This morning, my mother received a hand-delivered letter from her General Practitioner (GP), Dr. Jinchao Xie, at the Kemptville Health and Wellness Centre in Kemptville, Ontario. The letter claims that my mother was verbally aggressive and rude with her Physician’s Assistant (PA) during a recent visit to the Centre. A PA is a relatively new medical position, developed in 2007, and has similar accreditation to a Registered Nurse (RN). The PA’s role goes well beyond the RN’s purview, however; PAs interact with, diagnose, and treat patients and relay that information to the GP in a way that minimizes the GP’s involvement.
Traditionally, an RN would visit with a patient in preparation for the GP’s visit. They would take notes and provide an assessment of the patient’s condition for the GP to review, and this would be followed by the GP themselves visiting with the patient. In this approach, the GP’s visit is crucial – this is the expert’s chance to confirm or alter the diagnosis from the RN and prescribe treatment and medication as needed. While I’m not sure how PAs function in other doctors’ offices, this PA visited with my mom, diagnosed her, prescribed her medications and reviewed the visit with my mom’s GP. The real issue, however, is that the GP then signed off on my mom’s treatment without ever visiting with her directly. This was the source of one of my mom’s “aggressive complaints” that the letter was referring to. Most people would agree that a personal visit with a GP ensures the most accurate diagnosis and line of treatment, but apparently this is a new luxury in Canada’s mutating medical system.
The letter went on to describe the Centre’s Zero Tolerance Policy, which apparently excludes a patient’s right to express discontent with how they were treated or mistreated. This is yet another piece of evidence suggesting that Canada’s #1 “woke” arena is our healthcare system. Some core aspects of the woke are their inability to handle criticism, their inflated egos, and their victimhood personas; the letter my mom received from Kemptville exemplifies these attributes. It seems that, for the staff at Kemptville, a patient can be cast as “aggressive” for airing justifiable grievances. In my mother’s case, these were her complaints about being misdiagnosed, being prescribed medications that will conflict with current medical conditions, and being neglected by her GP. Taken together, these suggest that the Kemptville Centre completely lacks responsibility towards their patients, with this incompetence made all the more shocking by their attacks on any patient with the bravery to point out their degenerating standard of care.
The replacement of RNs by PAs parallels a disintegration of the GP role itself. The General Practitioner in Canada used to be a family doctor that would visit with patients at least once a year and spend quality time talking, treating, and getting to know their patients and their families. Although GPs are still considered family doctors, the same doctor rarely treats a patient’s family. In fact, they don’t seem to do any of the work that GPs were known to do, but get paid all the same.
This worsening standard of GP care seems even more unacceptable in light of the grinding inefficiency of the Canadian healthcare system as a whole. Dr. Xie accepted my mother as her patient this year after she had been on a waiting list for a GP for about 5 years. It’s well-known that the healthcare system in Canada has been on a downward spiral for over a decade. Yet the pandemic represents a breaking point, during which the system plummeted in efficacy, efficiency, and care. We now have a system where trained medical professionals consider a phone appointment as good as an in person visit, who pass off their responsibilities to lesser qualified staff and might go through an entire day without examining a single patient. Neglect has become a primary aspect of patient care and misdiagnosis a regular occurrence.
My mother is well-placed to see these flaws, both because of her medical history and her own experience in the field. Aside from the usual health and wellness stuff that happens to the average person during a lifetime, my mom has been suffering from several progressive illnesses and ailments. These have greatly affected her quality of life, causing her to live in daily pain for years. These last two years proved to be her worst yet; she was in and out of the emergency room several times and, on one occasion, almost died. Nothing was Covid-related and she has never tested positive for Covid – a miracle given her compromised immune system.
My mom is also a retired RN. She was a brilliant nurse, and when she retired from the profession to take care of my dying father her superiors begged her to stay because of her dedication to caring for patients. Given my mom’s experience in the field, her health conditions, her lack of proficient medical care, and the years of neglect she experienced, it’s no surprise that she is angry. She is angry at how she has been treated and angry at how she hasn’t been treated. Long gone are the days where a doctor in Canada is trained in assiduity.
At the most basic level, she is angry that at her very first appointment with her new GP she wasn’t even given a chance to meet her doctor in person. Dr. Xie would rather stand around chatting and giggling with her colleagues than have a face-to-face with my mother. This is not just me psychologizing at a distance: I accompanied my mother to her appointment that day, and while in the waiting room I saw Dr. Xie palling around. When my mom was finished with her appointment, I asked her what the doctor was like and she said, “I don’t know, I didn’t meet her.”
