She wasn't told she has cancer. She says that could have been a 'death sentence'

Five weeks after Cathy Croskery's right breast was biopsied for suspected cancer, she still hadn't received the results.

She figured that was good news. It wasn't.

The 58-year-old mother and wife eventually discovered she has invasive carcinoma, but had to track down that diagnosis herself.

Croskery doesn't have a family doctor. She said that led to barriers getting into the system and a breakdown in communication in receiving test results that would ultimately land her in an operating room for a lumpectomy days after finally receiving them.

"If I had kept going, 'No news is good news,' where would I be?" said Croskery, who lives in Middle Sackville, N.S., but is originally from Burlington, Ont. 

"That's a death sentence for a lot of people."

Experts say Croskery's case underscores that the province still has work to do to ensure better co-ordination within the health-care system, with the well-being of the patients it serves at stake.

Meanwhile, Nova Scotia Health says it is making progress on connecting the roughly 95,000 Nova Scotians on its need-a-family-practice registry with primary care providers, but recognizes challenges remain for those who still don't have someone to turn to when their health deteriorates.

Croskery said she started to notice new pressure in her right breast in early 2023. She had previously had a sebaceous cyst in the same breast in 2018, so she figured it was acting up.

When the pain worsened and she felt a lump in September 2024, she knew it was time to have it checked.

Without a family doctor, she wasn't sure where to turn. She called the Nova Scotia Breast Screening Program, but they told her the program is for screening only. Since she had felt a lump, she'd need a referral from a doctor for a diagnostic mammogram.

She tried to get an appointment at a walk-in clinic, arriving 30 minutes early two days in a row, but she was turned away due to capacity issues each time.

Croskery then tried the province's VirtualCareNS system, which connects patients to a family physician through the online platform Maple. Twice her sessions timed out without her seeing a doctor.

She was connected on the third try, but the doctor told her that type of referral fell outside of their scope as a virtual care provider and told her to go to Cobequid Community Health Centre.

"I tried everything I could to be seen, but the system just kept pushing me away," she said.

Croskery waited roughly three hours in the emergency room, only to be informed that they, too, could not refer her for a mammogram. The doctor told her to call the Bedford Basin Women's Health Clinic.

After waiting another month for an appointment at that clinic, the ball finally started rolling. She received a referral for a mammogram, which prompted a second mammogram, ultrasound and a biopsy.

Tissue samples were taken at the IWK Health Centre on Dec. 20. Croskery was told the results normally take up to 10 days to come back, but it could be up to two weeks because of the holidays. She reiterated that she does not have a family doctor, and they took down her number.

Five weeks later, she still had not heard anything.

"The waiting was a really good con game I was doing in my own head," said Croskery.

"I was saying to my girlfriend, 'No news is good news.' And as I was texting that, I literally felt like slapping myself across the face going, 'What are you doing? You can't take this as no news is good news. You need to call.' And I thought, I don't even know who to call now."

'We can't drop the ball'

Croskery then reached back out to the Bedford Basin Women's Health Clinic. It told her it would seek to retrieve her results.

It did, and Croskery's nightmare was confirmed — she had an 11-millimetre cancerous mass in her right breast. Her diagnosis would set off a flurry of appointments that ultimately saw her return to the IWK for a lumpectomy within a few weeks.

She said the lumpectomy went well but there will be further assessment to determine if more treatment is needed.

"I understand that errors get made. We're all human and we all make mistakes and we all drop the ball," said Croskey, who has a 27-year-old son and a 30-year-old daughter.

"But this is something that we can't drop the ball on because you're impacting not just the person themselves, it's the whole family"

Mary Jane Hampton, a health-care consultant in Halifax, said everything is in place in Nova Scotia for Croskery to have had a smooth experience navigating her case. 

The fact that she was met with roadblocks shows there is work to be done to ensure there is co-ordination throughout the system.

"I mean, with all of the apps that we have, the ability to email patients, to call them on the phone with the result, that is a gross breakdown in what should be a smooth and seamless experience in communication," said Hampton.

"But it's not good enough to say that it's unlucky in this encounter. There should be zero times that followup doesn't happen."

Hampton said it also reiterates why it's so important for patients to be their own advocate. Find out when you can expect to hear from health-care providers and follow up at that time, because "no news is just no news," she said.

Aaron Smith, a medical executive director with Nova Scotia Health, said the province is working hard to connect more Nova Scotians to primary care physicians through new technology infrastructure and recruitment, but realizes challenges remain for those who don't have a primary care provider to lean on.

Smith said those Nova Scotians have a number of options for accessing care, including primary care clinics and VirtualCareNS, but he acknowledged the system needs more doctors in order to handle the number of patients who are accessing it, so that appointments do not time out.

"We need to make sure we're getting better every day in terms of folks' access to the care they need, when they need it, at the right time, in the right place," said Smith.

An array of initiatives are underway to beef up the province's complement of primary care providers. The province is targeting Australian doctors, providing retirement top-ups and has started a program to reduce assessment time for licensing internationally trained doctors.

When asked about Croskery's experience at the Cobequid Community Health Centre, Smith confirmed emergency room physicians cannot give referrals for imaging like mammograms. That's because they're not able to adhere to the requirement of the referring doctor following up with the patient.

That's why it's important to see a primary care provider, and not an emergency room physician, for issues that will need to be followed, he said.

Wanted: patient feedback

Smith pointed to the province's 811 system for patients who need help navigating the system.

He also stressed that the province wants to hear feedback from patients — the good and the bad — through its patient relations department.

Nova Scotia Health removed 8,449 people from the Need a Family Practice Registry in February, bringing the total down to 95,875 — or about nine per cent of the population. The provincial government says it's aiming to get the number down to five per cent, or about 50,000 people.

The IWK Health Centre declined a request for an interview. But in a statement, a spokesperson said the doctor who ordered the referral is responsible for following up on the results and sharing those with the patient.

The Bedford Basin Women's Health Clinic did not return a request for comment.

Bukun Adegbembo, director of operations at the patient advocacy group Canadian Breast Cancer Network, said Croskey's experience is not unique.

She hears from patients across Canada who are met with barriers accessing diagnostic imaging, particularly those without a family doctor.

"You have to do a lot of advocacy work, a lot of calling, just to figure out where you can actually access care," said Adegbembo.

"Unfortunately, not everyone's going to have that ability to advocate. And I don't think everyone should have to advocate."

Adegbembo said health authorities need to improve how they educate and inform patients about screening programs and how to access health services.

Croskery said she wanted to speak out about her experience in the hopes of preventing another mishap.

"It's definitely left me feeling angry, but I don't want to carry that anger," said Croskery.

"So I just forgive the errors that have been made. I want to replace that anger with positivity about this, that hopefully this will make a difference for somebody else."