New trend: GPs screening out ill patients
Sun, 2008-01-20 07:15
#1
New trend: GPs screening out ill patients
Sun, 2008-01-20 07:15
#2
I'm surprised this hasn't come up on babble yet - it's been in the news for the past day or two and I've been meaning to post about it. (Unless it has come up and I've just missed it.)
Anyhow, apparently there's a new trend for GPs to screen patients, and refuse to take on patients who have any health issues that might force them to take more than 3 minutes per patient with their hand on the doorknob in the examining room. Yet another story that brings out my inner fascist. Any doctor who pulls this bullshit should lose their license. And not get it back.
[url=http://www.cbc.ca/health/story/2005/05/02/doctor-interview050502.html]A story from a couple of years back about the Alberta College of Physicians and Surgeons shrugging their shoulders over the practice - what a shocker.[/url]
[url=http://www.cbc.ca/health/story/2007/05/11/doctor-interviews.html]And from about half a year ago - Colleges give half-assed warning about discriminating against patients, leaving enough of a loophole to drive a truck through.[/url]
quote:
Some Canadian doctors are interviewing people before accepting them as patients, but licensing colleges are warning that discrimination is not allowed.Practice Solutions, a company owned by the Canadian Medical Association, advises doctors on how to maximize profits. The company recommends "meet and greet" sessions for physicians to meet prospective patients and determine whether the doctor is able to meet the patient's needs.
That's like saying, hey, you can ask people how old they are or their marital status or whether or not they have kids during a job interview, but you're not allowed to discriminate against them when making your decision. What a steaming pile of horseshit.
Sun, 2008-01-20 08:09
#3
Since we pay by the appointment, we shouldn't be surprised if doctors try to maximize the number of appointments.
Sun, 2008-01-20 08:19
#4
I think sometimes there are cases where a G.P. might be justified. There are patients with certain illnesses that would get better attention if they went to a G.P. that handled a greater volume of similar cases.
However, I think those few examples are used by some G.P.'s to justify quickly treating not really ill patients that enable them to charge the visit fee to O.H.I.P. in a fast appointment (so they can book more) where they don't have to crack a text book or tax their brains too much.
This way they can spend more time on education courses down in the Bahamas, learning from Perdue Industries wonderful non addictive benefits of prescribing 100 Oxcontin tablets for stubbed toes and the like.
Okay, I exaggerate.
But not as much as you think.
Sun, 2008-01-20 08:34
#5
As Doug says, if you pay by the appointment you can expect doctors to maximize the number of appointments they make and the number of procedures they do [e.g., charge for every time they renew a prescription, even if it's only a phone call to the pharmacy].
Add maximums on allowable billings and what exactly do you expect to happen?
Sun, 2008-01-20 08:51
#6
quote:
Since we pay by the appointment, we shouldn't be surprised if doctors try to maximize the number of appointments.
You've hit the nail on the head, Doug. It's the fee for service system that actually rewards doctors for bad practice.
And in my view, the current system also fosters drug addiction. I work in drug addiction treatment, and I can't count the number of times folks have told me their doctors got them hooked on, say, painkillers and the valium-type drugs, as it's faster and therefore more lucrative to give a prescription for a quick fix than the kind of in-depth care that determines what the problem really is.
I think, Michelle, rather than punishing individual docs, the system needs to be changed so that doctors who provide good care are rewarded for it.
Sun, 2008-01-20 08:59
#7
quote:
rather than punishing individual docs, the system needs to be changed so that doctors who provide good care are rewarded for it.
How do you measure that? Positive outcomes? Then just don't take any truly sick patients. Availablity? Just squeeze as many patients in at short notice as possible? Bedside manner? Yeah, he's a really nice guy but his patients die?
I know I'm being flip but how do you measure it?
Sun, 2008-01-20 09:02
#8
If I can be less disparaging-- just for a moment-- I think the problem is that we never stop to ask doctors and I doubt doctors stop to ask themselves even, what the expectations are for financial compensation. Aside from you know, "more".
Doctors are very forthcoming on explaining their time, work loads, expenses etc., but less so when it comes to identifying things like how much their education costs are subsidized, how much more difficult it is to prove malpractice in Canada, how their malpractice premiums are subsidized, etc,.
Frequently, they like to compare the bottom line income they have with doctors in the States, but they like to lie through omission about many of the subsidies they get that American doctors don't.
Personally, I want my doctors well compensated, and happy with that compensation.
But cherry pickers are cherry pickers, and I'd like to know what the hell is going on in medical schools or whatever, that has us saddled with the current batch of ne'er do wells.
Sun, 2008-01-20 09:43
#9
quote:
I know I'm being flip but how do you measure it?
