Pathology Picked up in Clinical Trials

In the course of my daily appointments with study volunteers, I am often surprised to learn how many people are not receiving the quality of care and treatment that they should be. I am also shocked at the serious disorders we turn up in people who are completely oblivious to their presence.

It is becoming commonplace for people not to have a regular family physician. For most, this is not a matter of choice but a consequence of a badly mismanaged health care system which has resulted in a serious shortage of trained personnel at many levels.

There are also many people who avoid going to the doctor as much as possible and go only to have a specific problem dealt with but don't receive the more general, recommended physical examinations.

Many disorders, such as hypertension or elevated cholesterol, have no noticeable symptoms and can only be discovered if diagnostic testing is done. Still other conditions can be confused for something they are not such as hyperthyroidism masquerading as an anxiety disorder or hypothyroidism as depression.

Within the psychiatric field, one of the biggest factors contributing to this problem is a lack of information or misinformation about options. Frequently, I see individuals who have experienced conditions such as depression for years and even understand that they have this condition, but have never sought psychiatric treatment because they believe they cannot afford the treatment. When I inform them that psychiatric services are covered as part of the provincial health insurance, they are usually surprised. Quite often, these individuals do not have a regular physician and are unaware of their options. Still more people don't understand the difference between psychiatrists and psychologists - psychiatrists are medically trained doctors who can prescribe medication.

Understanding the distinctions between conditions such as depression, anxiety and bipolar disorder can also make a big difference. Many times a person feels depressed, but doesn't realize that he or she actually has bipolar disorder, or an anxiety disorder which require significantly different treatment regimens.

We are bombarded daily by news about wait lists for surgery but we hear little about wait lists for psychiatric services. In most communities there is a 6-12 month waitlist for a psychiatric consultation if there is a psychiatrist available at all. That isn't much help to someone who is acutely depressed or off work for psychological reasons. Family doctors often simply don't refer because they are so frustrated and don't want to spend the time looking for someone who can see their patient promptly.

When we see these individuals, it is because they have volunteered for a clinical trial and have not required a referral from any other physician. There is no wait list and appointments are scheduled at the convenience of the patient. This is much like the private care that is being promised at private pay clinics in Vancouver for an annual fee. However, unlike the private clinics, our services are provided free of charge as all fees are covered by the study sponsor.

In the past month we have had two volunteers with undiagnosed diabetes, two with hypothyroidism, several with cardiac arrhythmias, one with hepatitis, and have also discovered polycystic ovarian disease and restless legs syndrome. These were all unexpected and had nothing to do with the disorder for which they were seeking treatment, but definitely needed to be dealt with by a doctor immediately.

Unfortunately, I think the situation in Canada is only going to get worse in the coming few years. Increasing numbers of people will be without a regular physician and waiting lists will likely get longer. The government has not yet grasped the seriousness of the situation and when it does, the solutions will take years to put in place at a time when most of the current health care professionals are nearing the ends of their careers.


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