In a recent proclamation of Family Doctor Day, the BC government states that family physicians lead the delivery of accessible health care, strengthen the capacity and overall quality of the health care system, and improve the overall health of the population (http://bccfp.bc.ca/wp-content/uploads/2018/04/Family-Doctor-Day-May-19-2019_Optimized.pdf).
In another breath, the BC government’s lawyers (in the ongoing constitutional challenge launched by the Cambie Surgery Centre, et al., against the BC Ministry of Health, et al.) have stated that “If patients are waiting too long for treatment and suffering harm as a result, it’s mostly because doctors aren’t making the right decisions.” According to court transcripts, the lawyers representing the BC government went on to say that “Patients shouldn’t experience unnecessary or unreasonable pain or suffering if treating physicians exercise their professional judgement appropriately. Doctors are supposed to assess, treat, and prioritize patients according to their medical conditions; if patients suffered, it was because of decisions made by, and actions taken or not taken by, their treating physicians.”
When I signed up to be a family doctor, I thought that I would be a diagnostician, healer, and confidante. I did not expect to be a navigation system for my patients. I am a GP, not a GPS. I did not expect that one of our office staff would be tasked solely with dealing with our patients’ referrals for appointments with specialists and tests such as MRI scans. This staff member spends hours on the phone and fax every day, trying to get patients the soonest possible appointments with specialists or diagnostic facilities. Not infrequently, I or one of my colleagues has to make phone calls to a specialist to plead for an earlier appointment. For many of these appointments, patients are waiting months to years.
Theoretically, I could refer the patient to the specialist with the shortest wait list, and I often do, but sometimes that specialist is someone I would not feel comfortable sending a family member to. I prefer to treat my patients as I would want to be treated. Thankfully, the majority of specialists provide excellent care, but as a result, they have long wait lists.
I recall two patients, in particular, from our office. One had spinal cord compression and early cauda equina syndrome. Despite my colleague spending hours on the phone trying to get the necessary MRI with contrast, and trying to get the patient seen urgently by the appropriate specialist, he ended up having to send the patient to an already overburdened emergency department to access the care he needed. The other patient needed urgent investigations for a pancreatic mass. It took multiple phone calls, eventually getting hold of the specialists on their personal cellphones, to arrange the urgent diagnostic tests and surgery that patient needed. Otherwise, these two patients and countless others like them would still be waiting for treatment, or worse, they would be permanently harmed or even dead.
We are not always able to pull the necessary strings to get patients in for the care they need in a timely fashion. Most of the time, patients wait patiently to be seen by a specialist or to undergo a diagnostic test. Most of the time, they wait longer than is reasonable. If the government can’t afford to provide comprehensive health care in a timely fashion, then they shouldn’t prevent patients from accessing it by their own means. I often joke with patients who injure themselves while at home or at play that they would get faster treatment if the injury had happened at work. But it’s not a joke. Workers, RCMP members, prisoners, federal employees, and visitors to Canada can all access expedited care through private insurance. As can the citizens of Quebec, thanks to the Chaoulli decision of the Supreme Court of Canada. As can your pet.
It is time to acknowledge that we already have a multitiered health care system. We have to pay for prescriptions, for spectacles, for physiotherapy, etc. Private insurance is available for those services. Why not make private insurance available for other medical services? It’s also time to rein in health care spending, by spending less on the administration of health care. Unfortunately though, the people charged with deciding how health care dollars are spent are not the people who actually provide the health care. Those of us on the front lines (doctors, nurses, and others) are the ones trying to do the best we can with limited resources. Don’t blame us for the rationing of health care.
Dr Chapman is part owner of a private diagnostic facility.
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
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