 "Photo: RandomHouse.ca")
To be honest with you, I didn't want to do this interview.On the morning of, I had yet again fallen behind on my readings, nearly lost the battle with my body to pass the 36-hour stress marathon I subjected it to, and all the while trying to manage a small fundraiser I set up that was slowly coming to an end. Furthermore the interview, as far as I knew, was a no-go two days prior, as I was informed by a publicist for the Word on the Street Festival that Lam was waxing poetic with our neighbours down south. I was let down and had moved on to another author, who evidently was unavailable as well.
On the day of the initial interview date with Vincent said publicist informs the phone interview was still an option. I reluctantly took it, knowing I had about 30 minutes to come up with some decent questions. Armed with questions that either solicited answers too long for the allotted 20 minutes, or were completely irrelevant to his book, Bloodletting & Miraculous Cures and a vaguely-formed analysis of the novel this newbie journalist was ready to take on the Giller prize winner and biggest Canadian writer.
Since previous interviews all dealt with his process as a writer as well as Margaret Atwood's seminal role in helping getting the book published, I decided to delve deeper into the book's themes and today's pressing health care issues.
The Strand: Michael Moore's recent documentary, Sicko, seems to have brought the issue of private VS public health care in the limelight, both in the States and over here. There are a lot of private clinics popping up in Canada, providing treatments, such as orthopedic surgery, that Canadians usually have to endure long wait times to receive. I know there's one in British Columbia and a few in Quebec. Do you feel that we're edging towards a private health care system? If so, how will it affect the public sector?
Vincent Lam: I think that there is a very small group of physicians who are interested in private activities, and a certain split within the physician community and a minority of physicians who are interested in pursuing these other models of treatment . But I think that it's very telling that these things occurred in particular fields that offer specialized services, and the reason that it has come up is frankly because those are the types of services that can be offered and money can be made, but the health care system has a hole in terms of equality. Sure, doctors can do MRI scans and charge patients a large amount of money for them and make a profit but I'll argue that it's much more difficult to run an inner-city primary care clinic for disadvantaged people and make money. So I think that once the observations just from the type of services being offered which I would make should point out to us that for-profit care is not the best system as a whole. I just don't see someone opening up a for-profit clinic for disadvantaged immigrants in Canada.
TS: That makes sense. With the prospect of making more money, some doctors would eventually want to cross over to the private sector, causing a shortage in the public sector, and that would ultimately affect disadvantaged people, who can't afford the fees private doctors demand.
VL: Yeah, and I think there's a danger when the motivations in doing care change. For example, if someone is running a private CT, MRI or orthopaedic procedure clinic then of course, at least part of their motivation - and I'm not saying all of their motivation if they're responsible health care professionals - but part of their motivations is to get people in to generate profit. This is not necessarily in the best interest of the individual patient who's being cared for, it's one thing to say that we're going to get you the services faster, but the question is: Are these the right services for you?
Imaging is a good example because it's very easy to perform a scan. But if the results holds that scan are indeterminate - as they often are - if the results shows something that's X centimetres big and could represent any of five possibilities and we don't know what those five possibilities are then the information from the results leads to other procedures such as a biopsies - essentially a different set of imaging procedures - and all of these things carry their own complications with them and so it's a common conclusion that we find ourselves in even in our current system that we perform tests for good reason but we end up with results that are difficult to interpret. And end up with results that require additional procedures which may give additional risk of harm to patients. I'm using diagnostic imaging as an example just to illustrate this point but you know the example is prevalent in many types of patients and procedures but
I would rather go to a doctor whose ordering the tests just because they think it's the right test, and I would rather not be going to a doctor and have to think "gee, I know they're ordering it for me, but could they have more reasons to ordering this test? Is there some profit motive to this?"
As a patient I'd rather not think about that and just go to a doctor who's thinking only of my interests. And if that means that I live in a system where sometimes a CT scan is not available quite as quickly but nonetheless is available when it's needed then that to me, as a patient, that is a very worthy trade-off.
TS: I'm pretty aware of the flawed characteristics and bureacracy of the health care system. A minor health problem had me racing to several different doctors who gave varying diagnoses and occasionally directing contrasting opinions. It seems, and I'm not the only one to say this among those I know, that the more opinions you get the more it becomes fragmented and bewildering, because every body is coming from a different perspective. Of course the degree of discrepancy between opinions varies depending on the specific case in question. I'm a lot better off than I used to be, with no physical restrictions whatsoever, but it must be very frustrating for those who have it worse...
is a member of the 
