Where Do I Go When I Need HealthCare?

ER, Walk In Clinic, Family Doc, or Urgent Care Centre…Where do I go when I need healthcare?

Why are we all so disgruntled with health care. It doesn’t seem to matter where you live or who you are, how much money you have or don’t have, or what your health care needs are, we all have complaints and critiques!

Waiting for care is a huge complaint. Patients are very upset to have to wait for an emergency doctor to see them, or to wait in fracture clinic to be seen by the orthopod, wait for their surgery, test results, wait for a specialist visit. They are so frustrated that many end up coming to the hospital Emergency Room (ER) because they feel they have no other options.

As Canadians, our high income tax contributions to socialized health care allow us the privilege to walk into any health care facility in the country and ask for care.

Patients with extreme pain, major trauma, who are very ill or near death will always get treated first as Emergency Room resources are prioritized to care for these more critical cases.

Triage System for Emergency Care

In Canada, the CTAS-Five Level Triage system assigns patients who present to the emergency room with a number from 1 to 5.

Level 1 patients require immediate resuscitation and include “conditions that threaten life or limb requiring immediate aggressive interventions” by the ER doc and ER nurse.

Level 2 patients are considered “emergent” and include those with “conditions that are a potential threat to life, limb or function requiring rapid intervention” within 15 minutes.

Level 3 patients, are “urgent” and include those with “conditions that could potentially progress to a serious problem requiring emergency intervention associated with significant discomfort affecting ability to function at work or activities of daily living” and should be seen within 30 minutes.

Level 4 patients have “conditions that relate to age, distress, or potential for deterioration or complications” who should be seen within 1 hour.

Level 5 “non urgent” patients have “conditions that may be acute but non-urgent, as well as conditions which may be part of a chronic problem, with or without evidence of deterioration” and should be seen within 2 hours.

The reality of the situation…

OK, how many people reading this are saying “Ya right, 2 hours? Last time I was in the ER I waited 5 hours!” The reality of the situation is that on the one hand, ER’s are busy and may not see level 5 patients for many hours because of the sheer number of Level 1, 2 and 3 patients already being treated.

In addition, there may be an overwhelming number of Level 5 patients who present to ER for treatment who could better be served at an urgent care centre, walk-in clinic or their family physician’s office.

I am amazed by the number of swollen knees and sore shoulders that come through the emergency department and are referred to fracture clinic with a history of several weeks of symptoms. Back pain patients who have had issues for years and have seen every chronic pain specialist in the city, come to the ER to be seen–why?  When I ask them why they came to the hospital instead of seeing their family physician, specialist or pain doctor, the answer is typically one of the following three:

1. I don’t have a family doctor.
2. None of the other doctors have helped me.
3. I’ve been waiting forever to see a specialist!

I find that many patients do not know their healthcare options.  So they come to the ER to have the hospital “sort it all out”. Here’s another idea: Health Care Connect!

Health Care Connect will find a doctor or nurse practitioner in your community who can assist you with your care needs.”

Remember the next time you take your long-standing complaint, strain/sprain or paper cut to the emergency department for care–you are taking up resources that are designed for people with acute, severe injuries or illnesses that need to be dealt with urgently. See the length of time you have to wait at an Emergency Room nearest you.

So let’s look at this another way…How would you feel if your mom had to wait to be seen for her hip fracture because the emergency doctor was busy seeing a patient with a bruised shin that happened 2 weeks ago? The hip fracture needs care. The bruised shin is taking up valuable ER time and could be better treated at a walk-in clinic or the family doctor’s office.

I don’t blame patients. I believe it is our job to properly educate patients on where to go for care. And our government is doing just that through the Ministry of Health website and campaigns to promote proper utilisation of services. There are urgent care centres and walk in clinics all over the GTA and other Canadian cities that are designed specifically to accept patients with minor injuries, chronic problems, or long-standing issues that are not in acute distress or danger.

