Monday November 3, 2008
Backlash Against Cherry-Picking Physicians
An estimated 5 million Canadians can't find a family doctor. The shortage has created a disturbing phenomenon: MDs who interview would-be patients in order to cherry pick the easy cases and leave the rest. It means picking low maintenance patients…people who are young, with few if any ongoing serious medical problems like diabetes, no disability, no substance abuse, and no complex psychiatric problems. If you fit that profile and you’re looking for a GP, you’re going to be able to find one, though you may have to do some searching. Any patient who is more complicated to manage, requires that more time be spent caring for them, and more forms to be filled out on their behalf, has been having a tough time finding a family doctor. The list includes seniors, people with three or four serious medical problems (diabetes, stroke, kidney problems, etc), people with dementia, disabilities,serious psychiatric disorders, and substance abuse. I see lots of patients in emerg who fit one of those categories and who have been turned down by MDs.
From the very first episode of White Coat, Black Art that aired in 2007, we've been raising awarness of this issue.
Now, it appears as if a backlash against cherry picking is gaining some traction.
Patients are complaining to human rights tribunals, some of which have ruled in their favor. Some of these tribunals have ruled that doctors who claim to be accepting new patients yet turn down some of them are discriminating against them. In another development, the Ontario Human Rights Commission has altered its procedures to give citizens more direct access to the rights tribunals. The move is expected to open the door to many more complaints from patients. Ontario is the first battleground, but other provincial human rights commissions are watching closely and will likely follow suit.
In response to public pressure plus rulings from human rights tribunals, the College of Physicians and Surgeons of Ontario has developed a new policy on beginning the doctor-patient relationship. The Manitoba College said if a doctor a physician is totally open to accepting new patients and competent to treat them, then they’d have to explain why they are not prepared to accept someone. Last March, the BC College warned family doctors about cherry picking. The Alberta College has been receiving complaints about cherry picking since 2005. It published rules based on the CMA code of ethics. Saskatchewan's College has issued its own guidelines explicitly reminding doctors not to discriminate.
On the surface, these developments are welcome. But, there are dark clouds on the horizon. The human rights approach is to cite doctors for inconsistent policies because they’re open to new patients yet cherry pick. One “solution” for doctors to close their practices to new patients entirely. That would solve the human rights problem, but would make it even more difficult for patients to find a family doctor.
We will continue to follow developments in this ongoing issue.