A collection of anecdotes, a step-up from bathroom literature.
Sunday, December 11, 2011
The Case for Private Medicine
Everyone has heard of the long wait-time for certain medical procedures. Likewise we've also heard of "private" clinics available on demand to perform many of the same services for a price. My latest encounter with the current "provincial" medical system has highlighted the differences though oddly not related to cost or wait-time. There appears to be a widening rift between the "provincial" medical professionals and the "public" they work for, even bordering on disdain by the physicians for the public. Loud and clear I have discovered that doctors are rapidly joining the ranks of those who are acutely aware of their prescribed duties and entitlements, primary facts which regularly trump pride in the work they perform. The physicians have - no doubt unwittingly - boxed themselves into the same corner one might find a wary and angry dog.
On Sunday morning last I determined after much consternation to visit the Emergency Ward of the local hospital. Lately I had been feeling certain symptoms which I had dismissed as one thing or another but the increasing irritation brought me to the conclusion that I was possibly ignoring something important. When I met with the attending physician I was surprised to witness what was obviously a well rehearsed rendition of the latest boardroom mantra: "What is it that has brought you here today on an emergency basis?" When the doctor discovered that the thrust of his performance was seemingly lost upon me (as my attempted explanation of the unknown affliction had obviously failed to impress him), he repeated the script again almost word for word. It was at this point that I considered he was becoming unnecessarily tiresome as clearly his characterization of a medical emergency and mine were very different. I for example consider that any time I feel obliged to see a physician in a hospital, it is an emergency. More importantly I have been reminded time and again by my former physician that too often patients wait until the last possible moment to deal with an affliction from which they have been suffering. This frequently precipitates an emergency at a decidedly inconvenient time and often could have been avoided entirely if the patient had heeded his or her albeit uneducated signals and sought the advice of a professional when the alarm bells first sounded. I suppose I could have waited until the middle of the night to put myself in a state of complete anxiety and discomfort. The emergency physician was thus virtually begging the question to ask me what the emergency was at this juncture especially as I had rather hoped to consult him about that very point. Nor did it help that the physician appeared to be enjoying the needling. Of course I accept that in the experience of an emergency-physician the standard of what constitutes an emergency is likely far more critical and possibly more self-evident than what it is to most others. However I am likewise reminded of the instance when a young lady who complained to the emergency-physician of a bad headache (and who was consequently admonished for her piteous intrusion upon the emergency service and sent home) was subsequently discovered by an intern on a return visit to have a massive brain tumour which necessitated immediate surgery. A further balancing qualification is warranted; namely, certain conditions are undeniable emergencies and that status alone normally entitles attending patients to immediate service. The corollary is that people in surrounding districts such as Kanata needn't concern themselves about being able to jump the line in their own bailiwick if they are truly enduring an emergency; otherwise, their roulette game with other hospitals in smaller centres is an affront to the capacity of those smaller hospitals.
Following the emergency-physician's diagnosis - which by the way precipitated its own impending emergency because of personal time constraints - I telephoned the local Family Health Team and left a message asking to meet with my new unilaterally assigned family physician (perhaps another less than glowing hallmark of the "provincial" system in this case directed at consolidation as a "Family Health Team"). Subsequently I made on-line enquiries about getting the matter attended to by a private clinic which specializes in similar concerns. And finally I shared those results with the family physician by email. This is the response I got from the family physician:
"I am in the office tomorrow and will check into the situation. Please don't contact me by email for health concerns. You can leave me a message at the office. As you can imagine, I have nearly one thousand patients and my personal life would be disrupted by this."
My first reaction to this communication was that it was a bit rich. Later however I began seething about it. As one who has carried on a professional private practice for almost forty years, this singularly abrupt response was a punch in the gut. While I don't expect the "modern" generation to be so foolish as I was in my dedication to clients, I was nonetheless reminded of what a Judge had told me fifty years ago. He said, "If you want to be a good lawyer, you'll read nothing but the law". I took that advice to mean that a good lawyer is one who is entirely committed to his practice. As I say I recognize that this type of servitude is highly unfashionable today. I did however recall the many times - to which I never objected either directly to the clients or behind their backs - that clients called me in the evening, on the weekends, on Sunday morning at 8:00 a.m., from a gaol cell at 2:00 a.m. and even after I retired and several times when I was wintering in South Carolina!
