This was first written about 10 years ago, as part of a presentation to our then MP Roger Valley.  I suggested that as in everything government touches, bureaucracy has made our medical system unaffordable and it needs to be rethought, and I offered some ideas from a patient’s point of view.  Such as protecting doctors from lawsuits so they do not have to do duplicate consultations and testing.  Such as giving patients some responsibility, by charging a modest ‘user fee’, and by providing them an annual statement of what the system did for them, so they would be a check on the system and allow a reduction in the bureaucracy.

Ten years later, the bureaucracy and costs continue to grow, and I fear the continued evolution of the system will not be for the better.    I thought it worth regurgitating the letter here, with a ‘future’ scenario added.  Food for thought.


Patient  –  Doctor, I have a sore ass

Doctor – Well, drop your drawers, and let me have a look.  My goodness, that’s a dandy boil you have on your butt.  Let me get my trusty scalpel and I will lance it for you.  This will hurt a little.

Patient – Ouch!

Doctor – Wow, look at all that pus and goo.  Okay nurse you can bandage that up now.  Sir, you will have to sit on the other cheek for a few days, and if this doesn’t heal up in six months or so, you come back and see me.

Patient – Gee, thanks, doc, what do I owe you?

Doctor – Oh, five bucks ought to cover it.


Patient – Doctor, I have a sore ass

Doctor – Well, let’s make an appointment for a physical exam.  (2 weeks later) Well sir, it appears you have a ‘fulminating bacterial subcutaneous eruption’ (or some similar medical gobbledy-gook which will give the patient bragging rights to dominate the conversation at, say, 4 coffee breaks at his place of work).  We will take blood for about 7 different lab tests, and schedule you for an appointment to see the surgeon, probably in about 2 weeks.  Here is a prescription for about $200 worth of painkillers.

Surgeon (one month later) – We need to schedule you for an MRI, a cat scan, an ultrasound, and two x-rays, and I will see you in about 2 weeks

Surgeon  (another month later) – Tests confirm you have an FBSE, and we will have to do corrective surgery on that.  You are scheduled for surgery in 6 weeks.  (Six weeks later), boil is lanced under local anaesthetic, requiring the attendance of an anesthesiologist, two nurses, and a prescription for another $200 worth of painkillers.  Patient is advised to make an appointment to see your general practitioner to check up on this in a month.

Six months later, an army of bureaucrats complete the transfer of government money to the hospital, the pharmacies, the professionals, all at an administration cost of only about 50%.  Total final cost, Oh, about $200 000.


Patient – Doctor, I have a sore ass

Doctor – I see you are over the age of 75.  We might be able to do some triage, drop your drawers and I will have a look.  Oh, it looks like it is just a boil; perhaps your wife can lance it with a sterile kitchen knife.  Our system will not allow me to do surgery on those over 75, the only option I can offer you is our ‘Happy Transitions’ program for seniors.  If you choose that option, I suggest you go home and make sure your affairs are in order.  Come back whenever, you do not need an appointment for the nurse to administer the fatal injection.  Have a good day.

Total cost, about 5 bucks.  Full circle.

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