I have been moved to write in response to the very interesting and engaging editorial by Dr David Richardson titled “Lacking special authority” (BCMJ 2014;56:313). He is surely not alone in the continued travesty that front-line primary physicians have to endure in filling out the profusion of forms required for patients. His good-natured perspective on his frustrations in filling out, or being responsible for, Special Authority forms was well written, and I have to applaud how well he couched the negatives among his jesting. The increasing complexity with the proliferation of different medications to be considered and advocated for is an increasing headache for many of us. But underlying the jesting is undeniably a painful truth: we are caught in a bind at great expense and exasperation as often we are placed in that adversarial situation when the patient before us does not qualify for the medication for which he or she feels perhaps entitled, being first propositioned by drug companies in the media or on the Internet. The time and expense involved in navigating the convolutions is not insignificant for the many patients often caught in the dilemma. The hoops and hurdles expected before certain medications are covered by Pharmacare are multiplying, and the variations of said forms keep getting updated, which to me is the ruse to obfuscate the process and to wear us down and give up the effort. If the latest updated form is not completed with all the proper ticks and boxes, it is returned and we start the process again. It reminds me also of the efforts required to get patients into special programs like multidisciplinary chronic pain clinics, where, once more, if the latest updated forms, yes, with even more categories and preliminary tests, are not completed, the referral is not even considered and more delays of the usual 2-year process follow. Insurance forms for patients, or those for disability benefits, are another example of chronic headaches for the practitioner.
If the word gets out loudly enough, you can readily see how newer graduates, who wise up to the nuclear explosion ready to take place, are not at all interested in pursuing the mundane world of the fading GP ranks. This is the Trojan horse in our midst; the insidious virus that is yet invisible to the general population blissfully unaware of the impossibilities. Can others see what I see? Are there really only a few sheep among the wolves?
—John de Couto, MD
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