QUESTION: My daughter is really sick. She always feels nauseous, has no strength and hasn’t been able to work in months. But her doctor can’t say what has made her ill, despite having sent her for numerous tests and to see several specialists. This is terrifying. Is it time for my daughter to go to a major clinic in the United States to get a proper diagnosis?
ANSWER: Determining what’s wrong with a patient can be challenging partly because so many conditions can have similar symptoms. Belly discomfort, for instance, may result from a wide variety of ailments including ulcers, Crohn’s disease, irritable bowel syndrome – or even intestinal parasites picked up on an overseas vacation.
To further complicate matters, in the early stages of some illnesses, the symptoms may come and go and change over time.
“Making a diagnosis is like solving a mystery,” say Dr. Donald Redelmeier, a staff physician at Sunnybrook Health Sciences Centre and a professor of medicine at the University of Toronto.
General practitioners will usually refer patients to specialists based on their symptoms and medical history. When the symptoms are rather nebulous a patient may see a variety of experts before the condition can be identified.
If it seems that a patient’s medical team has reached an impasse, then it might be worthwhile to request a second opinion from other specialists.
“A fresh set of eyes, with an outside perspective, can lead to a different interpretation,” says Dr. Redelmeier.
“But that is not necessarily a reason to go the United States,” he adds. “Instead, it’s a reason to seek a second opinion in your home province.”
Indeed, U.S. doctors don’t have any unique diagnostic resources at their fingertips – with a few exceptions, such as a wider range of tests for rare genetic conditions. But keep in mind that Canadian doctors can also order many of these tests. Patient samples can be sent to U.S. labs for analysis.
In general, the standards of health care and the level of medical technology are about the same in the U.S. and Canada, says Dr. Frances Wright, a cancer surgeon at Sunnybrook.
In the end, it will likely be a doctor with specific expertise and experience who solves the mystery of your daughter’s illness.
Unfortunately, though, Canadians often wait longer to see specialists compared to patients in some other countries, according to a report published in 2016 by the Canadian Institute for Health Information (CIHI).
This report is based on a survey of adults in Canada as well as 10 other developed countries, including Norway, France, Australia, the United Kingdom and the United States.
The survey found that 56 per cent of Canadians waited a month or more to see a specialist. By contrast, an average of 36 per cent of patients in the other countries waited that amount of time.
“If you’re trying to see someone who is pretty specialized and well known, then you’re going to be dealing with an even longer line-up,” says Tracy Johnson, CIHI’s director of health-system analysis and emerging issues.
Lengthy waits add to patient and family anxiety and fuel the desire to seek care elsewhere – even if it means paying out-of-pocket for medical services.
But before heading to a U.S. clinic, it’s important to consider the urgency of the situation and whether a delay in getting a diagnosis will jeopardize the patient’s long-term health.
“Talk to your own family doctor about your specific situation and if it’s better to be treated in the U.S. than Canada,” advises Dr. Redelmeier. “Your GP knows enough about you and the medical landscape to be able to give you a savvy and impartial assessment.”
He says that the family doctor might be able to provide some reassurance that illnesses needing relatively prompt attention – such as a cancer or a serious infection – have been ruled out.
The stability of the patient is also a critical factor. Many Canadian specialists will see a patient sooner if that individual appears to be deteriorating. On the other hand, stable patients may face considerable waits – adding to their uncertainty and frustration.
Ms. Johnson says patients can sometimes accelerate their access to care by offering to take the appointment of someone who cancels on short notice.
Still, long waits to see specialists are a reality for many Canadians – and that can make treatment outside of Canada seem alluring.
But Dr. Redelmeier points out that patients’ problems are seldom resolved with a single medical appointment. That means they may be shuttling back and forth at considerable expense and inconvenience.
If it turns out that a patient has an extremely rare disease, then it might be appropriate to go to a U.S. clinic with expertise in dealing with that particular condition.
However, for most common chronic illnesses, continuity-of-care is one of the most important factors in determining how well a patient will do. And it’s certainly easier to get dependable follow-up care when your doctor’s office is close to home.