It’s a funny old world. In my clinic this afternoon I was showing a patient a page in our fee guide, stating the fee for lifestyle advice. My patient is involved in federal initiatives for tobacco cessation. She was surprised (as was I, when I arrived in BC) to find that an MSP fee is not payable for lifestyle advice, including smoking cessation.
When I queried this in 1994, the then-minister wrote me a nice letter, explaining that in BC there existed an extensive public health and education system. Patients could and should attend there for lifestyle advice, whilst doctors got on with doctoring. Since arriving in BC my health unit seems to be otherwise too preoccupied to fulfill this mandate.
This evening I read my BCMJ to find Dr Bass’s exhortation on page 86 [BCMJ 2003;45(2):86]. I hope new and enthusiastic graduates don’t follow his advice closely. Unless they are very altruistic or independently wealthy, they could find themselves in conflict with MSP. That is unless their smoking patients are able to pay the $105 per half hour fee suggested by the BCMA fee guide. With the price of cigarettes today, that’s unlikely.
I confess to mentioning that smoking is not good for my patients and even offering advice on quitting. Fortunately most of my smoking patients come in with other diseases needing doctoring, often a consequence of their habit. The smoking cessation advice is complimentary. However I am unable to (or rather specifically forbidden to), provide the extensive motivation, counseling, prescription monitoring, and long-term follow-up recommended by Dr Bass under the Medical Services Plan. That’s a pity.
—Ralph Jones, MB
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