opinion: we can bring patients out of the dark with more transparency and control
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when a patient knows that a public hip replacement will take 16 months, but quality care in another province can happen within a few weeks for $24,000, they gain something they didn't have before: agency.
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in my five years practicing as a public family doctor, i’ve come to understand the pain of uncertainty.
as doctors, we have tools for pain: medications, physiotherapy, lifestyle changes. but for the unknown—for the opacity of the canadian healthcare system—we have nothing to prescribe.
every day, i see patients needing surgery enter the public system looking for help, only to find themselves wandering a maze with the lights turned off.
the journey begins a month or two before i even see them when they book an appointment with me. then they’ll need diagnostic imaging: add another two to 12 months.
at this point, i have a better understanding whether surgery is needed, but we have to exhaust non-operative options first. plus four to 12 months.
if the patient can’t find lasting relief with a physio or lifestyle changes, they make another appointment with me, and i make the referral. once accepted, we receive a confirmation with an estimated wait time and note: “please do not contact us for status updates, as we do not provide them.”
this is the waiting void. the longest, darkest part of the maze with no communication, no updates, no way to track their position in the queue. i’ve seen estimates for a few months, i’ve seen estimates for a few years.
on long waits, the patient’s world shrinks. the pain gets worse. they stop working. they go on disability. and because the system is a black box, they come back to me, their only lifeline, asking, “doc, have you heard anything? do you know how long it will be?”
i have to look them in the eye and say, “i don’t know.”
that is a terrible feeling for a doctor. we are trained to solve problems, but in this administrative purgatory, we are often as helpless as the patient.
inevitably, the desperation leads to the next set of questions: “what are my options? should i go across the border to buffalo? my friend had surgery done in mexico. what about private clinics in quebec? how much would it cost to get this done so i can go back to work?”
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this is where i hit a wall. like all canadian physicians, i was trained in the public system, for the public system. i didn’t know which private surgeons were reputable, what the costs were, how inter-provincial regulations worked.
my patients were trying to make life-altering financial and medical decisions based on reddit threads and hearsay because the medical establishment—myself included—couldn’t give them a map.
i decided i couldn’t stay in the dark anymore. i learned the regulatory landscape, compiled costs, and found surgical providers so i could confidently answer my patients’ questions.
last summer, i took what i learned and built a free, online resource for patients. not because i want to dismantle the public system—i’m a public family doctor and i believe in public healthcare—but because transparency is a form of care.
when a patient knows that a public hip replacement will take 16 months, but quality care in another province can happen within a few weeks for $24,000, they gain something they didn’t have before: agency.
many patients, when presented with the information, will still choose to wait for the public option. but simply knowing the landscape changes their psychology. it turns a helpless wait in the dark into an informed choice. for others, the financial tradeoff makes sense. if someone on a multi-year wait list for a knee replacement can’t continue working, then getting back on their feet sooner and managing a payment plan might be the only way to save their livelihood or prevent years of delayed retirement.
we need to stop pretending that private options and alternative pathways don’t exist, or that keeping patients ignorant of them makes the public system stronger. it doesn’t. it just leaves vulnerable people alone in a complex system with no light to guide them.
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if we want to support patients, we have to respect them enough to tell them the truth about the entire landscape—public waits, private costs, and everything in between. we have to turn the lights on.
dr. sean haffey is a public family physician & founder of surgency, a free resource for navigating private surgical pathways in canada.
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