Saturday , July 24 2021

The shortage of health care providers in the NB forces students to pay out of pocket to see the gynecologist

Mhairi Agnew, 20, is a smart, articulate college student who has suffered from recurrent abdominal pain for more than half of her life.

When she first complained when she was a child, her longtime family doctor suspected food allergies, but when tests ruled it out, she blamed the stress.

“That was always his answer … you’re too stressed. But no matter how much advice you get or how many relaxing things you try to do, the pain never goes away.”

Agnew’s struggle to find a doctor who would listen to her eventually led her to a private women’s clinic where she paid out of pocket for gynecological care. She is part of a growing number of women who have given up receiving timely care in New Brunswick’s public health system.

When puberty began, Agnew said, the pain got worse, but her family doctor would not do any gynecological exams or refer her to any other doctor or specialist.

“He refuses to touch me,” Agnew said of his doctor. “I asked him,‘ How to push here. It’s hard or it hurts here “and he won’t touch me. I asked him to give me an exam if he doesn’t want to send me to a specialist. He refuses.”

Mhàiri Agnew began experiencing abdominal pain in primary school, but after ruling out food allergies her family doctor blamed the stress and anxiety. (Submitted by Mary Agnew)

You don’t know why your family doctor doesn’t feel comfortable doing physical exams. He has tried to find another GP, but with a shortage in the province, it is simply not an option.

“The waiting list is for five years,” Agnew said. So I should rely on ancillary clinics if I lose my family doctor and I also have other problems I need prescriptions … it’s easier to keep him up for these problems, and then I’ve been trying to find a way to treat my other problems that he will not try “.

Jacqueline Gahagan, a professor of health promotion at Dalhousie University and director of the gender studies unit, is not surprised by Agnew’s experience.

“Women are still struggling to get the kind of care they need for patient-centered, women-centered and competent care. And that’s a problem,” she said.

“If someone doesn’t feel comfortable offering an internal exam, they probably shouldn’t have patients in their care who have an intact uterus and ovaries.”

Women face structural and attitudinal barriers to health care

Dr. Jeff Steeves, president of the New Brunswick Medical Society, said family physicians have the right to refuse to perform any kind of care they deem morally or religiously unpleasant, even though “the vast majority of physicians family would be comfortable and able to provide that care, ”he said.

“The physician’s moral belief should not hinder the care a patient receives … that the physician is not required to provide it, but is required to refer the patient to a resource so that he or she can obtain that care.”

Dr. Jeff Steeves, president of the New Brunswick Medical Society, cannot comment on specific cases, but said family doctors are expected to provide comprehensive care and if not, they can refer patients to someone else. . (NB Medical Society)

Agnew said that in her case, her family doctor refused to refer her to another doctor.

He tried to visit a mobile clinic, but doctors were told they were not treating abdominal pain. She was taken to an emergency room at the hospital, where she waited hours before leaving without ever seeing a doctor.

Gahaghan said the mix of attitudinal and structural barriers Agnew has faced in the health care system is not uncommon and can often lead to what is known as “abandoned health care”.

“In other words, the interaction with the health care provider is so unsafe and so insecure that people … will lose or give up trying to find other ways to treat it in a healthcare system that just doesn’t listen to them, doesn’t fa I don’t see them and I don’t know how to deal with them “.

Gahaghan said this, combined with the shortage of GPs, creates a “perfect storm” for people to remain untreated and undiagnosed for years.

“It’s all in your head, I’m sorry”

Agnew believes he tried everything, apart from filing a formal complaint against his doctor because he fears he may leave her as a patient and it is up to him to receive prescriptions.

At one point, she even tried to take her fiancé with her to appointments in the hopes that her doctor would be more likely to take her concerns seriously if they came from another man.

Agnew, here with her fiancé, has tried to take him to medical appointments in hopes that his doctor will hear his concerns if they were articulated by another man. (Vanessa Blanch / CBC)

Gahaghan suggested people turn the stage upside down and imagined a male patient with a history of prostate cancer visiting a female doctor who refuses to examine him to appreciate Agnew’s outrageous story.

“For a doctor to tell a male patient,‘ I’m sorry, I don’t feel comfortable putting my finger in my ass or rolling my testicles in my hand, even though I’ve been trained on how to do it … you’ll have to to go see someone else. And no, I won’t tell you a proctologist; it’s all in your head … I’m sorry. “

He said if that happened, he would be “on the front page of every newspaper” and not leave so quietly.

