The dapper Dr Theman stands unfazed in a thicket of microphones and TV cameras and repeats for the umpteenth time that proposed changes to the doctors’ Standards of Practice will not, repeat, not, shut down private MRI and CT services—these private clinics fall through a gap in the legislation and are outside the College’s authority.
Hmmm, says a reporter (who looks like she’d barely reached the legal drinking age), if that’s the case why is everyone talking about “banning” and ”outlawing” private MRIs?
Good question! How, pray tell, did a noble effort on the part of the College of Physicians & Surgeons (College) to protect the public from being charged for services that they are legally entitled to get for free turn into a media brouhaha over blocking access to private MRIs and CT scans?
Dr Theman paused…and turned the question back on the media. He said everyone started talking about banning private MRIs when the media started talking about banning private MRIs. What he didn’t say was that media frenzy was fueled by some of the most influential figures in the medical profession.
Dr Giuffre’s letter
It’s one thing to wade through vitriolic letters to the editor (and there were plenty); it’s quite another to discover that the most strident opponent of these changes was none other than Dr Giuffre, the head of the Alberta Medical Association (aka the doctors’ union).
In a letter to the profession dated August 30, Dr Giuffre set out his concerns. He said he’d had a conversation with Dr Theman which led him to conclude that the College had completely missed the boat. OK, I’m summarizing.
Dr Giuffre started with a garbled reference to the Vertes report in the Queue Jumping Inquiry and in an bizarre leap of logic concluded that the College had turned “a blind eye” to the core problem of access. Then he dragged out a number of red herrings to support his position. These included a reference to an irrelevant decision by the Supreme Court and a concern about interfering with the rights of those who have the money to buy their way to the front of private MRI lines.
All of this could have been dismissed as overblown hyperbole, but for Dr Giuffre’s rhetorical question: Is it the college’s role to establish public policy of this kind and magnitude?
I beg your pardon????
The College’s Mandate
The College regulates the practice of medicine in Alberta. It is a self-regulating body that is legally obligated to protect and serve the public interest.* This includes guiding the 7,500 or so doctors in the province by setting standards of practice and a code of ethics.
To suggest that the College has stepped outside of its mandate because it wants to clarify existing standards and add a new standard to address problems that have arisen in the past is ludicrous.
Given the tenor of Dr Giuffre’s comments one wonders whether he’s even read the proposed changes.
If he had he would have noticed that the standards were not directed at a specific medical service like MRIs or CT scans or at a specific type of practice like concierge clinics. The standards simply reinforce two key public health principles—universality and accessibility—that the College and every doctor in the province is legally bound to uphold.
The proposed changes assist physicians by clarifying the College’s expectations when a doctor relocates his practice and it becomes impractical for his patients to follow him, or when a doctor significantly alters the scope of his practice and can no longer handle his original patient load. It also clarifies an existing standard that addresses when and how a doctor may charge for uninsured medical services.
There is nothing untoward about any of these changes unless a physician prefers a set of standards so full of loopholes that he could move into a concierge clinic and refuse to accept his former patients unless they fork over an annual fee (ranging from $3000 to $10,000 a year) to purchase a basket of uninsured services (like diet counseling or massage therapy) even if the patient has no intention of using these services–ever.
In the business world the practice of providing a product or service on the condition that the customer buys another product or service is called tied selling. It’s illegal.
The Council Meeting
The College expected the proposed standards to be contentious. Clue: when the conference room is packed with media and representatives from the Consumers Association, Friends of Medicare, Whitemud Citizens for Public Health, the general public and a woman with a soapbox you know it’s going to be a rough ride.
College staff walked Council through the proposed changes and in no time everyone was engaged in a passionate discussion. Three camps emerged (there may have been more).
First there were those who believed in universal healthcare and the “special relationship” between doctors and their patients. They viewed the College’s self-governance role as a privilege that must be exercised respectfully and in the public interest.
The second camp supported a two-tiered healthcare system and wanted to clear the decks in order to let the market operate freely. Yikes!
The third camp argued for delay. They needed more time and more data to get the standards right. They were concerned about public opinion (surely not those vitriolic letters to the editor) and questioned whether Council had the power to make this decision in the first place.
Thankfully the matter went to a vote and the arguments in favour of universality and accessibility carried the day. We erupted into whoops and high-fives! Well no, not in a conference room surrounded by a bunch of doctors but later over drinks.
Dr Giuffre’s Response
According to the Calgary Herald “The Alberta Medical Association would not comment on Friday’s decision”. **
Really Dr Giuffre, after all you’ve had to say on this topic is that the best you can do?
*Health Professions Act, Section 3(1)
**Calgary Herald, Sept 7, 2013, A3