Ghislain & Marie David de Lossy/cultura/Corbis

Ewan Affleck, medical director of Yellowknife’s health and social services, describes it as “a huge issue that is largely unaddressed” in Canadian health care, in many ways “a hidden secret.” He’s seen it in the places he’s worked as a family doctor, from urban clinics in Montreal to hospitals and nursing stations in the Inuit villages of northern Quebec, and now in the primary-care centres of the sprawling Northwest Territories.

The secret is “unwarranted variation”: the stark and sometimes alarming regional differences in the health care patients receive, determined by things like the capacity of the local system on a given day or the preference of the doctor instead of actual need or even medical evidence. Canadians participate in a lottery every time they have a brush with the health care system; it can mean the difference between getting screened for prostate cancer or not, or whether or not you have your uterus removed. Though medicine is now supposed to be evidence-based, the simple fact of where you get care, and from whom, can influence your treatment as much as the latest science.

This arbitrariness disturbed Affleck, who has the lean frame and single-minded focus of the ultra-marathon runner that he is. “This is a national issue,” he says. “Who drives the Canadian health system? The day-to-day drivers are mostly doctors and other health professionals.” Continue…