The next time I need healthcare help, I won’t bother wasting my time on the phone.
My three-year-old son Emile had surgery a little over a week ago and, as I wrote in my previous column, the recovery from the removal of his adenoids and tonsils was far worse than the operation itself. But since I filed that story last Friday morning, it got considerably worse afterwards—in fact, almost immediately.
If this one reads less panicky than last week, it’s because though he’s not yet back at daycare, Emile is finally acting—and, more importantly, eating—like himself again following a frightening week during which he was regularly shrieking in agony or lying in stupor and lost 4 of his 30 pounds of body weight.
It’s been easily our most intense and scary week of parenting, with this past Monday and Tuesday being the worst, as his pain spiked well above his normal pain threshold, which is so high that he doesn’t blink when getting a vaccination shot.
But last Friday, my main concern was that he hadn’t eaten since the previous Tuesday, and had only just started drinking water in any real amount. In the early afternoon, just before nap, he started clutching his stomach and saying it hurt. I assumed it was because it was so empty, when all of a sudden he threw up all over me and his Homer Simpson stuffie. It was just water, with a few flecks of food, but I’d never actually seen Emile vomit before. I called my wife Carrie, and since his surgeon’s office voicemail said he’d respond in 2-3 days, she suggested I call Telehealth Ontario and ask their advice.
Except, as it turns out, they don’t really provide advice, at least not for any pressing issue. They just recommend you go to the emergency room, which, ironically, is a place Telehealth is supposed to make less crowded, not more.
After answering a half-hour’s worth of all-patient checklist questions from the registered nurse on the phone—including, absurdly, if he’d had any alcoholic beverages today—and waking Emile up repeatedly from his nap to answer questions and walk across the room, I was advised to take him to emergency.
My initial questions—about whether vomiting might be a side-effect of morphine or drinking water too fast, or if throwing up one time was something to be concerned about several days after the operation as we’d been told it might happen in the short-term—went unanswered.
She then asked if I was going to take him to emergency, to which I replied not yet. After all, spending six hours in the ER hardly seemed like the best thing for a three-year-old recovering from surgery, especially if there was no real concern.
Instead, we went to our pediatrician and she let us in even after they’d stopped seeing patients. She was not concerned by him throwing up once, or even by his lack of food so long as we kept him hydrated, but checked him out otherwise, reassured us that he was okay and then gave us a script for antibiotics in case a strep throat test came back positive over the weekend. (It did not.)
She also expressed exasperation when I explained what Telehealth told us, informing me that it was a private company (which I was unaware of) and that it seems they always tell people to go to emerg for fear of being sued. In fact, she said that ER visits have increased, rather than decreased, since Telehealth came online.
A few days later, her nurse, calling into check on how E was doing, further elaborated, noting that nurses are not allowed to diagnose patients, which is a doctor’s job. So the registered nurses manning Telehealth’s phone lines are simply not licensed to do much more than that for fear of being liable. “At the end of the day,” she said, “they just send everyone to emerg.”
I should add that I have a very positive Telehealth story, too. When Emile had a fever-induced febrile seizure in my arms at 18 months, my wife was out of town and I was actually on the phone with Telehealth asking advice because his temperature had spiked during his nap. When he started convulsing and I dropped the phone, the nurse called 911 and then called me back, talking me down while I waited for the paramedics to arrive. I could not have been more grateful.
But that was an extreme case where an emergency visit was obviously vital. If they’re telling everyone to do the same because they can’t diagnose or really provide any useful advice without seeing the patient in person—or, y’know, being a doctor—how is it even helpful? And does the fact that it’s privately run decrease its effectiveness due to fear of lawsuits?
Certainly, it’s not easy to find out that Telehealth is run by Sykes Assistance Services Corporation, which also provides roadside assistance, identity theft services and call centre outsourcing. In fact, Ontario’s healthcare site says it simply “is provided to residents of Ontario by the Government of Ontario and is free to all users.”
Ironically, the two press releases I dug up about Telehealth Ontario both boasted that service can help “Ontarians can save time, [and] trips to hospital emergency department.” Yet, at least anecdotally, that appears to not be the case.
The idea behind Telehealth is a great one—free, confidential 24-hour access to a healthcare professional who can provide more reliable advice than a Google search. Though the handful of other times my wife called about specific health concerns she was told to go to emergency, when she called last week to ask about giving Advil instead of the recommended Tylenol post-op—without mentioning Emile, thereby kicking off the checklist questions—she was connected to a pharmacist who explained why she should not. (It could cause internal bleeding and upset an empty stomach.)
But as ER doctor and blogger Dr. Alan Drummond put it earlier this year, generally the Telehealth system seems to be “fundamentally broken, ineffective and expensive.” (Oh yeah, it also costs taxpayers $39 a call, a figure that’s almost double that of other provinces.)
“Most emergency physicians that I know perceive no value to Telehealth lines for there seems to be a steady stream of patients referred to the ER with non-urgent problems that could have been addressed with a dose of common sense,” he wrote. “The more cynical of us perceive that Telehealth programs are yet one more way that government can pretend to be doing something about health care without actually doing anything of significance.”
This is a particular issue for new parents, who need something of significance because we simply don’t know what to expect from our children’s health issues and we’re not getting the help we need from Telehealth.
Perhaps there needs to be specific phone lines for pediatric help, or perhaps they could use Skype to give the nurses more confidence in their assessments. All I know is that bringing a sick-but-not-in-danger kid into emergency is the last thing the hospital needs, and the next time I need healthcare help, I won’t bother wasting my time on the phone.