Earth to Doctors: Wake Up!

Maggie Brown’s excellent piece on the new walk-in day clinic is shocking, if only because of the odd characterization of walk-in medical clinics as “fast food medicine” by the head of the PEI Medical Society.

Dr. Kathy Bigsby is quoted in the piece as saying:

What we’re seeing is that this is taking business, if you will, away from the regular family doctors, and the folks who are out there practising family medicine recognize that what makes the quality of their care especially good is continuity of care and I think they find it really alarming to think that folks are going to be choosing what some consider the equivalent of fast food medicine over their regular family doctor.

The day clinic at the Boardwalk Medical Center is a dramatic improvement over not only the night clinics, but also over the sub-par service available from many family doctors.

Catherine and Oliver have been to the Boardwalk clinic several times over the last couple of months, either because our family doctor has been on vacation, or because the wait to see her has been too long. In all cases they’ve been served quickly and professionally.

Continuity of care is great, and I agree that a personal, long-term relationship with a family physician is probably the best scenario. But this assumes that doctors have a reasonable patient load and thus lots of time to spend with patients, and enough free time in their schedule to allow them to see people without appointments. This is seldom the case.

Comments

Alan's picture
Alan on November 11, 2004 - 21:43

A family member of mine went through a serious medical condition here in large part through the assistance of a walk-in clinic. One of the features of the care was continuity though not necessarily always the same doctors. Each he met was aware of the case and assisted in helping him through a rigourous set of specialist appointments and tests. Just because you are not seeing the same docutor does not mean there is a problem with continuity. Beside, these clinics have operated for decades — just not there. Do you really need a pop-can law for medical care?

Mitch's picture
Mitch on November 12, 2004 - 00:12

The Medical Society’s take on walk-ins is simply outrageous…apologies in advance for any “ranting”.

An informed friend once told me that the well publicized family doctor shortage in PEI was actually an engineered construct of the medical hierarchy, actively pursued to ensure the “tenured” established doctors could earn max $$, with lots of overflow to fill any holes that might arise in their practices.

At the time, I thought that idea was preposterous…I firmly believed the Medical Society (and others) were doing handstands to bring in new doctors, old doctors, any doctors they could get their hands on, in order to relieve the suffering (yes, suffering) of hundreds of “unconnected” Island families lacking a family doctor and languishing in emergency rooms or the overburdened clinics of the time.

Since that time I have, by happenstance, been privy to several situations where the medical establishment has sought to bar, restrict or harass qualified doctors attempting to establish here, despite the urgent need. Was my friend correct ? It appears increasingly so.

Now we have the frankly foolish (or is that foolishly frank ?) comments of Dr. Bigsby. “[F]ast food medicine” ??? Cripes ! There are many many families who would gladly accept ready access to a “Happy Meal” doctor, when otherwise thet can’t even get a table, let alone service, at the Michelin 3 Star “doctoraunts” Dr. Bigsby implies are so superior.

As Peter and Alan point out, the superiority question is far from clear. But what is truly assinine is to to whine about taking business “away” from “established” family doctors when they can’t service the volume in the first place.

Nils's picture
Nils on November 12, 2004 - 01:42

If the “Medical Society” was viewed for what it is — a semantically glorified trade union — their bleatings against this necessary service would be dismissed by the public out-of-hand. Instead, the doctors glide through disputes like this on a cloud of practiced entitlement.

I cannot wait for the day when some Health Minister has the cojones to say “Enough. We need doctors here, the population exists to support new doctors, and if the Medical Society (which, after all, derives its power from the people of this province) won’t see fit to remove unreasonable barriers to new doctors, we’ll find other ways to accredit them.”

It is not a secret — within the medical community, among the public at large, and within government circles — that the Medical Society is (and has been, for a long time) engaging in blatant job protection at the expense of the most vulnerable members of our society. This is done out of greed and with no regard to the well-being of those on our Island who are sick and in need of care.

