Ms Soapbox has been in a quandary all week. She was troubled by what she’d observed at the meeting of the College of Physicians and Surgeons governing council. Finally the penny dropped. The College is deadlocked and incapable of living up to its mission which is “Serving the public by guiding the medical profession”.*
It’s become painfully obvious that the College is extremely reluctant to regulate doctors who provide uninsured services; let alone discipline physicians who breach the Standards of Practice and Code of Ethics by taking advantage of the public’s ignorance of how insured and uninsured services should be provided.
Sounds harsh, but consider this. There are roughly the same number of doctors as lawyers in Alberta (approximately 7000 doctors and 7800 lawyers) but over the last five years there were twice as many complaints resulting in disciplinary action against lawyers than doctors—50 actions against the lawyers including 18 disbarments and 5 resignations and just 22 actions against the doctors.**
There are two possible explanations for this anomaly: Doctors are more ethical than lawyers or doctors’ patients are less likely to complain than lawyer’s clients.
Are doctors more ethical than lawyers?
I have three words for anyone who thinks doctors are more ethical than lawyers: Queue Jumping Inquiry! Given the revelations surrounding the Helios clinic and what turned out to be a well-established queue jumping protocol, I find it hard to believe that doctors are more ethical than lawyers.
To further complicate matters, doctors have the challenge (and the luxury) of being able to charge for insured (government-paid) services and non-insured (extra fee) services. This confuses patients and gives doctors even more wiggle room under the Standards of Practice and Code of Ethics.
Lawyers on the other hand don’t have one foot on the pier and the other in the boat. Virtually all lawyers work in private practice or in-house for corporations or government. The question of who pays their bills is easily determined and there’s no opportunity for double-dipping.
Are doctors’ patients less likely to complain?
I left the meeting of the College of Physicians and Surgeons convinced that doctors’ patients are less likely to file a complaint because they’re not properly equipped to do so.
When a lawyer messes up, his client finds out pretty quickly. The deal goes sour, the client loses his deposit, etc. Clients are furious and fire letters off to the Law Society at the drop of the hat.
A lawyer’s client knowns what he wants to get accomplished, he just needs the lawyer to help him do it. Doctor’s patients on the other hand, don’t know what’s wrong with them, let alone how to heal themselves. This makes it difficult for patients to know when they’re receiving inadequate medical care. Furthermore, the nature of the doctor/patient relationship requires patients to trust their doctors. Consequently patients will endure a great deal of substandard care before they raise the alarm or switch doctors.
Given this state of affairs, the College must do everything possible to protect the public by enforcing the Standards of Practice and Code of Ethics. Does it?
The College’s duty to protect
The Code of Ethics states that it is a doctor’s fundamental responsibility to “consider first the well-being of the patient”. This principle alone would prohibit a doctor from limiting his patients to only one ailment per visit, thereby forcing patients to book three separate appointments on three separate days. This may enhance the doctor’s ability to bill the system but it’s certainly detrimental to the patient’s well-being.
The Standards of Practice prohibit the tying of uninsured services to insured services. (This may be illegal under competition law as well). So a doctor can’t close his practice, ditch his patients, re-open his practice in a concierge clinic and demand that his old patients pay him an annual fee of $3000 to $10,000 for uninsured services before he’ll agree to provide them insured services.
The College is well aware of these and other abuses. And yet it is reluctant to amend the Standards of Practice to make it crystal clear that such practices will not be tolerated. Instead it sends the staff back to the drawing board to “clarify guiding principles that would frame any future discussions surrounding” amendments to the Standards of Practice.***
This is deeply troubling because the problem isn’t a lack of clarity. It’s a lack of fortitude. The College must deal with the elephant in the room. Will it fight for public healthcare by enforcing the existing Standards of Practice and adding amendments to stop the incremental privatization of healthcare or not?
There’s a lot of money to be made in providing uninsured services. The College will face fierce headwinds if it disciplines physicians who provide these services improperly. But, hey, someone has to do it. Shouldn’t that “someone” be the College of Physicians and Surgeons, the self-regulating body empowered under the Health Professionals Act to discipline wayward physicians?
Time to get militant
At this point the College is deadlocked. The amended Standards are under review (again). We can’t afford to wait for the College to decide whether it will support public healthcare or turn a blind eye to the physicians sneaking privatized healthcare into Alberta through the back door.
So let’s force the College’s hand. Let’s stand up for ourselves. Let’s take a lesson in militancy from my little physiotherapist who challenged her doctor for writing her a prescription for over-the-counter vitamins. (She also challenged her dentist for charging $400 for a cleaning and an X-ray and a waiter for charging her dinner companion a $10 split-meal charge when her friend only had a beverage).
The next time you visit your doctor take the Standards of Practice and Code of Ethics* with you. Ask your doctor to explain his fees and whether he’s charging you for an insured service. If he insists you book a second appointment to describe some of your symptoms ask him how that’s consistent with the Code of Ethics.
And if you don’t get a satisfactory answer file a complaint with the College of Physicians and Surgeons. If we don’t stand up for ourselves who will?
**These are high level statistics based on information available on line. Additional information from doctors or lawyers is welcome.
***Council Meeting Highlights, May 2013, CPSA website