Notes on self-advocacy in healthcare bureaucracy

We recently moved internationally and we needed to maintain the medications we were already taking. My wife was focused on onboarding into the new job that moved us, so I ended up taking up most of the logistics of getting us continuity of medical care. I’ll save much of the rant for another day, but here are some tips on the healthcare system for newcomers to Ontario, Canada.

Start on the paperwork prerequisites immediately

You will likely need an OHIP card, for which you’ll need an Ontario address, an ID, and a valid work permit of duration greater than 6 months (potentially among or instead of other eligibility proofs). As long as you don’t leave Ontario for more than 30 days in the first six months and spend at least half your time physically in Ontario all year round, you qualify immediately for OHIP. There used to be a 3 month waiting period so other immigrants may warn you of it, but this has changed semi-recently. https://www.ontario.ca/page/apply-ohip-and-get-health-card

You will want to get on healthcare waiting lists which you won’t have access to until you have an OHIP card.

Health Care Connect

Once you have the OHIP number on the piece of paper from Service Ontario, even before the card arrives in the mail, you can sign up for Health Care Connect in order to be mailed information on a family doctor. There used to be a dire shortage of family doctors but that has changed recently so now there is only a shortage of the good family doctors. So your Health Care Connect match might not be a good match. Ask probing questions about your specific needs before you sign on with them. Once you sign on with them you may not be permitted to see walk in clinics and even if you are the walk in clinicians will NOT refill anything that they think you should get from your family doctor instead (including continuing your transgender care - even if your family doctor refuses to continue managing your transgender care). You will also not be able to get on waitlists for other clinics if you have a family doctor. The “nurse practitioner clinic” in my area has much better recommendations by local queer people, but over a year’s waitlist.

At one point I called my local Health Care Connect office and left a voicemail, and from that was able to speak to the person who connected us to the family doctors. She was kind but she didn’t have any transgender specific services she was aware of that I hadn’t already found on the web. She said that I should call one local clinic that said on their website that they were closed to new patients. I did. They were still closed to new patients.

Know what you have access to

We probably should’ve used my wife’s employer’s telehealth clinic instead of trying to literally walk in to walk-in clinics, but I didn’t know it existed.

Pull the threads of your network

When someone says no, ask them what/who they would recommend instead. Often they will not know or will recommend something you’ve already tried. (e.g. the local Planned Parenthood equivalent does gender affirming care…. but they have a waitlist of six months to a year and aren’t able to prescribe until the first appointment. I made an appointment in March that was over six months out but will need more medication refills before then and nobody really knows what to do about that.)

The most helpful thing that happened to me in this process was that I posted in a Slack backchannel I was in, and someone there invited me to a regional queer discord, and someone in that discord posted about a Trans Health Fair hosted at the local library for Pride month, so I went to every table at the fair and picked up fliers for every clinic and got a lot of useful information from asking the people at the tables about how to navigate how healthcare works in Canada.

Know the rules and be polite and persistent about your needs

At one point I was turned away from a clinic because of our residency status. They said on the phone that they don’t serve temporary residents. I checked their website, which said that they serve “newcomers to Canada” (they are colocated with a refugee clinic) and had a policy on their website that said their policies must all be on their website. The policy of not serving temporary residents was not on their website so I went in person to ask for a printed copy of the policy. They did not have one, because it isn’t actually a written policy of theirs; they looked into it at my request, and now we have appointments there.

When something starts to go in a way I don’t like, I make a persistent written online record of it in case it’s useful later. I write down what happened - who I spoke to, what they said, what date, if I spoke on the phone then the extension and number I called. If I’m expecting potential trouble I download my online document and email it to myself so there’s a timestamp that isn’t just written by me.

I am not averse to showing emotion but I try to ensure that the emotion I’m showing is constructive to the outcome I wish for – e.g. if I’m angry I try to state clearly what the specific negative impact to me is of the thing that I’m angry about. I try to always thank the person I’ve spoken to at the end of the conversation, for the information they’ve provided if nothing else.