First, do no harm …” has been replaced by “First, make sure the billings don’t drop off.” That — and not concern about “fast-food medicine” — is what the Doctor’s Union is concerned about.

Ken's picture
Ken on November 12, 2004 - 02:11

Corrupt doctors, greed, here in PEI? We have no idea what their services cost us  — patients do not get the bill.
How much did that surgery I had cost? I’ll never know.
I’d like to see the invoice for the surgery I had last year.
I wonder what it cost, and I’ll never know.
I’m not accountable.

More like soup kitchen medicine.

The phrase ‘pay at the first window’ doesn’t apply, more like ‘can you pull up and wait for your order’.

Publish doctors annual salaries in the newspaper, they are paid by the public but not accountable to the public. Only to boards half of whom are doctors. Health board members are appointed now — why aren’t they elected. An elected member would be more accountable to us.

Will Pate's picture
Will Pate on November 12, 2004 - 06:37

Oh thank God, maybe now I can get some medical service. The last time I made it into my family doctor’s office he perscribed me a medication with serious side effects in less than two minutes, without even looking me in the eye. That’s not treatment, that’s revolving door perscription service.

When I dropped in to ask when I could get a flu vaccine they had absolutely no idea. Hey, it’s not like it wasn’t all over the news and US Presidential candidates were certianly not debating about Americans coming here to pay for them. I got a call 4 days later saying there was 1 hour of 1 day of 1 week I could come to a clinic to receive one, and it was 2 days away. When I told them it was impossible for me to make it because of scheduled appointments, they basically told me tough luck.

What a joke.

jeff himelman's picture
jeff himelman on November 12, 2004 - 17:18

A couple of points. First, I didn’t see the story in question so I can’t really comment on the dayclinic question directly.

The question seems to be how to clear the backlog of people needing timely medical service, whether by traditional means or by something different. I say medical service rather than doctors because I think there are a lot of ER, clinic type cases which could be addressed without the obligatory doctor prsence..through a nurse, nurse practioner or what have you.

This brings forward the point about ‘empire building’ and there’s way too much of it in health system from all quarters (doctors, nurses, bureaucrats, patients, etc.) so I don’t know where you start with that. That being said, is it the Medical Society that builds these walls to new doctors entering the system or is it College of Physicians? Does anyone know the difference betweeen them or which answers to whom? I’ve come across excellent doctors (people in ER and specialists, a mix of salary and billings) and poor ones on the Island (my quasi-family doctor is a turnstiler who makes faith healing seem cutting edge), so they’re not a monolith in terms of quality service, regardless of how they’re compensated.

Beyond those issues, another big reason we have a backlog is demographics (we’re all aging which inevitably requires more service), human resources (not enough people working in key positions in system)
and the responsibility of the users (patients don’t take enough responsibility for their own health). Speaking as an overweight smoker who doesn’t exercise enough, if we all took a little more care over our health we might be less inclined to run to the doctor every time we get a sniffle or an ache and maybe the lines wouldn’t be quite so long.

As for the accountability of health boards, the biggest reason why more people get appointed than elected is that not enough people bother to put their names forward.

Lisa Howard's picture
Lisa Howard on November 13, 2004 - 13:46

I’m with Nils, there’s a shortage of doctors in a lot of small towns. I think that’s because no one wants to work in a backwater and there could also be other monetary reasons as well. But something has to be done about it.
I don’t think the answer is for ordinary people who don’t have a lot of medical expertise to take more ‘responsibility’ for their health. I think we should be realistic and admit that most people either through laziness or busy-ness aren’t going to exercise. And everyone gets old. I think the bypass that those people need should still be there for them. I think the hip replacement should also be there. That doesn’t mean that we should have private care (which is more expensive). It means we should reorganise the doctors we have and put more money into the system where it’s needed.

Lisa Howard's picture
Lisa Howard on November 13, 2004 - 20:37

By the way, I didn’t mean to imply that *I* think PEI is a backwater. Also, I’m not saying that I think people shouldn’t try to live healthy lives, I just think we should be compassionate towards those who don’t.

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