4. MISTRUST AND NONADHERENCE
Providers are concerned about patient noncompliance and particularly with the frequency with which patients miss appointments. On the flip side, patients report not fully trusting the Canadian health care system. They say they may ignore physician advice when it appears to be uninformed about the patient’s experience of sickness. They are frustrated when they miss appointments and then face fees and long wait times for appointments. Patients commented frequently on how strange the Canadian medical system is compared to what they had been used to in their home land or in the other nations that they had lived in.
Canadian health care providers do not seem to understand that the Canadian system is unusual compared to many of the world’s health care systems. They find that providers fail to appreciate that patients’ assumptions about the kind of care they expect to receive are well founded and based on long experience with multiple other nations.
The long wait times to see a specialist, the lack of access to medicines at a pharmacy without a prescription, the use of a “wait and see” approach rather than prescribing medicines or tests, and the rushed nature of clinic visits – all aspects of a socialized approach to medicine where stewardship of health care resources is a key consideration – were commonly cited as bewildering and unusual aspects of the Canadian health care system.
For providers, then, the experience is that patients don’t know about or don’t care about physicians’ busy schedules, a congested health care system, and their own health care. For patients, the experience is that the health care system is odd in the context of the world’s medical systems, and that doctors don’t know or don’t care enough to provide effective and immediate treatment.
“Sometimes you can come to the hospital, you see that your son is sick, and they just give you the appointment of three months, four months – and for a mom, she knows the thing that this is not right, you know. In the home country if someone sick and you come there so they have to treat you immediately; but here is different, you can come and they give you an appointment maybe two months after, three” [Refugee patient 8: formal and informal support worker and interpreter, man, Swahili speaking]
“Back home you can just go to the pharmacist sometimes and say to him that ‘I have this symptom’ and he will directly like give you a kind of medication that will be good for you; or even going to the doctor who will prescribe something directly you know. But here they prefer not to prescribe a lot of medications, usually they will prefer, like, to leave the person to deal with it, let the body deal with it… So [I] found this problem with the system here” [Refugee patient 3: man, Arabic speaking]
“I mean, those doctors have in their minds that, okay those people are or came from countries that there’s no rules, they do not know anything about health system … the doctor’s being angry with them or saying ‘I’m not going to see you anymore because this is the third time that you cancel, or you even didn’t show up in your appointment’” [Formal and informal support worker 5, interpreter, international student, recent immigrant patient]