Get ready for the new two-tier medicine: real doctors for the rich; internet apps of the rest of us.
You think I'm kidding?
Wednesday night, I found an email in my inbox from Telus Corp., the company based in the Vancouver suburb of Burnaby that was once two excellent publicly owned utilities in British Columbia and Alberta.
Telus president and CEO Darren Entwistle was reaching out to me personally, or so he said, "to let you know the TELUS team is here to support you and our fellow Canadians as we manage through COVID-19."
Well, thanks, Darren! I really appreciate that, buddy!
Anyway, after the usual folderol about how Telus is taking important precautions to maintain social distancing that we've all heard from a variety of corporations these past few days, Entwistle went on to invite me to try something called Babylon by Telus Health.
Why they chose that name, I cannot say. The mysteries of corporate branding are, well, mysterious.
Regardless, Entwistle personally advised me, through Babylon I now "have access to a free, customized COVID-19 online symptom checker, and patients in B.C., Alberta and Ontario can schedule a one-on-one video consultation with a licensed doctor at no cost from your smartphone and in the comfort and safety of your own home."
Well, never let it be said that any old global catastrophe isn't a chance for someone to make money, I concluded. End of story, I assumed.
When I checked yesterday to see what was up, however, I discovered a news release from the Alberta government informing me, "New app helps Albertans access health care," and furthermore, "Albertans can now meet with Alberta-licensed physicians through their smartphone, thanks to an initiative by TELUS Health."
"Albertans can use the service to check symptoms, book appointments, see a doctor, and get prescriptions and referrals for diagnostic imaging and specialists -- all covered by Alberta Health Care," the press release said.
It also contained a nice canned quote from Health Minister Tyler Shandro: "Alberta is pleased to partner with TELUS to deliver physician services in a new way. This app … comes at a time when our health system is actively asking people to self-isolate as a result of the COVID-19 pandemic. Using this app is an alternative to visiting physicians face-to-face when you're not sure if your symptoms are related to the novel coronavirus or at any other time." (Emphasis added.)
There was an even more enthusiastic quote in the release from my buddy Entwistle, who, among other things, told Albertans Telus hopes it can "mitigate the enormous pressure on our health-care system through our technology, human ingenuity and compassion."
Remember, this news release is from a government that until last Wednesday was openly at war with Alberta's physicians, and which furthermore is relentless in its pursuit of ways to cut costs in public health care while skimming off potentially profitable business for its friends in the private sector.
As a medical layperson, Babylon strikes me as an exceptionally bad approach to clinical practice. Whether or not it has merits as an emergency plan in a crisis open to question.
"There is no good replacement for a family doc," Dr. Joe Vipond of the Canadian Association of Physicians for the Environment reminded me. "Walk-in clinics suck. I see such bad medicine from them. How could this not be 1,000 times worse?"
He's right. Your family doctor has a relationship with you, and solid knowledge about your medical needs. A telephone service, as Vipond observed, "sounds like a 'scrip writing machine."
In a post on Facebook, Peace River MD Heather Shonoski wrote: "Family physicians have been begging the health minister to allow us to provide virtual care to our patients so that we can keep our vulnerable patients at home and promote social distancing.
"Physicians from my clinic have called Telus and were told they cannot see their own patients through this platform, rather they would have to provide virtual walk-in," she wrote. "We want to be able to see our own patients in our own critically underserved rural community where we know our local resources. We want to provide continuity of care, which has been proven to save lives and minimize resource use."
Allowing a doctor elsewhere in the province to advise patients not knowing conditions at local clinics and facilities is dangerous, Shonoski added. And she argued Alberta's billing rates for telephone care by family doctors are too low: "Do we have patients physically come in to the clinic and increase their risk or do we shut down our clinics / go bankrupt / lay off our staff and keep patients safe? I guess the question is whether we as a society want family doctor offices."
According to Shandro's press secretary, Steve Buick, Babylon doctors' pay is based on Alberta Health's basic $38 office visit fee. Family doctors, who can actually see your charts and know your history, are restricted to $20 per call, out of which they must pay the costs of running their practice.
App docs, of course, will redirect patients back to their family physicians as quickly as possible.
The few details provided in the government press release about how this is financed are extremely murky. "The service is being delivered to Albertans through an alternative relationship plan between the Alberta government and TELUS." The project has a budget of $1.5 million.
Babylon could set the stage, though, for something the UCP, Shandro and Premier Jason Kenney would all truly love: two-tier medicine in which there were real physicians for the wealthy, and an app for the rest of us.
Shonoski noted that the College of Physicians and Surgeons of Alberta, the profession's regulatory body, and the Canadian Medical Protective Association, a not-for-profit mutual insurance organization, have endorsed such telemedicine apps as Medeo and doxy.me, as well as use of email, telephone, Skype and FaceTime to provide virtual care. "Why is it that none of these are being supported?"
"I am very concerned that the government is using this pandemic to further their own push for privatization," she concluded.
As a student of Alberta politics, I would not be at all surprised to see this extended to many more uses in less critical times, providing the opportunity for the United Conservative Party not just to save money by delivering significantly worse service to most patients, but to get some revenge by jamming the Alberta Medical Association in the next round of bargaining.
This a model already being applied with lamentable results to public post-secondary education, so from the UCP perspective, why not inflict it on public health care too?
Another government press release the same day, also using the global COVID-19 pandemic as a news hook, said pharmacists will now be used for "screening of patient health indicators."
This too smacks of outsourcing work traditionally and more appropriately done by physicians. However, a close look suggests there's not much there but political fluff intended to make it look like the government's doing more than it really is.
I get it. This is an emergency. I also get it that this is a government that's quite prepared to use the Shock Doctrine to push its ideological agenda. So beware!
David Climenhaga, author of the Alberta Diary blog, is a journalist, author, journalism teacher, poet and trade union communicator who has worked in senior writing and editing positions at The Globe and Mail and the Calgary Herald. This post also appears on his blog, AlbertaPolitics.ca.
Image: Mack Male/Flickr
Editor's note, March 22, 2020: An earlier version of this story misspelled the last name of the Telus CEO. He is Darren Entwistle, not Entwhistle.
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