������ϱ�

Alya Niang

What should you do if you’re sick and you’re concerned about your symptoms, but you don’t have a family doctor and you can’t get to a clinic? When people need the care of a doctor or nurse practitioner, some turn to their local emergency room.

Every year, more than 15 million people visit ERs in Canada. But recent data show that around 15% of these visits, or 1 in 7, involve conditions that could be managed by primary care. We’ll be talking to a patient who says she had no choice but to go to the ER because her doctor wasn’t available. And Shelley Petit says she was ashamed to take a seat in a crowded ER in New Brunswick.

Shelley Petit

And I felt guilty for being there. There were babies that were really sick. And I thought, I can’t take a bed from a sick baby.

Alya Niang

Hello and welcome to the Canadian ������ϱ� Information Podcast (CHIP), the platform that brings you real experiences on health topics that matter to all of us. I’m your host, Alya Niang. Please bear in mind that the opinions and comments of our guests do not necessarily reflect those of CIHI, but this is a free and open discussion. Today, we’ll be talking about the national primary care crisis and its repercussions on emergency rooms across Canada. Shelley from Fredericton is joining us today.

Hello, Shelley. It’s a pleasure to talk to you again. Thank you for being here.

Shelley Petit

I’m glad to get a chance to talk to you about such an important topic.

Alya Niang

So, Shelley, you didn’t want to go to the ER when you were experiencing sudden pain, right?

Shelley Petit

No, because going to the hospital or the ER is never fun. And it’s not what people want to do because in the media, it always seems like we’re the ones causing the problems. We go there too often. We go there when we don’t need to. So you think, okay, I’ll stay home a little longer. Maybe it’s just me. But sometimes, it’s too urgent. And you need to go, but you’re scared.

Alya Niang

And when that episode happened, what was different about the pain that worried you? What made you think, “Oh, I really need to be seen for this”?

Shelley Petit

I can’t really explain it. It wasn’t one specific thing. But it was because I know my body really well. That time, the pain was suddenly beyond what I could handle. It was like my body said to my mind, “Whoa, it’s more serious this time. You have to go. You can’t ignore it.” And the pain dragged on. And as it went on, it got worse and worse. So my partner looked at me, and he said, “That’s enough. You’ve got no choice. Either you go, or I’ll call an ambulance. You have to go and get care this time.” And, eventually, I agreed and we went.

Alya Niang

So, it had gotten to that point. Something really had to be done.

Shelley Petit

Yes, it was at that point. Frankly, I was afraid that I was going to die. It was that bad.

Alya Niang

I see. And Shelley, you’re one of the lucky Canadians with a family doctor. I don’t have one. Where is your doctor? Can you go and see him?

Shelley Petit

Well, I live in Fredericton. My doctor is still in Saint John because I lived there for 30 years. Saint John is about an hour down the highway. But unfortunately, in New Brunswick, doctors have to work in the ER for 3 weeks...

Alya Niang

Mm-hmm.

Shelley Petit

...a year to keep their licence. He was working in an ER, but in Saint John, there’s an ER for really urgent cases and one for less urgent ones. He was at the ER for less urgent cases, which doesn’t do X-rays or anything like that. So, I definitely couldn’t go there. We weren’t going to drive an hour, so I had to go to another ER, where my doctor wasn’t working.

Alya Niang

So what did you do then? What did you decide to do?

Shelley Petit

Well, before going to the ER, because again, I was concerned about that, we called Tele-Care. After asking me a few questions, they said it was too serious and that I had to go to the ER. I still did my best to avoid it.

Alya Niang

Yes.

Shelley Petit

But in the end, they said I had to go. So, I had no choice.

Alya Niang

So, you really did try to avoid going to the ER. I’d say that was the right thing to do. And do you think the virtual service really tried to solve your problems? Or was it just easier for them to send you to the hospital?

Shelley Petit

In my case, that day, no. They were erring on the side of caution. I really believe that. They were afraid it was really urgent. And they didn’t want to take the risk of saying that they could take care of me when I was actually dying and I wouldn’t be able to get to the ER in time. I’ve used Tele-Care in other situations and it was fine. But there are times when it doesn’t work.

Alya Niang

So, in this particular case, they really didn’t want to take any risks.

Shelley Petit

No.

Alya Niang

Exactly. They thought the best solution was for you to go to the ER.

Shelley Petit

Yes. Then they said they’d call me an ambulance right away. And I said, “The hospital is like 3 minutes away by car. Normand will drive me in the truck.”

Alya Niang

So you went reluctantly?

Shelley Petit

Yes. Exactly.

Alya Niang

Unfortunately. Shelley, when you got there, what did you see in the waiting room? What exactly did it look like?

Shelley Petit

When I looked around, it felt like a movie, like those scenes in Afghanistan, where the hospitals are chock-full of people. There were people in wheelchairs who’d been there for 6 to 8 hours. There was a man who was crying because he was in so much pain. There were children who were bawling. It was full of people and it was a disaster. There was no respect for these people’s illnesses, and it was heartbreaking.

Alya Niang

So, it was really tough to see, I imagine.

Shelley Petit

Yes. And the week before, someone had died in that ER in Fredericton while waiting to be seen, so everyone was worried.

Alya Niang

How did it feel to see something like that?

Shelley Petit

Well, I didn’t feel like I was in Canada. I’m very proud to be Canadian. This isn’t our health care system.

And I felt guilty for being there. There were babies that were really sick. And I thought, I can’t take a bed from a sick baby. If I’m going to die, at least I’ve lived to 54. They’re just a baby. I know you’re not supposed to think like that, but that’s where my mind went.

