Minor ethical dilemma (but it's a big deal to me)

In My Humble Opinion
1

In our city there is a MAJOR shortage of family doctors. My daughter is just little and I am tired of dragging her to clinics. Plus I wanted a consistent doctor for myself. So I begged a friend of mine who knows people in the medical profession to try to get me on a list somewhere, and she came through a couple of months ago with her sister-in-law who works in an office where a new doctor is starting in November. I’ll call this doctor Dr S. She is a young female doctor, which appeals to me as a mom with a little girl.

I hadn’t met the friend’s sister-in-law and details were a little sketchy about this new doctor, so I still kept my eyes & ears open. Right around that same time after making a few calls, I found out about a second new doctor coming to town starting in September, so I got on his list too. I’ll call him Dr K.

Dr K did interviews of prospective new patients to pick his patient list. We met him at the beginning of September. He is nice enough, but he is old, hard to understand, and also hard of hearing. My little girl didn’t like him, and to me he is okay but not fantastic. Plus he looks like he is going to retire any day! Anyway, he took us on as patients, and I have seen him once since, for my annual exam and to ask a couple of questions.

I have a follow-up appointment with him scheduled for next week to remove a troublesome but not worrisome mole, and he also referred me to a neurologist for a possible carpal tunnel issue, and sent me to the lab to get some blood work done.

Last week I heard from my friend’s sister-in-law and picked up the forms to become a patient of Dr S. While I was at that office, another office assistant asked me if I already had a family doctor - I said that I had seen Dr K once. She said “I’ll pretend you didn’t say that, because we are only taking patients who do NOT have a family doctor already.”

So now I don’t know what to do - do I see Dr K to follow up on the mole removal and bloodwork? Or is that wrong? Do I cancel and wait to see Dr S? If I start seeing Dr S, do I tell anyone there about Dr K or just leave him right off of my forms & paperwork? Do I owe Dr K an explanation or apology? He is VERY nice just … not what I’m looking for in a doctor. What if I am honest with Dr S and they refuse to take me as a patient?

I am just twisted up in knots over this. This mole has been bothering me for a year or more and now that I finally have the chance to get it removed (it’s big and deep and in a VERY awkward spot), I really want to get it over with. And I’m worried about lying to Dr S’s office - I don’t like to lie. But I’m also worried that if I’m honest, they won’t take me and my daughter as patients.

I’m looking for advice please! Thank you.

2

Good grief. You’re supposed to pick your doctor - NOT the other way around, despite what some of the princesses in the profession would have you believe.

Tell Dr. S. you have no family Dr. Your daughter doesn’t like Dr. K. You find him hard to understand. If Drs were plentiful would you stay with him? Probably not.

The space you vacate with Dr. K. will be filled in short order. Go to the Dr. you like and don’t think another thing about it.

3

Do what’s best for you and your family. Some doctors would like you to think they are doing you a favor by seeing you but they are in a customer service business and you are the consumer here.
Cyn, RN

4

Well, Canadian health care is what it is. Instead of market forces, a scarce resource (primary healthcare providers) is distributed through other means (waiting lists). The rules such as only admitting patients without existing primary care doctors are presumably designed on a national or providence level to more equitably distribute healthcare resources to those that need them most and provide the most cost effective means of spending state healthcare dollars. I think that most of this board would agree with the statement that this means of provisioning care is part of what allows the Canadian system to provide pretty good health outcomes for much less money than the United States, for instance, spends on healthcare.

In less well developed nations the distribution of public resources via personal relationships and networks is less charitably referred to as corruption. I hate to say it, but you’re contributing to an expansion of corruption in the distribution of Canadian healthcare. I don’t think you’re a terrible person, but I can’t say you’re absolved of any morally sticky situations here. In just my own humble opinion, you should follow the rules established in your healthcare system to obtain care for an apparently cosmetic, non-life-threatening condition.

5

After putting all my worries down in writing in the OP, I realized I’ve been wasting a lot of emotional energy on something quite simple.

I will fill out the forms for Dr S for both myself & my daughter. I will cancel the appt with Dr K for the mole removal and wait until Dr S can do it. I have to assume that if my Pap test or my blood work came back with any problematic results, Dr K’s office would contact me.

