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

Unless I am misunderstanding this thread my thinking is “is this the great health care plan Canada has? and we should adopt in the USA?”

You should be able to see Dr. that you are confortable with. And not once you see one Dr. he is your Dr. from then on.

I belong to an HMO and if I did not like my Dr I would not make appoointments with her. I had to go through one than one before I found one that I liked.

If there are enough doctors, you are free to do this. The problem is when there is a doctor shortage, which is the same deal as in the US. I have a feeling that if everyone had insurance in the States, you’d be seeing a similar problem, which is why we have universal healthcare in the first place: so everyone can have a primary care doctor, not just those who can afford it.

not that my opinion matters that much, but: when I posted I had assumed that doctors could not give preference based on personal relationships. clearly that’s not the case per alice’s last quote. so I take that back. best wishes with the new doctor.

I belong to an HMO (well, technically, a PPO) in the US as well, and I am in the exact same situation as is described in Canada: No doctors in my town are taking new patients, and I either have to go to the walk-in clinic a town over or stick with my current family doctor–who is utterly useless for anything but extreme critical stuff and renewing prescriptions. I have to call months in advance just to see his worthless physician’s assistant.

Eh, our system has its difficulties, just like any system. The big differences are that no one goes bankrupt paying for their health, people don’t make job and marriage decisions based on healthcare coverage, and you get the healthcare you need, not the healthcare you’re covered for.

No kidding - about 50% of US bankruptcies are caused by health care costs, as opposed to about 7% of Canadian ones.

Certainly the system is not perfect, there is a shortage of doctors, and sometimes you have to wait for care. However, people don’t live in fear of a minor health issue bankrupting them.

And, as I always insist on stating in threads like these, I have a metric ass load of health issues and I’ve never had to wait an unacceptable amount of time for assessment tests, follow ups or referrals to specialists. I recognize that my experience isn’t universal, but it’s not that unusual either.

About a year ago, a family member came down with a very mysterious disease. This was a young guy, with wife and two kids, who was a fireman and volunteered to go to New Orleans after Katrina. Shortly after he came back, he got very tired easily, then it progressed that he could not stand very well, then he couldn’t stand up at all and in a few short months, he was almost immobile and was losing weight quickly. This guy (about 32 I think) was dying in front of his family. Every specialist in large cities nearby was perplexed and didn’t know exactly what the cause was.

My cousin broke her personal ethical rules, contacted the parents of a student in her class (they have a relative who is a specialist at the Mayo clinic) and pleaded with them to allow this guy (her son-in-law) access to a doctor at the Mayo clinic…up to then, the next appointment was 6 months out and she was afraid he would not live long enough to make the appointment. The parents of her student came through and he was rushed to the Mayo clinic in less than a week.

The Mayo clinic found a very rare disease that he most likely contacted while in polluted water in New Orleans. It was so rare, they were not surprised that no other doctor had figured it out. They gave him a few shots, and he felt better. They prescribed the same medication. and 6 months later, this guy was back to normal health and back to work! The doctors at the clinic said he might have died, or at least become totally paralized if he had not come when he did.

So ethically, cutting in line is a bad thing, but when it comes to someone’s health, I think there are some gray areas. Did my cousin do the right thing? Did getting him in there mean someone else had to wait a day or two? All I know is that the end results seem to have made her decision valid.

I’m not convinced of your interpretation of the rule about only accepting patients who do not already have doctors. Presumably one should still expect some level of screening when going to any Canadian doctor. As an adult and an American citizen, I wouldn’t expect to be able to show up to Canadian pediatrician that is accepting new patients and be enrolled on a first-come first-serve basis because I’m not a Canadian and I’m not a kid. Rather, I think this position refers to a position on “cherry picking” patients based upon their medical conditions. Furthermore, I am familiar with programs here in the states that explicitly prioritize those without current primary care providers for the reasons outlined above. Perhaps that biased my interpretation of the rule, and again, I’m sorry if my interpretation is incorrect but from the information made available so far I think it’s a reasonable one. The rules for such programs were Byzantine enough here in the states, and I’m not about to invest the effort in a deep understanding of the minutiae of how all of the Canadian provincial health systems work. With all due respect, you really don’t know either and haven’t provided a convincing argument for the basis of this rule in my opinion. Your cite isn’t even from the government, it’s a position piece from an organization of Canadian physicians that broadly addresses the topic of a primary care shortage without delving into the rather particular ethical issue brought up in this thread. You’ve, dare I say it, cherry-picked from the document. It does seem to address the “interview” the OP had with Dr. K, which I admit I find rather bizarre.

Here’s an actual link if anyone would like to read the policy in its entirety:

Here’s a more extensive quote that better explains the scope of the policy:

I’m tempted to have the OP ask her physicians what the reason for the rule was, but I wouldn’t want her to jeopardize her spot or new relationship with Dr. S.

As I’ve said before, if I’ve misinterpreted the source of the rule, I apologize. To go even further, if the OP was really unaware of the rule and didn’t use any personal connection to get around it, I think that the onus is more on the office and physicians to try to keep pace with and follow the rules of the provincial healthcare system.

Really now, isn’t this being a bit histrionic? I’ve reviewed my posts. They’re not exactly the most shockingly excoriating posts yet to appear on this message board. Thanks for the suggestion, but I think I’ll decline the self-flagellation or hari-kari for the time being. :rolleyes:

DMark, I absolutely agree that there are grey areas and that rules are meant to be broken when there’s a compelling reason.

