Difference between the canadian and american medical systems.

[skiingfiend]

I was talking to one of my best friends yesterday who is an ER MD and has practised on both sides of the border, US and Canada. He cracked the following joke summarizing the two systems which I thought I'd share with everybody.

In the american system the philosophy is "don't just stand there - do something".

In the canadian system the philosophy is "don't just do something - stand there".

--‐-----------

Now this is not necessarily disparaging to the Canadian system because what he is saying is: Americans are tilted towards immediate action and figuring things out as they go, whereas Canadians are tilted towards watching and figuring things out before acting.

Both strategies are valid, the art is knowing when to apply each one.

‐--------------

If you've been following my saga this is exactly my dilema:

My MO switched treatments on me with bad outcome, he wants to act like a Canadian and wait and see what happens. I on the other hand want to act like an American, I'm like f*** that, I want to switch back to my previous regime now.

Full saga starts here:

healthunlocked.com/advanced...

‐--------------

I've spent about 1/2 my career working with canadian firms on the C. side of the border and 1/2 my career working with american firms on the A. side of the border, I don't have any problem acting like an american.

[skiingfiend]

So I put my american hat on, called my MO and told him the time for waiting is over, I want to be reinstated on Firmagon immediately.

Lets see what happens.

[skiingfiend]

Everybody reacts different. We weren't expecting reactions but obviously eligard didn't work for me. It's gone on long enough and gotten so bad that remediation is needed.

Eligard would have been more convenient, once every four months instead of monthly. Additionally on eligard I don't have any hot flashes and my testicles have grown back larger than they were on firmagon. But that's small consolation if you're in constant pain and popping hydromorphone like candy.

[RyderLake2]

Hello,

Your problem is not Eligard vs Firmagon. It should be an easy switch going back to Firmagon (degarelix). A few years ago my Radiation Oncologist switched me from Zoladex to Firmagon. A year later he switched me back again. Your problem is finding a medical oncologist who is willing to work with you collaboratively. You don't have that right now.

[skiingfiend]

Belated answer to your question.

The clinic doesn't handle injections so they don't care. They outsource injection management to the drug supplier who contracts with nursing service to deliver the injection.

So in my case the drugs are mailed to my house from the speciality pharmacy on a schedule. The nurse contacts me to schedule a time and comes to my house to deliver the injection.

It's actually a very good system and very convenient for the patient. It's designed to operate at Provincial scale and handle a large volume of patients.

When I say clinic that's a misnomer, it's a Province wide cancer management organization with over 3,000 employees, six cancer care centers (ranging from clinic to hospital scale) and a $1B (CAD) annual operating budget.

I would say the only downside for my care team is bureaucratic overhead to get a patient setup or to change them from one drug to another.

[skiingfiend]

I've never had a problem but I'm sure there's a risk of traffic and weather related delays.

The downside of the BC system is that it doesn't handle rapid changes in direction. In your case, you can decide to change drugs and execute near instaneous. In my case, a change in drug takes 1-2 weeks to execute.

It's a system design issue, their mandate is to deliver cancer care to the entire population of BC many who will not live near one of the six regional centers and would find it onerous to travel (multi-hour road trip or flight) for an injection. BC is 1.5 times the size of texas with about 20% of the population.