I will continue with the referral to the neurologist and just ask his office if they can send the results to Dr S.

threemae although I understand your disapproval, I am not sure what you are recommending I do.

I am not worried about Dr K having any problems filling our spots on his patient list - he is listed on the provincial website as the only doctor in town accepting new patients, so I am positive that our leaving will not cause any hardship for him.

6

I’m American so forgive my confusion. Do doctors never take new patients who already have a primary care physician? How does anyone ever switch doctors?

7

not to speak for threemae, but I think the problem was using your personal connections to put yourself on the list with Dr. S in the first place. If everyone did this then the “good” doctors will go to well-connected families, and families without connections get the guys like Dr. K (old, hard to understand, not personable for small children) or continue to use clinics.

8

Go to Dr. S and don’t worry about it; like you said, Dr. K will probably be retiring soon, and then you’ll be back at square one again if you stick with him. And yell at the next doctor who tells you in a snotty voice, “You know, you have to get a family doctor.” Yeah, thanks for your input; that never occurred to me in the 18 years I’ve been looking for one here (we finally got one last year - a new clinic opened up near us, and we were practically standing in line as the doors opened to get on with the new family doctor there).

9

Sorry - I forgot to address this - you can go to any doctor you like, any time you like, except family practices that are full won’t see new patients, so you keep on going to the walk-in clinics and having doctors tell you in a snotty tone that you need to get a family doctor. Dr. S’s clinic was probably just not taking people who have doctors already in a sense of fairness, to try to help people who can’t find a family doctor.

10

Thanks featherlou.

And honestly I never considered that I might have done something wrong by using my “connections” to find a family physician.

I would have felt unfit as a parent if I didn’t do everything I could to secure a family doctor!

11

I have to jump right in here and say this is just plain old false. There is no ‘lottery’ for good doctors. You find doctors taking new patients, find one you like and go to that person. Some small towns have less new doctors - this is true all over the place, including the US.

Stainz - don’t worry about this - you’re finding the best health care provider for YOUR family. Dr. K will be the best health care provider for some other family. It’s a joke to think that your ‘connections’ are somehow preventing someone else from getting health care.

12

My Mantra:

Professionals work for you. If they don’t work for you, find another.

This applies to every profession, from Doctors and Dentists to Accountants, Lawyers and Plumbers. You’re paying them. You’re HIRING them. You are the Customer. YOU are in charge of the relationship, not them.

13

Ahahaha. Except that a lottery actually happened. Nipawin, a small community in Saskatchewan recently held a lottery because there were more patients than the doctors could take. Cite

I’m still driving over an hour to go to the same family doctor I had since I was born.

14

I think you’re being unecessarily harsh here.

Since when does the use of a personal network considered “corruption”? Fact is, most of us can claim connection to someone in the medical profession within a couple of degrees (by “medical profession”, I mean doctors, nurses, hospital or clinic admins, or anyone else who works in the healthcare system), so it’s not like any one person is at a greater advantage.

I don’t really see it as any better or worse than relying on a personal network to get your resume into the right hands if you’re job hunting. Keep in mind, Stainz didn’t pull strings to skip the waiting list or use a backdoor - she just used her network to find a good clinic nearby and was put on the waiting list just like everyone else who didn’t have an “in”.

Besides, from what I understand, the intent of the “do you already have a family doctor?” line is to prevent patients from having multiple family doctors when some can’t even manage to see a single one, and is not to discourage patients who are seeking to replace their current physician for whatever reason (be it long travel times, personal fit issues, gender preferences, or whatever else since the why is irrelevant here).

15

Well maybe it did happen in Nipawin, but it’s certainly not happening as part of a country wide doctor lotto that was implied.

If a small town chooses a novel approach to a doctor shortage, good for them. The suggestion that Siege is stealing resources from others through insider connections is totally false.

Honestly, threemae’s post shows a total lack of understanding of the Canadian health care system and I’m unsure why she posted at all.

16

I don’t mean to be rude, but you obviously have no idea how the Canadian system works. There is a shortage of doctors in most places. My GP in a 12,000 pop town in Ontario had a shortage and no doctors were accepting new patients. My doctor would accept a few if they were new to the area and related to an existing patient.

When I moved out here to rural Alberta, small small town, there are 2 GP’s, and waiting lists too. My mother’s doctor accepted me as a patient as a courtesy to my mother.