Alya Niang

I understand. And, the fact was, you weren’t feeling well. But when you got to the emergency room, you saw people in worse shape than you. And it made you feel a little guilty, thinking maybe you were taking someone else’s place. Was that it?

Shelley Petit

Exactly. You know that if you have to wait too long, it’ll get worse, and maybe even kill you. But at the same time, you feel guilty that you’re taking the place of someone else who may be worse off than you, or is at least as bad off as you.

Alya Niang

Were you surprised that you felt guilty and were thinking about how scarce this resource is? Because we’re in Canada, and universal health care with quick access is somehow built into our Canadian way of life.

Shelley Petit

Yes, it’s not the same as when I was growing up. When I was young, if you broke your arm or got into a car accident, you got the help you needed quickly. Then you’d go home and get on with your life. If you were injured at work, you could probably go back to work the next day. But now, you have to wait too long. Too many people are leaving emergency medicine. It’s ridiculous. This isn’t the Canada I grew up in.

Alya Niang

I understand. Things have changed drastically as far as I can tell. When you got care in the ER, how were you treated? I understand that you were a little surprised.

Shelley Petit

Yes, in the beginning, they treated me like I was wasting their time. They were like, “Why are you here? You’re wasting our time. You’re crazy. You’re overreacting. It’s not that bad.” But then there was a younger doctor. He was new and was somewhat knowledgeable about my condition. In the end, he was the one who really helped me. He argued with the head doctor and the head nurse, because the head nurse was awful.

Alya Niang

Right. I imagine when you’re really sick and you’re treated like that, it can really hurt.

Shelley Petit

Yes. I really doubt I’ll go back the next time something happens to me.

Alya Niang

Did they solve your problem?

Shelley Petit

Yes and no. They started treatment and sent me to a specialist. Two years later, I’m still dealing with it. I’m making progress, but I still have the problem.

Alya Niang

I understand. Could your problem have been solved if your family doctor had prevented you from going to the ER, if you’d had access to your family doctor?

Shelley Petit

Probably, because at the end of the day, he knows about my condition, too. He’s had training on it, because it’s a very rare disability. And it’s what caused the other problems. So, he’s had training on it. He understands. He probably could have done the same thing the hospital did, but in 5 minutes.

Alya Niang

I see. And that would have prevented all these problems and inconveniences?

Shelley Petit

Yes, all these problems. And from taking someone else’s bed, because I was there for several hours.

Alya Niang

And from making you feel guilty, too.

Shelley Petit

Right. And it didn’t help me get better, either.

Alya Niang

Right. So, Shelley, you were reluctant to go to the ER, right? You didn’t think you needed to go but you realized you had no choice. So my question is, what would you do to remedy the situation? And how important is this issue?

Shelley Petit

Well, if I had the answer to remedy the situation, I’d be pretty popular in Canada. But honestly, I think clinics are the solution. We need integrated clinics that have a doctor and several nurses. Because you don’t always need to see a doctor. Sometimes, it’s a nurse. Sometimes, it’s a dietician. Sometimes, if you’ve hurt your knee, it’s someone who’s trained in physical therapy. So, you don’t always need to see a doctor. Canadians need to change the way they think. The specialist I see for my disability works in a clinic like that in Nova Scotia. And it’s fantastic. It’s an amazing experience. They even have a psychologist. So, if you start to feel guilty or like you can’t go on with your condition, they have a psychologist who can see you. It depends on the situation that day, and on what you need most urgently. And it works.

Alya Niang

And have you gone back to the ER since that incident? I don’t suppose you’ve wanted to.

Shelley Petit

No, it would have to be really serious for me. Maybe if I went into anaphylactic shock, if I stopped breathing, but other than that, it would have to be something really rare. And my family doctor is fantastic. He gave me his cell phone number. He said, “Next time, call me, and I’ll see what I can do.” He said not to give his number to anyone else, but that in my case, this was the best thing to do. And it’s all I’ve needed so far.

Alya Niang

That’s great. I think you’re lucky.

Shelley Petit

Yes, I’m extremely lucky, and I’m very worried because he’s going to retire in the next 5 to 10 years. And then I’ll be in big trouble.

Alya Niang

Have you worked out a plan with your doctor to avoid going to the ER? What would you do differently? As you said earlier, he gave you his private phone number.

Shelley Petit

Yes. I call him. And we talk about the situation. He also has the number for the specialist in Nova Scotia. In one situation, I called my doctor and he called my specialist. He called back and told me what to do. So, I did that and it worked. Now, at home, Normand and I know what to do if it happens again. It doesn’t totally solve the problem, but it makes it more tolerable. I can handle it, but it goes on for around 24 hours. Then things go back to normal.

Alya Niang

One of the concerns of Dr. Howard Ovens, an emergency physician in Toronto, is that people will misinterpret the ������ϱ�data and think that 1 in 7 people shouldn’t go to the ER, that they don’t need to. What would you say to patients?

Shelley Petit

You know your body best. You’re more of an expert than anyone else. If you think you need to go to the ER, you should go. No one knows more about what’s going on inside your body than you do.

And if you need to go, you have to, because if you stay home and wait, by the time you get there, it will either be too late or it will cost a lot more and take a lot longer to resolve it.

Alya Niang

Great. Thank you very much, Shelley, for sharing your unpleasant experience in the ER. I really hope that the authorities can remedy this long-standing problem. Thanks again. It was a pleasure.

Shelley Petit

Thank you very much for drawing attention to this topic. It can help change things. It’s very important.

Alya Niang

This report contains much more data, including provincial differences in ER visits by patients who could have received primary care but did not. All of this data is available at cihi.ca. A big thank you for taking time to listen in.

Please subscribe to the CHIP wherever you get your podcasts. I’m Alya Niang. Talk to you next time.