One way around that problem is not to measure anything. For instance, docs in some remote rural ERs are paid a salary rather than a fee for service, because these ERs don't get enough patients over the graveyard shift to pay adequate compensation.
Pharmacists (like me) are paid a salary, and nurses are paid a salary, so why not doctors? Fee for service was a compromise in the first place that Tommy Douglas accepted in order to get drs on side with medicare. Maybe it's time to negotiate something different.
Sun, 2008-01-20 10:01
#10
Did you know, Sineed, that in the feature articles on Oxycontin in the London Free Press and Church Bulletin some while ago, pharmacists that had transfered to London from other places were quoted as saying they couldn't believe the quantities of Oxycontin being prescribed here? That they'd never seen anything like it? Doctors interviewed by the Freeps said that they had no specific training in how to handle patients with chronic pain.
I mean, who knew opiates were addictive?
What I'm getting at is we can and surely will come up with a better compensation system for doctors, hopefully one they are reasonably happy with and that goes a long way to promote good health care for those who are paying for it.
But I don't know we'll ever come up with a system that can eliminate unconscionable predators, with an over reaching sense of entitlement who think nothing of destroying lives and neighborhoods for financial gain.
I'd like to think we could have a court system that might tackle this, but then you can't be hauling people who work in three piece suits to account like they were ordinary citizens.
Sun, 2008-01-20 10:09
#11
remind
quote:
But cherry pickers are cherry pickers, and I'd like to know what the hell is going on in medical schools or whatever, that has us saddled with the current batch of ne'er do wells.
Not sure if it is just med school, I know that the CoC and the CFIB were both tryiing to recruit Drs, as sole proprietorships, into their ranks.
But there is also dynamics at work of; "why should I waste my time if you are not willing to look after yourself" and "will this person be too problematic", at work.
[ 20 January 2008: Message edited by: remind ]
Sun, 2008-01-20 10:33
#12
What remind says is true; all patients are owed a duty of care. But cherry picking happens if a doctor is in a position where he/she can't possibly take all comers.
quote:
Did you know, Sineed, that in the feature articles on Oxycontin in the London Free Press and Church Bulletin some while ago, pharmacists that had transfered to London from other places were quoted as saying they couldn't believe the quantities of Oxycontin being prescribed here? That they'd never seen anything like it? Doctors interviewed by the Freeps said that they had no specific training in how to handle patients with chronic pain.
I mean, who knew opiates were addictive?
I know all too much about the Oxycontin problem. I've refused to fill dodgy scripts for it, I've had people screaming at me for it, and I had a highly amusing conversation with a drug dealer in jail for peddling it who explained in detail his system of buying scripts from pain patients. Oxycontin has replaced heroin as the opioid of choice in most Canadian cities (Vancouver remains a major exception). And a large part of the problem is over-prescribing is over-prescribing by physicians. I see it all the time.
Sun, 2008-01-20 11:45
#13
At the risk of digressing that reminds me of [url=http://forums.studentdoctor.net/showthread.php?t=257985]thread[/url] that discusses things doctors in emergency learned from their patients:
quote:
learned yesterday...
if you are given a prescription for narcotics wait until the rx is filled before you try to sell them...
pt yesterday with bs pain complaint gets rx for vicodin and trys to sell them over the phone(loudly) in the E.D. lobby..." they gave me 30 vicodin...how about $250? ok meet me here in 20 minutes".
pt overheard by staff who took written rx from pt and ripped it up in his presence.....
Sun, 2008-01-20 12:39
#14
My mother in small-town Ontario, in her 70's and living with advanced rheumatoid arthritis, did not have a GP for several years. Then her rheumatologist went out of practice so she had no medical care at all. The township where she lives spent a ton of money to build a new medical centre in hopes of recruiting a new physician. Mom's was almost certainly one of the first names on the list and we followed up monthly, but surprise surprise, she didn't get a call. So my brother, who also didn't have a doctor, called and received an interview right away; he went and asked the new doctor in person if she could take my mom instead. Out of discomfiture I assume, the doctor took them both. That's better than winning the lottery in this part of Ontario.
Living in this area are at least two advanced practice nurses who would each be capable of assuming their own caseload of patients. The CMA does not allow them to practice alone, and they can't find any doctors who are willing to work with them.
One of my clients is a pediatric surgeon in Pakistan, who also lectured and did extensive research on TB, whose degree is formally recognized as equivalent to a Canadian degree. He can't get a license here and has been working as a janitor for five years.
Hopefully the new Ontario group practices will ensure that more of our health professionals can actually find work in their field.
Not sure how much that impact that will have on the CMA's stronghold on these policy issues though.