Is that corruption? Networking? Or just Professional Courtesy? It is what ever the doctor allows.

In Canada, if you are lucky enough to get a family doctor you count yourself lucky. If you actually like him or her, you treat them well and don’t forget to give them a nice Christmas gift!

To The OP, you are fine, cancel the old crusty Dr, go forward with the new younger one. Good Luck!

17

I am not exquisitely familiar with the Canadian healthcare system, and unclear on some of the points in the OP. However, based on that limited understanding of the exact rules for the Canadian healthcare system, I doubt very much that a physician would independently opt to refuse patients that already have primary care providers just for the hell of it. I think it’s far more likely that this is a requirement from the provincial government. My understanding is that this rule is in place to, as others in the thread have suggested, provide healthcare to people that don’t currently have primary healthcare providers and have a more pressing need for getting a spot in with a family physician.

Obviously, if the spot you’re giving up at Dr. K can be transferred to someone else effortlessly and without consuming healthcare resources, this is a moot point. Go forth and find the person you like best. But it seems obvious to me that the administrators whom designed this system don’t believe that to be the case, or else why would they prioritize patients without current family physicians in allocating slots when a new doctor comes to town? Won’t “getting started” with Dr. S after Dr. K require a second initial appointment and all of the attending administrative legwork, thus consuming more of the constrained resource here: primary care appointment slots? A large part of the advantage of having your doctor comes from the longitudinal relationship that develops and that doctor learning more about you as an individual patient and tailoring care to your specific needs, hence the somewhat cheesy phrase oft applied to primary care: “our specialty is you.”

So, presuming that there’s good reason for the rule, “we are only taking patients who do NOT have a family doctor already,” and if I’m correct in understanding that you used a personal relationship to help get around that rule, then how is this not using who you know to drive the appropriation of what’s a public resource in Canada? It’s breaking the rules of how healthcare resources are supposed to be distributed according to the laws of where you live.

Again, I’m not here to rail against what you did; you have very understandable reasons for doing it that I empathize with. But is it ethically unclouded? In my humble opinion, it is not.

I apologize in advance if I’ve misunderstood the source or rationale for the, “we are only taking patients who do NOT have a family doctor already,” rule or something else about the situation here. This has nothing to do with the personal feelings of Dr. K.

18

That is obvious.

There is no federal or provincial mandate to only accept patients without a current doctor. At all. Whatsoever.

This particular physician is obviously trying to weed out people who are double dipping. Many doctors insist on interviewing potential new patients so they won’t wind up with people that are too fussy. Or want too many appointments. Or are a pain in the ass.

This particular physician obviously doesn’t want to be shopped by potential patients.

However, all of your finger pointing and tisk-tisking at Siege is misplaced.

You are basing it on an incorrect assumption which has now been cleared up by more than one poster intimately connected to the Canadian Health Care system - namely it’s user- and yet you persist in your wrongheaded opinions and your criticism of Siege.

Shame on you.

19

The MOA (medical office assistant) who asked me if I already had a family doctor and then told me that she would pretend I hadn’t said that we’d seen Dr K once already, had NO idea who I am or that I have a friend of a friend who works in her office.

All the MOA knew was that I am a mother of a young child who somehow knew that her office had a new physician who was accepting patients.

I think she was just being nice by saying what she did, and giving me the applications regardless.

I DO feel guilty about the cost of another initial visit, threemae, and I will feel extra guilty if the bloodwork results cannot be sent from Dr K to Dr S, incurring more costs for duplicate labwork.

I’m not trying to get away with anything, or be a scammer, but I didn’t know that Dr S was a sure thing, so I had to go with Dr K initially in order to secure at least some kind of physician for us.

sigh

20

Stainz - firstly, sorry I called you Siege about 5 times.

Secondly, I urge you to strongly ignore everything that threemae has said in this thread.

Here is a link to the College of Physicians & Surgeons of Ontario Guide to Accepting New Patients - it is in draft mode with a due date of October 29th, 2008.

Firstly, it says this:

Please note the bolded part. Screening would include excluding patients who already have a family doctor.

Secondly, and more importantly, from the appendix of that document:

So you did exactly the right thing. You should feel no guilt at all. threemae is totally off base and should be ashamed of herself for attempting to make you feel guilty about this.