 Source: http://www. health.gov.on.ca/en/public/programs/hco/

Unfortunately web-links of information will not be seen by many of the people who look for care –the elderly, lower income labor workers who might not have access to a computer, immigrants with no computer skills or access.
See where the health care services are in your neighborhood!
Source: http://www.hco-on.ca/English/Home-Page

Options for Minor Injury and Illness Care

So, here are the options for the walking wounded, tummy aches, headaches, joint pain patients, strain/sprains, small burns/cuts, and the chronic complaint patients who need help but don’t need to start at the ER:(if you have an issue that should be seen urgently, one of the health professionals at these organizations WILL direct you to the ER if needed)–

Where To Go When You Need HealthCare!

An Urgent Care Centre (UCC) can provide diagnosis and treatment for most injuries and illnesses through emergency trained doctors and other health care professionals.

Go Here If: You have an urgent, but non life- threatening illness or injury like sprains or strains, if you think you need stitches or have a minor burn that needs treatment.

Walk In Clinics or After Hours Clinics offer convenient access to advice, assessment and surgery1treatment for minor illnesses and injuries such as cuts, bruises, minor infections, sprains and skin complaints. Go Here if: You’re in a non-urgent situation; Your family doctor’s office is closed or if you don’t currently have a family doctor; You need care for minor illnesses and injuries including infection and rashes,      fractures, emergency contraception and advice, stomach upsets, cuts and      bruises, and burns and strains.

Go Telehealth!

Telehealth Ontario is a free, confidential telephone service you can call to get health advice or general health information from a Registered Nurse.

That means quick, easy access to a qualified health professional, who can assess your symptoms and help you decide your best first step. Telehealth nurses are extremely well-trained, personably, knowledgeable and multi-talented folks who can help you decide whether to care for yourself, make an appointment with your doctor, go to a clinic, contact a community service or go to a hospital emergency room. They provide a valuable service and I have always been impressed by their excellent advice, care and direction.

TELEHEALTH: 1-866-797-0000 TTY : 1-866-797-0007

Need To Know Where To Go NOW?

And if you are stll uncertain where to go, CLICK HERE! for the Government of Ontario’s “HEALTH SERVICES IN YOUR COMMUNITY” website.

Have I missed anything? So, pop quiz: you sprained your knee last weekend and it is still sore….where do you go? If your answer is “The ER”, then you need to re-read this blog!

Here is a list of Urgent Care Centres in the GTA:

Nexus Health Urgent Care
Toronto, ON M5G Map location is approximate (416) 616-0300

Midland Urgent Care
1153 Ellesmere Rd, Toronto, ON M1P 2X6 (416) 285-4406

North York Urgent Care Centre
4646 Dufferin St, Toronto, ON M3H 5S4 (416) 222-9604

Etobicoke Urgent Care Clinic
25 Woodbine Downs Blvd, Toronto, ON M9W 6N5 (416) 741-2273

Malton Urgent Care
3530 Derry Rd E, Mississauga, ON L4T 4E3 (905) 672-2273

Mississauga Urgent Care Inc
1201 Britannia Rd W, Mississauga, ON L5V 1N2 (905) 826-2273

Markham Stouffville Urgent Care Centre
110 Copper Creek Dr, Markham, ON L6B 0P9 (905) 472-8911

Pickering Urgent Care Med
1450 Kingston Rd, Pickering, ON L1V 1C1 (905) 831-8333

Finally, for more information: For other health questions please call:
ServiceOntario, INFOline at 1-866-532-3161.
Hours of operation : 8:30am – 5:00pm, Monday to Friday.
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282

Is Canada’s HealthCare System Failing Us?

With increased longevity goes an increase in the number of Canadians living with chronic illness and an aging population requiring more care than a younger population with fewer illnesses. So as we age, so do all of Canadians. Fewer of us die, therefore the burden on the healthcare system grows.


