by Dr Ishma Harford

When is the right time to see a doctor? Is it when you first start to feel sick? Or do you wait to see if it gets better on its own?

If money wasn’t a problem and you had a doctor at your fingertips, the answer would perhaps be at the very first sign. But if you don’t, it varies wildly.

Do I have the time? Can I get time off work? Do I have the money? Do I trust that my problem will be resolved? Do I honestly value my health enough to put it first? Or is it just that, culturally, we wait till the last minute?

Rationally, it would seem the best time to seek care is as soon as the need becomes apparent. But in reality, many things cause a delay.

What, then, does the delay cost?

For the individual, with serious or chronic conditions, waiting allows the disease to continue and worsen. Early on, many of these diseases cause little suffering. High blood pressure and diabetes can go years without a single symptom, which is precisely why many wait: the need is there long before it is apparent. But the consequences come later, as a stroke, a foot that will not heal, or kidneys that fail. What the disease eventually takes from your productivity and quality of life far outweighs the suffering you ignore.

As for the healthcare system, it is much more costly and intensive to treat a patient whose disease is advanced. Every bed, hour and dollar spent on late disease is one not spent on early care that could have prevented it.

So, if earlier care benefits everyone, why isn’t it the default?

The question assumes we are all rational consumers of health, which we are not. Healthcare is unlike anything else we buy. Illness arrives unpredictably, and we rarely know enough to judge what we need or whether the care we receive is any good. We are also prone to discounting tomorrow. The lost day’s pay and the bus fare are certain and immediate. The stroke we might avoid is distant and uncertain. Faced with that trade, waiting can feel sensible.

Culturally, as well, especially among men, seeking care may be seen as weak or unmanly, something to put off until it can be put off no longer. Women are more inclined to seek it, often because they are caregivers themselves, and because pregnancy, family planning and children’s clinic visits bring them through the system’s doors regularly. Men frequent these doors much less.

But what about the system? What does it do to help itself?

If it is less resource-intensive to treat a patient earlier in the disease, and the individual is not always rational, shouldn’t the system be rational and reach its destined patients earlier, if only out of self-interest?

A functioning system already knows how its patients behave. The man in his fifties who hasn’t had his blood pressure checked since he left school. The caregiver who brings her mother to every diabetes appointment but has never been checked herself. The tools exist: education, primary care, community medicine. Yet too often, the system sits and waits for you to arrive, sicker and costlier than you needed to be.

And so, the waiting continues on both sides of the counter; where no one wins, everyone pays.

Dr Ishma Harford is a medical doctor and a Commonwealth Scholar who completed a master’s degree in Health Analysis, Policy and Management. The Health Imperative is an educational, non-partisan column about health, the system that delivers it, and all the implications in between.

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