Since making terrible farfetched analogies is a personal passion of mine, I think it’s like getting on a jam-packed airplane that’s an hour behind schedule when everyone has been rebooked onto from another flight. Maybe you want the widow seat, maybe you want the aisle seat, but the harried person working the desk doesn’t give a damn and just wants to put some people in seats and get the plane turned around. The flight attendants will tell everyone to just sit in their assigned seat, try to board in an orderly fashion, etc. For 95% of the people on the plane, they’ll be just fine sitting in whatever seat they were randomly assigned. It would be rude for them to get in line and insist on being reassigned or to waste time when loading the plane switching around seats and further delaying the aircraft. However, if you originally booked yourself for an aisle seat because you’ll suffer a panic attack that will necessitate them turning the plane around if you have to sit in a window seat, obviously this is a different story.

You know, I really can’t prove a negitive - i.e. that such a law doesn’t exist. The onus is on you to prove that it does. I’ll even help you.

Here is a link to the Canada Health Act: http://laws.justice.gc.ca/en/C-6/

I have read the entire thing.

Please go through it and find the part that says patients aren’t entitled to go to a new family doctor if they already have one, or switch family doctors if they’re not happy with their current one.

I’ll wait.

Cute, you’re actually arguing that this pithy little 15 page law actually includes all of the relevant administrative rules which provinces use to run their health programs? That’s funny, it doesn’t even say what Canadian dollar amount the programs will reimburse at for repairing a superficial 3 inch laceration on someone’s right arm.

Let me know if you’re interested in having a serious discussion about this topic.

Ok, here’s a link to the BC health website:


Why don’t you find it there.

Really, you’re spouting off about a health care system that you’ve already made a number of factually incorrect statements about. You don’t appear to have any actual knowledge about it, have offered no cites, and instead of offered your own speculation about ‘laws’ or ‘rules’ which you’re sure exist.

I have offered two cites which contradict your statements. I have now offered a third.

I suggest that you put up or shut up.

And yet none of them actually say what you say they say. Linking to Google doesn’t really count as a cite, nor does linking to the BC Health website.

In all fairness, your cite count is zero.

And yet my statements are supported by the Canadians posting in this thread - including me - and yours are not. Before I got my current doctor I went to 4 others. I was never asked if I already had a family physician.

I worked for 13 years at a Faculty of Medicine. In the Billing Office, Undergaduate Medical Education, Health Records, Admissions and Rural Inititives. Never, in all of that time have I come accross a piece of health legislation that even hints that patients are restricted from changing family doctors or that family doctors are restricted from taking patients who already have care.

I’m sorry - you really, really have no idea what you’re talking about and are making yourself look rather foolish.

threemae, I’d suggest you read up on the background of the Canadian medical system… your foot is so far down your mouth at this point that it’s tickling your esophageal sphincter.

Canadian medicine is a loose conglomeration of policy and law, most of which is administered by the various provinces in tandem with professional associations. The CPSO, as the national governing body for Canadian physicians, is responsible for certifying all Canadian doctors regardless of their specialty (including family doctors).

While the government will get involved in cases of gross negligence which may require more severe charges (ie. murder), in most cases, they leave it to the CPSO to take care of investigating and disciplining their members as appropriate. To discount the validity of a CPSO policy is to disregard the fact that they have the ability to impose severe penalties on offenders including suspension and even revoke a member’s certification altogether. (the CPSO page is down, so I’ll point you to wiki for now: http://en.wikipedia.org/wiki/CPSO)

Once again, the practice of asking new patients if they have an existing doctor is SOLELY for the purpose of preventing patients from double-dipping during a shortage. If the patient is seeking to replace their current physician for any reason and does not plan on continuing that relationship, then it is perfectly acceptable to seek out a new doctor. Interviews with prospective patients should be solely for the purpose of establishing that the doctor and patient are a good fit for each other, and not to screen out “undesirable” patients.

If you’d like to play the expert game, here are my qualifications: lifelong end user of the Canadian medical system, BA in Bioethics from University of Toronto, daughter of the director of a Family Medicine program of a major Canadian university, and cousin/close friend to a half-dozen other family doctors with practices located in the provinces of Ontario, Quebec and Alberta. IANAD, but I’ve got 30 years of full immersion in the Canadian medical system on both the personal and professional levels.

In my professional opinion, Stainz did not do anything wrong from an ethical perspective. If anyhing, had the doctor refused her as a new patient based on the fact that she has a doctor (albeit one she’s not happy with), then it’s the doctor who would be on questionable ethical ground.

Actually, you would be able to go to any doctor in Canada. The first question they ask is for your provincial healthcare card, so when you produce an American insurance card of some kind, they will happily treat you, and bill you for it, and you can bill it back to your insurance if you have travel insurance, or whatever arrangement you have for travel insurance (as I understand it). Doctors here are still a business, and they’ll take your money as soon as anyone else’s; the difference is that services to the citizens of the province that the doctor is in are billed to that province, not the patient.

Sadly, because of doctor shortages throughout most of Canada, the reality is that doctors are choosing their patients.

I want to say that this has been covered recently on White Coat, Black Art on CBC radio.

I’ve had family doctors in the US refuse to take me on because their practice is full. If doctors have too many patients they can’t take good care of them as it will take too long to get an appt.