Do You Have A “One Problem” Doctor?
09 Dec 2008
Have you seen this sign in your doctor’s office? It reads, “One problem per visit, please.” An editorial in the Canadian Medical Association Journal says this sign is popping up in the offices of some family physicians. So how will the one-problem- doctor affect your medical care?
How did this asinine situation happen? One evening I attended a dinner to hear the President of the Ontario Medical Association announce an upcoming meeting with provincial health officials about the OMA fee schedule. The President gave the usual rally-the-troops speech but left immediately to catch a plane as she had to see patients the next morning! Can you imagine the uproar from Canadian Auto Workers if their president was a part-time leader who couldn’t stay for the entire meeting?
Years ago I wrote a series of articles about prominent Canadians. I asked Shirley Carr, then president of the Canadian Labour Congress, why doctors continually lost battles with politicians. Her quick response, “You need good negotiators. Doctors are not trained in how to bargain.”
Without skilled negotiators to deal with politicians it’s like sending a 98 pound weakling into the ring with Mohammed Ali. Rather, physicians desperately need a permanent “Buzz Hargrove” to fight for their interests. They should have paid him a million dollars a year. Instead they waste millions on part-time, rotating presidents and committees of doctors, to look after the financial interests of the country’s physicians.
The result is a fee schedule that would make Hargrove blush. Like a grocery list its $15.75 for this service, $12.80 for that service, etc. These ridiculous fees set the stage for today’s rapid assembly line office visits, to cover the increasing cost of running a medical practice.
Faced with escalating costs and a grocery-like fee schedule Hargrove would demand pensions for family doctors. Since family doctors are in effect socialized why shouldn’t they be treated the same as teachers and others who enjoy escalating pensions.
Elementary school teachers $93,000 a year with zero overhead!
Don’t blame family doctors for this one- problem approach. I sympathize with them as I used to be one. The fault lies with colleagues themselves who believe part-time, short-term presidents can be effective. It’s unbelievable that the president of the OMA only has to be available 150 days of the year when the annual budget is in the millions.
Dentists have been smarter. So have lawyers. The more problems you bring to them the more they like it, and the more they charge. But not doctors.
What does this mean to patients if they have a one-problem-doctor? This decision threatens anything from simply the annoyance, inconvenience and waste of time of having to return to the doctor for several symptoms. Not to mention inefficient medical care. But there’s a much more hazardous side to this approach. I’d predict that-one problem-doctors are going to miss serious and life-threatening diseases.
What about the patient who is suffering from an attack of sciatica, the type that shoots knife-like pain down the leg and makes grown men cry? You can bet that not being able to stand due to incapacitating pain is a more urgent problem than painless rectal bleeding. So faced with a one-problem office visit, rectal bleeding can be postponed. Then the patient may decide the bleeding is due to common hemorrhoids and never see the doctor again, until colon cancer has spread beyond hope of cure.
The CMA journal says the one-problem-per-visit will take many years to address. It’s probably right because I’m not aware of any major effort to solve the doctor shortage in this country. But there are ways to start removing these signs.
Why don’t we use foreign-trained doctors who have been granted permission to enter this country? Some are driving taxis or employed in an assortment of jobs while trying to get a medical license. There’s no reason why these physicians couldn’t act along side other doctors until they’ve satisfied Canadian standards.
Hell will freeze over before this happens. But if there’s a clone of Buzz Hargrove around, doctors should offer him whatever he asks to look after their financial affairs. Then their fees won’t look like a Loblaws grocery list. And the one-problem-per-visit signs will gradually disappear.