“And this 20-year-old has to take her boyfriend to meet with a male doctor to say again,‘ No, it’s not all in your head. I live with her. I see. I know he is in pain. please help us “”

Jacqueline Gahagan says the structural and attitudinal barriers women face in trying to access medical care lead to worse health outcomes in the long run. (Submitted by Jacqueline Gahagan)

As waiting lists grow, so does the demand for private care

In a last-ditch effort to get someone to listen to his symptoms and help him find the cause of his pain, Agnew did what most people do: he wrote his request for help in the search bar. Google.

She discovered a new private women’s health care clinic in Moncton, where she was able to book an appointment within three days with a gynecologist for a cost of $ 180.

Price was another barrier for Agnew, who lost his part-time job when the pandemic began, but decided it was his only option.

After a consultation, Dr. Karen Desrosiers sent her for a blood test and an ultrasound.

“It was instantaneous, like,‘ Okay, I think you could have endometriosis or polycystic ovary syndrome just because of the sounds of your symptoms, ’” Agnew said.

She has since received test results pointing to polycystic ovary and septal uterus disease, which is a congenital defect that could explain the pain she experienced when she was little.

After years of seeking consultation with a specialist, Agnew finally paid $ 180 to see a private gynecologist in Moncton and was referred for an ultrasound, which pointed to polycystic ovary syndrome and septal uterus as the cause. of their symptoms. (Submitted by Mhairi Agnew)

“It’s annoying that there has to be a private clinic and you have to pay for it and it can’t just be public,” he said. “But at the same time … in the end, it’s honestly worth it.”

Gynecological problems are still “taboo”

Katie Kelly is the co-owner of the private clinic, ReConnect Health Center, where Agnew is receiving care.

Since the center opened last summer, the demand for women has steadily increased, according to Kelly, who is a pelvic floor physiotherapist. Your next available appointment will not be until mid-July.

Kelly said in New Brunswick, unless it’s an emergency, women in need of gynecological care can wait more than a year.

Katie Kelly, co-owner of a new private women’s health clinic in Moncton, said services for women are in high demand and that New Brunswick’s public health system cannot always meet that demand in a timely manner. (Vanessa Blanch / CBC)

“Things like urinary incontinence interfere with their ability to play with their children or a prolapse of pelvic organs prevents them from running again because that’s what they wanted to do,” Kelly said of patients she sees suffering from quality of life.

“Or women have questions about menopause and they don’t have someone who can give them hands-on exercises that can help you with those conditions.”

Kelly said women’s health issues are “taboo” and do not receive the care or funding they need.

“We are trying to fill a gap for women who may not have access to a GP, who want a woman to do their exam, who want to access a gynecologist a little faster than the public system can provide.”

Call for review of women’s health services

Dr. Jeff Steeves agrees that there are deficits for women who need non-urgent care.

“There’s access to almost everyone’s attention,” he said. “So we need to improve this to get rid of the word ‘almost’.”

The New Brunswick Medical Society began calling for a review of “women’s reproductive health and services,” including gynecological care, family planning, and fertility, “a few years ago,” and has also raised it. with the current Blaine Higgs government.

The New Brunswick Medical Society calls on the Blaine Higgs government to conduct a comprehensive review of women’s health care, which includes gynecological services, family planning and fertility. President Jeff Steeves says emergency care is available, but non-urgent care needs to be improved. (Shutterstock / BlurryMe)

Kelly hopes more women will talk about their experiences and that New Brunswick will finally be able to “move the needle” when it comes to health services.

“Gynecological problems … are embarrassing. Maybe we make jokes with our best friends who laugh when we pee. We don’t discuss having painful sex. We’re not talking about birth traumas.

“So if we don’t report these issues, we can’t expect funding to help them.”

Gahagan believes that the ultimate impact of the structural and attitudinal barriers Agnew has faced is that women’s health as a group will worsen over time.

“These microaggressions and this kind of sexism and misogyny that is experienced in trying to meet your health needs are so incredibly painful and time consuming. You just have to say, ‘Screw it on.’ It can’t bother me, ”he said. .

“And he shows up in the emergency room later with a heart attack or some kind of cancer that could have been easily detected and treated.”

Agnew has come to the conclusion that until something changes, to get the help he needs in New Brunswick, “then yes, I have to pay.”

On Wednesday, the second part of this story will explore what led Dr. Karen Desrosiers to give up her full-time practice as an obstetrician-gynecologist and how New Brunswick doctors are allowed to charge patients and provide private care.

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