We already know that our current healthcare system is not meeting the needs of Canadians. The following key problems prove that there is a decline in the efficiency and productivity of the system–we have issues providing timely access to care. Check these statistics out:


 Twenty percent of Canadians state their time has been wasted due to poorly organized or badly coordinated care.

 12% of Canadians report their specialist was missing basic personal information at the time of their scheduled visit.

 One in four reports that their regular doctor did not seem up to date on the outcomes of a specialist visit based on their own referral.

 In the past two years, 44% of Canadians visited an emergency room and 47% of those visitors say they could have been treated by a primary care physician if one were available.

 Canadians have the highest rate of emergency department use among 11 OECD countries.

 65% of Canadians believe access to weekend and holiday care is somewhat difficult to attain. Canadians who find it “very easy” to contact doctors on holidays and after hours are far more inclined to rate the quality of care they receive as excellent.

 Fewer than 45% of Canadians report being able to get an appointment with a primary care physician the same day their request is filed.

 16% of Canadians have no primary care provider (family doctor).

 46% of Canadians say they would use a walk-in clinic rather than having to wait for a doctor’s appointment.

Healthcare as a whole is Canada’s largest business sector, yet it’s certainly not run like an efficient, effective business. In fact, if you were to rate the healthcare system using business grading methods, it would fail in the number one output for success of any business: customer satisfaction.

“Soaring health care costs, increasing rates of chronic illness and an aging population leave Canada struggling to meet the growing demand for quality health care. This is a time for new and innovative solutions to old problems.”
Source: http://sites.ivey.ca/healthinnovation/files/2011/02/Consumer-Engagement-White-Paper-Final.pdf

Why Do We Wait So Long For Surgery in Ontario?

One of the most frequent complaints I hear from patients relates to waiting times for surgery and diagnostic studies like an MRI. Although we have the ability to expedite patients with serious conditions who need immediate care, the elective waiting list for nonurgent conditions and routine testing can be frustrating for most patients.

In Canada, with our public health care system, there is no way to “jump the line” and receive procedures sooner by paying out of pocket, which we see in two-tiered health systems like the UK or in private systems like s57the US. In Canada, patients are treated equally regardless of socioeconomic status .

The reasons we have to wait for tests or surgery are numerous but primarily related to the availability of resources. Even with MRI units running 24 hours per day, 7 days per week, there are simply not enough of these million dollar machines to offer immediate access to patients requiring testing.

As for surgery, Ontario hospitals are constrained by health care allocation budgets which dictate the number of surgeons, nurses and anesthetists who are able to offer surgical services based on the number of operating room blocks or units that are allotted to a hospital. Most surgeons operate one to two days per week and spend the other 3 to 4 work days in the office seeing patients or in hospital outpatient clinics caring for post operative or injured patients.  Even if we, as surgeons, have extra time to operate in our personal schedules, the hospitals we work for may not have the resources in the budget to offer us more “OR time”–including nursing staff, operating room space and hospital beds to care for post operative patients.surgery

The average wait times for various surgical procedures in Ontario:

Procedure                     Provincial Average   Humber River

Total Knee Replacement        230                             153

Total Hip Replacement           186                             130

Knee Arthroscopy                   148                               84

Shoulder Surgery                    205                               74

Average Wait Times in the Emergency Room
Provincial Average for total time spent waiting to be treated for complex conditions is 5.7 hours, for minor uncomplicated conditions is 2.2 hours. The total time spent in the emergency room for complex conditions is 10.9 hours and for minor conditions is 3.7 hours. Humber River Hospital reports very similar wait times across these same parameters.

The Ontario provincial average wait time for an MRI is 83 days (71 at Humber River). The alternate method of obtaining an MRI which is becoming more popular is to drive to Buffalo, New York and pay between 500 and 1500 for MRI testing.

The unfortunate bottom line is that we have a public funded system with a limited amount of resources and even at more than full capacity, the system is unable to eliminate wait times for non-emergency patients.

Source: http://waittimes.hco-on.ca/