What waiting, prevention, primary care and shared responsibility can teach us about a health system under pressure
Like many people in Canada, I have experienced the peculiar anxiety of waiting for health care.
You notice something in your body. You wait to see your family doctor. Perhaps you are referred to a specialist. Then you wait again. If a test is required, there may be another wait between the appointment, the requisition, the test and finally the interpretation.
During that time, life continues. But somewhere in the background there is an unanswered question about your health.
It is easy, in that situation, to become frustrated with “the health-care system.” I have felt that frustration too. But the more I work in public health, and the more I experience the system as a patient, the more I think that simply asking what is wrong with Canadian health care? does not get us very far.
Perhaps a more useful question is:
What can each part of the system do differently, including those of us who use it?
That does not mean shifting responsibility for system failures onto patients. Long waits, workforce shortages, fragmented information and limited access to primary care are real system problems. But health is also something that develops over years, often long before we reach a hospital or specialist’s office.
Maybe improving health care requires thinking about both sides of that equation.
Health is often a story, not a single moment
One thing I have increasingly come to appreciate is that health rarely exists as an isolated laboratory value, scan or symptom.
It is often a pattern.
A change in energy. A symptom that appears and disappears. Something that began six months ago but only became concerning recently. A family history. A medication started years earlier. Changes in sleep, work, diet, stress, movement or weight. Several small pieces that may mean little individually but become more meaningful when viewed together.
This is one reason continuity in primary care matters.
A regular primary-care provider is not simply someone who treats a sore throat or writes a referral. Ideally, that person becomes the clinician who knows the longer arc of your health: what has changed, what has remained stable, what has already been investigated, what runs in your family and when a pattern deserves closer attention.
CIHI describes a regular health provider as an important point of continuity for preventive care, health advice and chronic-disease management, as well as a gateway to specialist care. It also notes that the relationship and accumulated understanding that come from regular access can contribute to more personalized care. Yet in 2024, only 82.6% of Canadian adults reported access to a regular health provider. Source:CIHI
Even having a provider does not necessarily mean seeing them quickly. Among Canadians who had a regular provider in 2024, only 27% of adults reported being able to see them on the same or next day for a non-urgent problem. Source:CIHI
That gap matters.
Because when the front door of health care becomes difficult to access, people do not stop becoming sick.
They find another door.
The emergency department is designed to answer a different question
Emergency departments are extraordinary places.
When something may be immediately dangerous, the system is designed to identify that risk quickly. Is this a heart attack? A stroke? Sepsis? A serious injury? Is there evidence of organ failure, severe infection, internal bleeding or another condition requiring urgent intervention?
That is an enormously valuable function.
But it is different from longitudinal primary care.
An emergency physician meeting someone for the first time, often in a crowded department, may reasonably focus on the question:
“Is there something dangerous happening right now?”
rather than:
“What is the complete story of this person’s health over the last three years?”
In 2024–25, CIHI recorded 16.1 million emergency-department visits in its national reporting system. Two-thirds were classified as high-acuity visits requiring urgent or rapid evaluation. Half of patients waited just under two hours for an initial physician assessment, while one in ten waited more than five hours. The most seriously ill patients were appropriately seen sooner. Source:CIHI
At the same time, CIHI found that 15% of emergency-department visits between April 2023 and March 2024 involved conditions that potentially could have been managed in primary care. Importantly, this should not be interpreted as people “misusing” emergency departments. People without primary-care access, young children and people living in rural or remote communities were among those more likely to use emergency care for these conditions. Source:CIHI
That is less a story about irresponsible patients than about what happens when one part of a health system becomes difficult to reach.
A doctor’s comment made me think differently about “root causes”
During one recent medical conversation, I asked a doctor why something might be happening.
He was busy, clearly carrying a heavy workload, and responded that the more useful question was not necessarily why, but how: how do we treat it?
I kept thinking about that exchange.
My first reaction was that perhaps modern medicine is designed primarily to manage disease rather than understand its root causes.
But that conclusion is too simple.
Modern medicine spends enormous effort investigating causes. Infectious diseases, genetic disorders, environmental exposures, nutritional deficiencies, autoimmune disease, cardiovascular risk and many cancers are studied precisely because understanding causation can change prevention and treatment.
What I think that conversation revealed instead was something about the clinical encounter.
A physician working within a limited appointment may have to prioritize:
- What needs treatment now?
- What dangerous possibilities need to be ruled out?
- What investigation is clinically justified?
- What should happen next?
- That is not the same question a researcher might ask, or the question someone living with unexplained symptoms may desperately want answered.
Both questions matter.
Why is this happening?
and
What can we safely do about it now?
One of the challenges of health care is creating enough continuity for both questions to eventually be addressed.
The waiting is real, and so is the pressure behind it
Patient anxiety about waiting should not be dismissed.
CIHI’s national analysis found that diagnostic-imaging waits remained longer in 2024 than before the pandemic. Compared with 2019, the median wait increased by 15 days for MRI and three days for CT imaging. The same report describes growing demand, population aging, workforce pressures and increasing complexity as factors health systems are managing. Source:CIHI
Behind those numbers are people waiting to know what happens next.
But there are also people on the other side of the appointment.
Doctors, nurses, pharmacists, technologists, environmental-services staff, allied-health professionals, administrative teams and many others are working inside the same strained system that patients experience from outside.
CIHI has documented continuing overtime and staffing pressures in Canadian hospitals, noting that sustained overtime can contribute to fatigue, burnout and disruptions in care. Source:CIHI
In the Canadian Medical Association’s 2025 survey of roughly 3,300 physicians and medical learners, 46% reported high levels of burnout. Source: Canadian Medical Association
So when we talk about a stressed health-care system, there are two human experiences happening simultaneously:
- the patient who is waiting, and
- the health-care worker trying to keep up.
