittimes/surgery/default.aspx

Ontario Wait TimesSurgical and Diagnostic Imaging Wait Times – Adult Search Criteria for Ontario
http://www.waittimes.net/surgerydi/En/What.aspx?View=0&Type=0&Modality=&ModalityType=

Ontario Wait TimesSurgical and Diagnostic Imaging Wait Times – site for Health Care Professionals
http://www.health.gov.on.ca/en/pro/programs/waittimes/surgery/default.aspx

While all this information is interesting, what does it have to do with anything? Why would the Ministry of Health and Long Term Care spend money and use resources on this? Here are some points to ponder….

1. How much did it cost to build this structure? Could that money have been better spent on purchasing MORE machines, staffing hospitals/clinics, training them, making them available to people who really need them? 

2. While interesting to know the shortest time to get an MRI;  aren’t I subject to my Physicians hospital/Centre’s  privileges? While I can get an MRI booked in a month in a smaller city, I highly doubt my Dr. will order it there.

3. Ontarians/Canadians are inherently confident in our Healthcare System. We believe our Doctors will get us in the fastest……..while in all reality, they have almost no control on who can get in when. Making this information valuable how?

4. The majority of Canadians are not going to have all the above tests. If they do,  most likely they are more concerned about the reason for the test, what it will be like and the final result. It doesn’t seem plausible, one would search the Ministry of Health and Long Term care to find out how long it will take?

There are legitimate reasons for being careful about ordering tests.  They are expensive to run, staff and train; which means it should be a resource used wisely. It is not only the Ministry that frustrates me, but also my fellow Canadians. Intrinsically, Canadians have confidence, reliance and dependence on our Healthcare System. The majority do not have serious health issues and there is very little understanding of the costs/ issues involved. Therefore, some simply don’t show up for their Diagnostic Tests. They don’t understand, their failure to appear means someone else didn’t get to have a test that day. They also cannot comprehend; being late means someone who is in pain or scared had to wait just that much longer.

To curb abuse of the system, here are some suggestions to the Ministry:

1. Charge patients who fail to appear a significant fee/penalty. Possibly the actual cost of the appointment – staff, electrical, etc.

2. Charge patients who are late a fee. If they are more than 30 minutes late – they must pay the failure to appear fee.

3. Run the machines 24 hours a day, 7 days a week. This will allow many more patients to have their tests. Very few Chronically Ill Patients will say no to a 2am appointment. It may not be fun, but it may provide a result, which leads to a diagnosis, which leads to treatment, which may lead to the end of their pain. I am confident most of my fellow Painies would be willing to do this.

4. If a patient wishes to have a test the Dr. does not believe needs to be done, they may pay for the test themselves. If something is discovered through the test, the patient will be refunded the fee.

Conclusion:

Diagnostic Tests are expensive. Money needs to be there to purchase the machines, fit them into facilities, hire staff, train staff and manage all the administration. It is reasonable that tests should not be ordered on a whim or willy nilly. However, for those  in Chronic Pain, Diagnostics need to be done not just once, but possibly several times. Instead of making a patient wait or beg for a test, they should be able to get what they need and soon. Extended wait times will cause an additional strain on the system, as the patient may deteriorate between wait times. Once the condition changes, the patient is virtually starting over which in turn leads to longer wait times.

Costs can be spread out, by making those who abuse the system accountable. Everywhere else has late fees or failure to show fees, why not OHIP? Why let machines sit there for hours unused, why not keep running them? Why spend money on a web program and PR that is absolutely irrelevant to all involved? Take that money and put it towards actual patient care. Patients who are able to pay for private clinics are able to get certain tests done quickly. Again, this begs to answer…is our Health Care System free? Or are we on a two tiered system? Or are we just failing miserably? Without access to care, Chronic Patients are lost and forgotten pieces of the population.

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