The other detail which disturbed me is that after almost forty years of practice my client roster numbered approximately 5,000. I failed to see that the family physician was overburdened by 1,000 patients. I am confident in surmising that the vast majority of people have little need for either a lawyer or a doctor except occasionally.
I found it most unusual that the physician, in rebuffing my email, seemed to suggest that the convenience of email was Anathema in the medical vernacular. The physician certainly did not come anywhere near suggesting an alternate "business" email. And it did not widen my humour to be told gratuitously that I could "leave me a message at the office". The physician had undertaken a calculated effort to snub my communication while - again no doubt unwittingly - embracing the archaic and inconvenient method of exchanging information. It was monstrous of the physician to have extrapolated erroneously that my email was some attempt at social engagement meant to disrupt the physician's personal life! By contrast everything I had succeeded to accomplish with the private clinic (including requisition of a preliminary Medical Questionnaire and submitting it for review by a physician) had pointedly been conducted seamlessly on-line and by email.
When I later met with the local physician there was significantly no mention of my email. What however did surface is that, in determining to enquire about the availability of a surgeon to assist in my cause, the physician sent an email to someone for that purpose. Clearly a business email exists for the physician. Of further interest was that the physician feigned not to have read my email and much of the information which I had provided was of necessity repeated, sometimes twice for clarity at the physician's behest. It was also evident that the physician knew little or nothing about the private institution referred to in my email and about which I was effectively consulting the physician concerning my ailment. Neither of course had any attempt been made by the physician at self-education on that particular point. In the result my attendance upon the physician was close to being a complete waste of time for us both (other than for the diagnosis of a skin rash in my nether regions for which sadly no remedy was even suggested by the physician much less proferred). It leaves me breathless to wonder why the physician made no attempt at an explanation of the cause of my condition nor about what if anything I should do until it is repaired. Seemingly this particular physician sees agency and referral as the only active role in the matter (rather echoing the summary performance of the emergency doctor). I confess as well I find it odd that someone such as I who is so obviously overweight has never provoked any attempt by my physician to encourage consultation with the services which I had understood were offered by this so-called Family Health Clinic. This may only highlight what is becoming the ritual rant of the public that if one doesn't take his own case in hand no one else will do it for you, but I find that a small compliment to the physician.
In an effort to be fair to the "provincial" system, I cooperated with my physician when my proposed surgery was referred to a local surgeon. I had some hesitation in this cooperation because as I informed my physician I had heard from others who had dealt with the proposed surgeon. The account goes that he had never returned telephone calls when promised (or at all for that matter) and that as a result an alternate surgeon was consulted (and in fact retained). Not surprisingly to me my physician had no knowledge of these apparent qualifications, yet another trenchant vacuum.
The day following my meeting with my physician I received a telephone call from the physician's office advising that I could expect to receive a call from the surgeon that day. I am still waiting. That was three days ago. Incidentally the clerk at my physician's office advised that they had no record of my email address. I advised it was my understanding that the physician did not use email to which the clerk replied, "We use it to send information to you."
Meanwhile I have received two further communications from the private clinic. One from staff, the other from a physician. The information provided has been both helpful and to the point quite unlike my experience in the "provincial" system. Oh, by the way, those communications from the private clinic were by email! How convenient! The final straw in dealing with my so-called "family physician" (a title which sadly for both the medical profession in general and the physician in particular has become synonymous with blazing mediocrity) was that, in response to the physician's request that I advise the outcome of my communications with the private clinic, I telephoned the physician's office and left a message with the telephonist that the private clinic had contacted me and required me to lose 45 pounds before they would consider the surgery. I have yet to hear a peep from my family physician regarding the management of this significant matter, a silence which rather flies in the face of the physician's previous advice, "Please don't contact me by email for health concerns. You can leave me a message at the office." Clearly there is something further missing in the physician's alleged performance of duties. I can only conclude this inappropriately named family physician is a glorified referral agent and even that is questionable.
It was no small coincidence that today, when speaking with someone completely unrelated to me or my medical concerns, the name of my physician surfaced in the conversation and not in a good way. It appears that my physician has developed such skill at being repeatedly obnoxious that the polished talent is shared pervasively and indiscriminately! In that at least I have some satisfaction.