Tell Me Again, and Again
In my old age I find myself reflecting on things. Most are pleasant but every once in a while I get to thinking about two dark clouds out there with the capacity to tarnish my ‘golden years’. Will I continue to enjoy reasonably good health? Will I have enough money to live on until I don’t need it anymore?
Exploring the money issue is pretty easy. I make an appointment, go to the bank, put my card in a machine, punch in my PIN to access my financial record, and ask the smart young woman opposite for her prediction of how long the combination of my savings and income will continue to support my modest but comfortable lifestyle. Together we look at the figures and charts on her computer screen, talk for a while and I leave, reasonably reassured that, barring some major unforeseen change in the economy or in my pattern of expenses, the running-out-of-money cloud will remain over the far horizon.
What about the health cloud? Looking into that is considerably more complicated. My doctor, nurse and other health professional friends protest that forecasting a person’s future health is infinitely more difficult than making financial forecasts. Thinking back to the recession of 2008, I am not too sure their protest is well founded. But I do acknowledge one factor that makes predicting anybody’s future health status difficult – the lack of shared data and the strong possibility of there being conflicting and/or incomplete information in the fragments of my health record found here and there with those individuals and institutions that have provided me health services over time; there is no consolidated health record available to me or any other Canadian.
Contrast my appointment at the bank with that with my family health team. There too I take a card out of my wallet but I give it to the receptionist who checks it against something on her screen; there’s no PIN. Once assured that the government will pay for the service, a nurse weighs me, measures my height, puts on the blood pressure machine, and inserts a card from the lanyard around her neck and enters the data into her computer. My family physician is relatively new; the old one who knew me so well is, like me, retired, and probably reflecting on the same things as I am. The doctor inserts her card, looks at the computer screen, and asks me how I’m feeling. I tell her that I am feeling well, but a little worried because I have noticed over the past several months that I have lost a bit of weight and seem to have shrunk (my pants are too long), that I have not been sleeping well, annoyed at having to urinate in the night, and have developed a funny kind of tingling in my fingers and hands; I tell her about my thinking about the health cloud and thus my decision to pay her a visit. Peering at the screen, she comments that my blood pressure is normal and her records show that like most my age I am slowly shrinking. She does a rectal examination and compares the result with what I presume is a description entered by my former physician a couple of years ago. She says my prostate seems unchanged but that she will order a test of my PSA. Examining my hands, she suggests that the tingling is likely the result of some arthritis in my neck, something a course of physiotherapy might be able to alleviate if not fix; in the meantime she will order an X-ray and hold off on referring me to a neurologist.
So now I am off to appointments to have a blood sample drawn and have my neck X-rayed, pulling out my health card again each time. The physiotherapist understandably wants to know why my physician has sent me to her, so I repeat my little story about the shrinkage and tingling hands, information she writes down in the paper chart she created when last I saw her a while ago for another problem. And I know that if I have to see a neurologist or urologist (or any other specialist), I will have to repeat for each of them the story of what brought me there.
Everybody’s financial and health records are both important and highly personal. It strikes me as both bizarre in this day and age and fundamentally not right that while I control access to my financial record with my card and PIN, my health record is scattered hither and yon among the wide variety of professionals and institutions that provide me with services. Their records, access to which they, not I, control, are certainly about me but they are not really mine. This and the fact that they are not consolidated into a single comprehensive record need to be fixed, and soon!
About the Author(s)Duncan G. Sinclair, PhD, DVM, Emeritus Professor of Physiology and Fellow, School of Policy Studies, Queen’s University, 2015 inductee, Canadian Medical Hall of Fame – Health Leadership
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