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Why Does Everyone Want Me
to See My Family Doctor?

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 21 in the November 20-21, 2004 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.

It really depends in what context this question is posed. It might be that the reader has not seen her family doctor for some time, or it may also be a way to level great expectations that are impossible to deliver. I will endeavor to explain. "Go see your family doc" has become a convenient way to move patients along without engaging in large quantities of unremunerated work. Most areas of the medical system have discovered this strategy, including hospitals, clinics, specialists, and agencies. I do not view walk-in clinics as being something evil, but rather a sad response generated by the pressures of the time-constrained instant-service generation. These clinics are proliferating, and pretty soon I am certain that we will have more walk-in clinics than doctors. Walk-in clinics provide convenient and quick service for the simplest of problems. Very few life-threatening situations grace these facilities in our city. They are mostly used for convenience. Impersonal and anonymous, no muss, no fuss, little follow-up and no charts. After expenses and taxes, the doctor working there will get about an average of $10 to see you. It seems like a small amount but family doctors accept it as an alternative to long office hours and complicated problems. The walk-in clinic system is founded on maximizing the inadequacies of the OHIP system. Bring in a list of problems and the main one gets addressed while the others are met with songs of "Go see your family doc".

To understand this behavior, you must understand how OHIP works. It was designed to deal with one medical problem at a time. Astonishingly, your full-service family doctor and the convenient one-stop doctor are remunerated at exactly the same rate. The walk-in can deal with your quick problem in about 7 to 10 minutes and end with a closer such as "See your family doc for that MRI, referral, legal letter, form or whatever". Walk-ins generally do not conceal this and are honest about what they do up front. Most people will take the more difficult problems to their family doctors or group their problems together. It is human nature to do this. Unfortunately, the family doctor is often the one who then has to sit down and break the news of realistic expectations within our system. They are also the ones who often will see the other problems on your "list" for free, ask how your family is doing, and will spend hours seeking out services, compiling letters to specialists, reviewing and updating your chart, awaiting results and making many calls on your behalf. They are the ones who will be there for your Cesarean or other surgery, and may provide a familiar face when you are hospitalized. They are the ones with whom you get upset when your call-in problems are not immediately settled, or that "unremunerated favor" was not performed. They are also the ones who take the blame when your test is not completed immediately and the consultation takes months. Because there is a personal investment in your relationship, they too share your frustrations.

This is also the group that takes the brunt of the burden when the rest of the system breaks down. Recently, I had a long-time patient appear at my window in a crisis situation when the overworked specialist who was following the problem could not be reached. I did what I could, and then placed a call to my colleague for strategic advice. Imagine my surprise when the answering machine suggested that I see myself if it's an emergency. In another case, the specialist reported the results of a long sought after test and concluded by suggesting that I arrange a second urgent test. I left a message asking whether he realizes that his advice is confusing since he himself oversees the arranging of these tests with a waiting list of 9 months. Never did hear back.

Community Care Access Centers (CCAC) are new organizations which are tasked with looking after sick people discharged from hospitals but who are not well enough to care for themselves. Amazingly, these large, somewhat costly, virtual out of hospital care units were launched all over the province in the belief that they did not require physicians within their framework. The result is a situation where, to properly function, they must intrusively thrust themselves at other parts of the system. The overwhelmed full-service physician is a favorite target for downloading time-consuming and often unattainable requests.

Imagine if society ever decided to treat the right to own, drive and maintain cars like we do in health care. Garages would be "free" and while most of us would value our privileges, some people would insist on a wash, vacuum and oil change every time they stopped for gas. And those gas line-ups would be long, because in a publicly run system, I would envision only two gas stations in a city the size of Mississauga. Each station would have numerous managers, cashiers and gas attendants. This would leave little room for the mechanics who only have two bays to work in, and who would be encouraged not to clutter the facility. Of course, the station would run 24 hours a day. Pretty soon, simply filling up becomes an all-day chore and an oil change needs to be booked a year in advance. Yet at other times, you simply pull up and get your tires immediately topped up with air, and you mistakenly conclude that it seems to work fine.

It is no wonder that the full-service physician is falling off the radar screen. The real issues stem from how the status quo attacks the Hippocratic Oath. Full-service physicians are spending greater parts of their day informing their trusted patients with complicated medical conditions that the optimum course of investigation or treatment is not readily available, and then agonize for weeks and months while they and their patients go through the tortuous health care maze while the clock ticks. Guilt and helplessness have replaced satisfaction. More time is eaten up with non-medical administrative tasks like forms, calls and management. There are no pensions, sick time or locum help available to these folks whose working hours may be considered inhumane in other sectors. No wonder the young residents take a look and say "No, thanks." A recent wage proposal enticed burned out doctors to provide more service which would result in more pay. Einstein's ghost crafted this one which leads me to this practical Tip of the Day: Try to see your doctor in morning when his or her mind is least cluttered. The best diagnoses are made in the morning.

The only things family doctors want for Christmas are to work reasonable hours, spend more time with patients, and have access to diagnostic/treatment services. Christmas miracles are in short supply these days. One stress-coping mechanism, seen more often recently, involves closing the full-service practice to join the ranks of the walk-in clinic. Half the hours at the same pay! No personal commitments, no need to hone diagnostic skills, track long term problems or advocate preventative medicine, no feelings of satisfaction or even a thank-you when the sore throat gets better. So, be wary the next time someone tells you to see your graying dinosaur of a family doctor for a quick fix because, with each transgression, the clock ticks a little closer to extinction!

Related Resources:
Are the days of the family doctor numbered? from IrishHealth.com

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