Neither benefits from blaming the other.
Prevention is not a guarantee. It is an opportunity.
This is where I think public health enters the conversation.
Health care is extraordinarily good at rescuing people when things go wrong. But no health system has unlimited diagnostic machines, hospital beds, physicians, nurses, operating rooms or specialist appointments.
That makes prevention important not only for individual health but also for the sustainability of health systems.
Prevention does not mean believing that every illness could have been avoided.
It could not.
Age, genetics, environmental exposures, socioeconomic circumstances and simple biological chance matter. PHAC explicitly distinguishes modifiable behavioural risks from factors people cannot change and notes that social and economic conditions strongly shape people’s ability to make healthier choices.
There should therefore be no moral judgement attached to becoming ill.
But there is still a meaningful space in which many of us can act earlier.
We can know our family history. We can participate in recommended screening. We can pay attention to changes rather than waiting indefinitely. We can manage blood pressure, cholesterol or blood glucose when these become concerns. We can use vaccines and evidence-based preventive services. We can reduce tobacco exposure, remain physically active where possible, eat reasonably well, protect sleep and seek help for health problems before they become crises.
Cancer screening illustrates the principle well. Screening cannot prevent every cancer and is not appropriate for everyone at every age, but appropriate screening can detect some cancers or precancerous changes earlier, when treatment may be more successful.
This is not about turning patients into doctors.
It is about becoming more active participants in our own health.
Shared responsibility does not mean equal responsibility
I think this distinction is important.
Governments have responsibilities.
Health systems have responsibilities.
Healthcare organisations have responsibilities.
Clinicians have responsibilities.
Communities have responsibilities.
And individuals have some responsibility too.
But those responsibilities are not equal and they are not interchangeable.
Someone cannot exercise their way out of a six-month specialist wait.
A person cannot obtain timely primary care if there is no provider available.
Someone working two jobs, living with food insecurity or caring for family members may have far fewer realistic opportunities to practise the version of “healthy living” that wellness culture often promotes.
At the same time, a publicly funded health system works best when people who are able to participate in prevention, screening and ongoing health management are supported to do so.
For me, being proactive does not mean obsessively monitoring every sensation or ordering unnecessary tests. More testing is not always better medicine.
It means developing a sensible relationship with our health.
That might include:
- building continuity with a primary-care provider when access is available;
- keeping a simple record of important diagnoses, medicines, investigations and family history;
- following evidence-based vaccination and screening recommendations appropriate to age and risk;
- seeking medical advice when persistent or significant changes occur rather than normalizing them indefinitely; and
- working on modifiable health risks where circumstances allow, while recognizing that prevention reduces risk rather than eliminating it.
None of these actions will solve Canada’s capacity problems.
But collectively, stronger prevention and stronger primary care can help shift some health care upstream.
We should also make it easier to be a proactive patient
There is an obvious limitation to telling people to “seek care earlier” in a system where accessing that care can itself be difficult.
That is why individual prevention has to be matched by system design.
If we want people to use primary care instead of emergency departments, primary care needs to be available.
If we want people to participate in screening, screening pathways need to be understandable and accessible.
If we want patients to track their health over time, their health information should not be scattered across systems that cannot communicate with one another.
And if we want clinicians to spend more time listening to the story of a patient’s health, we have to reduce the amount of their day consumed by administrative work.
This is one area where technology may genuinely help.
AI could give us something surprisingly valuable: time
The most useful contribution of artificial intelligence to health care may not be replacing doctors.
It may be giving some of their time back.
AI tools are already being explored for clinical documentation, summarizing encounters, administrative tasks, information retrieval and decision support. In the CMA’s 2025 physician survey, 59% of doctors reported that AI had already reduced the amount of time they spent on administrative work. Source:CMA
Imagine what becomes possible if a family physician spends less time typing and more time listening.
Or if a patient’s longitudinal record can be summarized without losing the clinician’s oversight.
Or if health systems can identify patterns in demand earlier and allocate resources more intelligently.
But health care is not an ordinary technology environment.
AI can make errors. Data can contain bias. Health information is deeply private. Clinical responsibility cannot simply be handed to an algorithm.
Health Canada now has specific guidance for machine-learning-enabled medical devices and emphasizes transparency, safety, effectiveness and communication of risks to patients and providers.
The goal should therefore not be AI instead of clinicians.
It should be technology removing unnecessary friction so clinicians and patients have more capacity for the parts of medicine that require human judgement, context and trust.
Maybe the question really is “how”
Everyone seems to have an opinion about Canadian health care.
We talk about wait times.
We talk about family doctors.
We talk about emergency rooms.
We talk about how much governments should spend.
All of those conversations matter.
But I increasingly find myself returning to the doctor’s response that initially bothered me:
Not only why. How?
- How do we preserve universal access while improving timely access?
- How do we strengthen primary care so emergency departments are not carrying problems they were never designed to manage?
- How do we protect healthcare workers from an unsustainable workload?
- How do we use technology without losing the human relationship at the centre of medicine?
- How do we make prevention easier?
- And how do we, as members of the public, become partners in our health without pretending that health is entirely within individual control?
- Perhaps the answer is not one dramatic reform.
Perhaps it is a series of improvements occurring at the same time: better primary care, stronger prevention, smarter use of technology, better-connected health information, healthier workplaces for healthcare workers, and a public that is supported to engage earlier with its own health.
A publicly funded health system is ultimately a shared resource.
Protecting it is not solely the responsibility of patients, clinicians or governments.
It is a collective project.
And maybe that is where a more constructive conversation about Canadian health care can begin.
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