TESTING: PRIVATE VS. PUBLIC?

CANADAHASA single-payer health-care system of which we are justifiably proud. Many other countries with government-run and -funded health care, however, allow some private medicine for those who wish to pay in order to take some of the burden off the public system. Numerous private clinics have sprouted up across the country. These may provide primary care or specialist care, and there are also private imaging clinics and private surgery clinics.

The advantages of these generally are the access to more rapid care, testing and surgery, as well as having access to a physician off-hours, on weekends and holidays. And the doctor has more time to build a therapeutic alliance with their patients.

There are a couple of concerns about these clinics: first, the idea that people are getting better care in private clinics goes against the spirit of fair, equitable, excellent health care for all. While it is not necessarily true that they provide better care, they do provide more personalized attention and service. More care is not necessarily better care.

Another concern being raised with the Choosing Wisely campaign is about overtesting. This national campaign is part of a global movement that aims to assist clinicians and patients to take part in a dialogue about unnecessary tests and treatments, and make smart and effective care choices. Some feel that in an effort to provide more service to paying customers, private clinics will offer screening, testing and treatment that is not evidence-based, such as exercise stress tests for seemingly healthly 30-yearold executives. The problem is that not all screening tests are totally benign. If you look hard enough, you will find something. That something may end up being benign but, in order to determine if it is benign, the patient will have to undergo testing, sometimes testing that is invasive, with serious potential. And sometimes finding an abnormality means a referral back to the public system for specialty care, perhaps putting undue stress on the system – a system in which every Canadian is entitled to the same excellent quality of care, no matter their wealth or status.