Instead of meeting her own doctor, my mom spent the hour talking with her PA. Initially she was only allowed to discuss one “issue,” otherwise known as one symptom. This an efficiency measure introduced several years ago for sick Canadians visiting medical clinics, meant to save time as clinics were experiencing longer and longer wait times. Perversely, these longer clinic wait times were themselves due to the increasing number of Canadians without a GP. Although I can understand the logic, in practice the rule is ridiculous for any real-world patient, let alone for a patient on her first visit with her GP. Most ailments have several symptoms, and the best way to make an accurate diagnosis is to go through the details of those symptoms.
The PA must have felt some sympathy for my mom, as she at least let her talk about her multiple problems. In the end, though, the PA didn’t actually pay any mind. According to my mother, the PA ignored most of the issues and proceeded to discuss what she deemed more important. The first problem that the PA wanted to address was my mom’s concerning ECG results; the PA’s analysis of the ECG results was that there was something very wrong with her valves and that she needed to see a cardiologist as soon as possible.
All well and good, you might think; those do seem like serious issues. Yet as I’ll show, this was yet another serious misstep and example of negligent care. My mom, for her part, desperately wanted to talk about her chronic pain from rheumatoid and osteo arthritis, chronic cough that was increasing in severity and the fistula in her bowel and vaginal wall that causes blood and feces to come out of her vagina. The PA felt that my mom’s ECG and slightly elevated blood sugar was more important that her chronic pain, cough and fistula. The PA proceeded to set up an appointment with technicians to test her heart and prescribed her a short-term medication for her elevated blood sugar levels. My mom’s other, arguably just as serious, issues were just swept aside.
My mom left the office, went home, and ordered her prescription. Unfortunately, her cough was still chronic and getting worse, and my mom was forced to go to the emergency room only a few days later. While she was being treated by an emergency room physician, she decided to ask about her ECG and showed him her results. She had the results on her smartphone as they were sent to her from the Kemptville Health and Wellness Centre…maybe the one way that her visit to the Centre wasn’t a complete loss. The ER doctor looked at the results and flatly stated that the test wasn’t done correctly. He said that it was obvious that the leads had not been attached and that “any medical professional” should have recognized this and ordered another ECG, which he promptly did. And…wait for it…according to the ECG performed in the ER, there is nothing wrong with my mom’s heart and there is nothing to be concerned about in that arena.
Her chronic cough, however, is a different story. The ER doctor diagnosed her with pneumonia, estimating from her chest x-ray that she had had it for approximately 5 weeks. This was more of a disappointment than a shock, as my mom had asked the PA in Kemptville for an x-ray; given her experience as an RN, she already had a sneaking suspicion that she had pneumonia and knew that she needed an x-ray to diagnose it, but she was ignored. The x-ray proved that she did in fact have pneumonia, as well as emphysema. It’s obvious that the PA would have discovered these conditions had she listened to my mom’s complaints. Finally, the PA in Kemptville either neglected to review my mom’s chart or didn’t bother to look up the side-effects of the medication she prescribed for her high blood sugar because the main side effect was diarrhea, which could possibly aggravate and enlarge her fistula which, in turn, could have led to death.
How my mom was treated by the so-called professionals at the Kemptville Health and Wellness Centre is just one example of many negative and neglectful medical experiences that she has had over the last few years. Dr. Xie’s complaint about my mom’s “attitude” is a clear indication that Dr. Xie herself has poor interpersonal skills and has yet to learn about fear, illness, and chronic pain and their psychological side-effects on patients. Her attacks on my mother even while failing to uphold the standard of care show she is incapable of listening to constructive criticism, taking responsibility for her own failings as a medical professional, and passes off her responsibilities to unqualified personnel at the patient’s expense.
Given my experience witnessing my mom’s consistent mistreatment over these last few years, I feel justified in saying that Covid precipitated disastrous changes in the Canadian medical system. Covid completed the system’s transformation into a racket that is no longer about caring for patients, but rather about waiting for them to die while the so-called professionals take home the bacon and the lesser professionals pass out diagnoses like Russian roulette and hand out pills like candy.
I feel shame as a Canadian citizen at what our medical system has mutated into. I moved back to Canada 4 years ago and have been progressively outraged bearing witness to the neglectful and apathetic treatment my mom has experienced. As my mom’s primary caretaker, I have been with her for many of her doctors’ visits, emergency room visits, and near-death experiences. I’ve watched her hobble in pain most days, for years, asking every doctor she can for help. I’ve witnessed how little these doctors, who took a Hippocratic Oath to do no harm, care about her health and wellbeing. The fact that anyone would even question my mom’s frustration and anger after all these years, let alone claim that she is harassing staff, is careless to say the least. But I guess that’s what it means to be a medical professional these days: careless. If you can’t care less go to medical school, you’ll fit right in.