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OPINION
It’s only a flesh wound
(on being ‘unwell’)
By Robert G. Johnson, MD
Queen Elizabeth II recently celebrated her 60th anniversary as American Academy of Orthopaedic Surgeons (AAOS) newsletter
monarch. Her husband, Prince Philip, couldn’t make the ceremony explained how, despite a demand for orthopaedic services that is
because he was, according to one article, “unwell.” A colleague asked “greater than ever,” Canada faces “an unprecedented oversupply of
me what “unwell” meant. It’s not used much in the United States, orthopaedic graduates.” Seems like a contradiction, until you realize
and being Canadian, he figured I could explain. Truth is, I’m not the government controls the jobs. These graduates are doing
sure myself—I guess it’s somewhere between “sick as a dog” and “just locums, working as “contract trauma surgeons,” covering call for
fine.” It’s just one of those endearingly vague British-isms. We might established surgeons or doing multiple fellowships. There’s 10 years
label it a euphemism. Over-thinking it later, I concluded it must be of your life well-spent. Kind of like the situation in England where
a product of our disparate healthcare systems. Let me explain. one remains a “registrar” forever until the “professor” retires or dies.
I interned at a huge downtown Toronto hospital which had exactly
You heard about the Brit who, upon seeing the doctor for his bad four (4) orthopaedic surgeons on staff. Another hospital, with the
hip, was told he would have surgery three years from next Wednes- second-busiest ER in the nation, had three-and-a-half (3.5) full-
day. The patient politely asked the surgeon if it weren’t possible to time orthopods. And remember, in Canada, even back then, bright
make it Thursday because “the plumber’s coming Wednesday.” new graduates couldn’t just get privileges and start working. The
hospital (government) decided when to hire.
The north-south debate over which healthcare system is superior
rages on. There are the usual horror stories from Canada: 3-year In an American hospital, a new physician is welcomed with open
waits for a pain clinic; 1.5 million Ontarians can’t find a family arms; he or she is seen as an asset, a profit center for the hospital.
doctor; the Montrealer who took the provincial government to In Canada, that same doctor is seen as just another piglet at the
court over his agonizing one-year delay for a hip replacement; the teat, another mouth to feed. In the United States, if a hospital is
community in Nova Scotia that held a lottery to mete out doctor falling on hard times, they ramp it up, advertise, go looking for
appointments. In the United States, the problem is rarely access, new business, buy a robot or two … In Canada (this actually hap-
it’s the cost. Few Canadians file bankruptcy over medical bills. pened last year in a medium-sized hospital in a large city in Al-
berta), the afflicted hospital stopped all elective surgery during
BATTLE CONTINUES holidays and the summer. In other words, to save money (keep
We all know the stats: Life expectancy is a little higher in Canada within the budget), they stop spending. Probably the closest we
come to this scenario is the VA system.
(83.1 years vs. 78.1 years), but remember that homicide (which is
unrelated to healthcare) and most often affects younger people, is SUBTLE SEMANTICS
more prevalent in the United States and may explain the five-year So, back to being “unwell.” It’s a word that contains, as its root,
discrepancy; healthcare costs as a percentage of GDP (10.1 percent
Canada vs. 16 percent United States); physicians per 1,000 popu- a term that implies health. It’s a distraction. If you say it fast
lation (2.2 Canada vs. 2.4 United States); infant mortality rate (4.5 enough, or slur a little, it may sound like you’re actually “well.” Like
Canada vs. 6.9 United States). The battle continues with victories getting a C minus rather than a D plus — they’re both crummy
on both sides. grades, but one sounds better. A northern friend once quipped that,
“Canada has the best healthcare system in the world — if you never
As I see it, the real difference between Canada and the United use it.” So why these subtle semantics? They evolved to make peo-
States lies in the philosophical chasm separating socialized from ple feel better about long lines. If you’re “sick as a dog,” you need
private (for-profit) medicine. Government funded healthcare is like medical help now. If you’re merely “unwell,” you can wait.
a kid’s allowance — a fixed amount has to last all week (or all year).
Every expenditure further drains the cistern. A recent article in the Continued on page 34
20 San Antonio Medicine • April 2015
