The following is quite a SCARY snapshot on the state of Health Care in
Canada in respect to Parkinson's
My apologies for the lenght of the article.
I just met a fellow parkie over the age of 65  here in Manitoba at my
last support group  meeting who in 8 years of having PD had yet to see
any neurologist, never mind  an MDS neurologist!! His GP Doctor had
never referred him to one. If you don't get referred here by your
regular doctor you will never get an appointment with any type of
neurologist  directly.

Don 53/5


Parkinson's patients may not be getting best available care     Jul. 31, 2002
Provided by: Canadian Press
Written by: HELEN BRANSWELL

TORONTO (CP) - Many people with Parkinson's disease may not be getting
the optimum care that's available, a new study suggests. Analysis of six
years of Ontario medical data shows that fewer than half of Parkinson's
patients in the province saw a neurologist annually and 41 per cent
never saw a neurologist during that period.

Among older patients - those over age 65 - only 37 per cent saw a
neurologist every year, a figure lead author Dr. Mark Guttman termed
"disastrous." Many appeared to be simply under the care of a family
physician, who would not have the training to give Parkinson's patients
the best possible medical attention.

"I think it's a sad state of affairs," said Mary Jardine, national
executive director of the Parkinson's Society Canada.

Jardine insisted that while the study looked only at Ontario data, the
problem is a national one.

It's also a worrisome one. Parkinson's is a neurological disease that is
hard to diagnose and treat. Symptoms and severity vary from person to
person. Drugs that work for one patient may not work for another.

"It really takes someone who knows about Parkinson's to truly recognize
the symptoms and to be able to treat accordingly," said Jardine.

"That's why the optimum treatment is not going to be given until they
see someone who does specialize in Parkinson's."

But many patients never get to see such a specialist, according to the
study, published in the Canadian Journal of Neurological Sciences.

The authors cross-referenced three Ontario government databases to
identify a pool of 15,304 Parkinsonian patients. (Parkinson's disease is
one of a cluster of conditions that appear similar, especially in the
early stages, and which are treated with the same types of drugs.) They
compared that group's use of medical services to that of a control group
of 30,608 non-Parkinson's patients.

While nearly three-quarters of Parkinson's patients under age 65 saw a
neurologist at least once during the period studied, most older people
with the disease did not.

This left the authors wondering if there was an age bias at work -
whether family doctors, who are responsible for referring patients to
specialists, were simply deciding that for their older Parkinson's
patients, it wasn't worth the wait to see a neurologist.

"It begs the question: What's going on in our system? Why are people not
getting access to care? And is there some kind of bias or
differentiation by age?" Guttman asked in an interview.

About half of the people in the Parkinson's group saw an internal
medicine specialist during the study period. Neurology is a
sub-specialty of internal medicine, so some family doctors may have been
referring their Parkinson's patients in that direction because of long
waiting lists to see neurologists. (The authors couldn't be sure: the
Parkinson's patients may actually have seen the internal medicine
specialists for heart disease or other problems.)

But given that some neurologists lack the specialized training to truly
treat Parkinson's patients effectively, internal medicine specialists
probably aren't the answer, said Guttman, a professor of medicine at the
University of Toronto and a neurologist with a sub-speciality in
Parkinson's disease.

"If you just had a heart attack, would you be satisfied seeing your
family doctor and not seeing a cardiologist?"

While he acknowledged that part of the problem is a shortage of
neurologists and further a shortage of neurologists who specialize in
Parkinson's disease, the statistics show that isn't the only factor at
play.

By following the patients for six years, the researchers could determine
that it wasn't simply a matter of long waits to see neurologists. In
some cases, family doctors "are not even requesting the consultations is
the bottom line," he said.

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