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You ask, we answer

Well, we asked for questions, and you didn't disappoint us. Nearly 400 came via email, voicemail and our blog. We've picked the most intriguing questions to answer on this week's show on Monday December 15 at 1130 am (noon NT) and again on Saturday December 20 at 430 pm (5 pm NT). Thanks again for making the show a success.

Today I'm in Sudbury, Ontario, to give a lecture to students of the Northern Medical School. While I'm here, I'll be paying a visit to the first nurse practitioner-led primary health-care clinic in Canada. The clinic opened November 19, 2007, and it's been running non-stop ever since thanks to two powerhouse nurse practitioners: Marilyn Butcher and Roberta Heale. The clnic has been so successful that the Ontario Government has asked for 25 more NP-led clinics throughout the province.

I'll have more to say about NP-led clinics following my visit. But I will say this right now: 4 million Canadians can't find a family doctor. If this clinic helps deal with that problem, I'm all for it.

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Previous Comments (4)

You just answered a letter that asked - are we allowed to see our patient file - and your answer was yes, definately.

I have not only asked Careplace Medical Clinic (been going there over 15 years) to see my file, but I want a copy to take with me because I want to get a family doctor. I have asked three times, they say it is their property, and not only am I not allowed to see it, but I'm not allowed to have a copy. I phoned the College of Physicians & Surgeons, told them, and their response was - it is the clinic's decision whether to give me a copy but they will usually charge a fee, and they cannot step in to help me obtain a copy.

Where are you getting your info saying I CAN get a copy, so I can bring this to someone's attention. It's important only because I have had severe symptoms of Crones/IBS, I don't know over 15 years and after testing of every single kind (my thought is they've been doing everything for the money and no solution/diagnosis) so I am literally dying to find another doctor - and if I don't take a copy of my two inch thick file, I'll be forced to do all the tests again.

Please help me! thanks--and I absolutely love your show!!
Michelle

Michelle Snow, December 15, 2008 2:56 PM

Michelle,

Sorry if my answer sounded totally black and white. On my side of the gurney, things never quite work out that way.

Let's drill a little deeper here. In June 1992, the Supreme Court of Canada ruled in McInerney v. MacDonald that “in the absence of legislation, a patient is entitled, upon request, to examine and copy all information in her medical records which the physician considered in administering advice or treatment, including records prepared by other doctors that the physician may have received.”

Now for the grey area. The physician may hold back parts of the file if he or she believes that releasing that part of the file to the patient is not in the patient's best interest. That said, the Supreme Court ruled that the physician must justify why he or she withholds the information.

The above provision was not intended to give the physician an unfettered right to refuse such access.

There are other factors that may have an impact on access. Physicians are not obliged to maintain records forever. The physician would be legally permitted to destroy parts of the record that are outdated.

Here are specific provisions in Ontario:

• Physicians have a duty to maintain adequate records on each patient.
• Certain basic elements must be included in that record.
• Records must be secure and they are the property of the physician.
• Records must be maintained for a defined period.
• Patients have a right of access to their records at reasonable times.
• Authorized representatives have right of access to the records or their copies.
• Patients may request transfer of the medical information to another physician.
• A fee may be charged for this transfer of information or copying of records.
• Physicians may only deny access to a medical record when they believe on reasonable grounds that such disclosure may lead to harm to the patient or violate a confidence.

Source: Physicians In The Health Care System
Excerpted and adapted from Health Personnel Trends in Health Care, 1993 – 2002 (published April 30, 2004)

Dr. Brian, December 15, 2008 5:48 PM

With the difficulty in getting in to see a local specialist and the long wait times for apointments of any kind I have consulted with an American doctor in the US that was recommended by a friend. On reviewing his credentials I found he is actually a D.O. (fully licenced osteopathic physician) rather than a M.D. (medical doctor). I am told D.O.s can practice in any hospital and do everything a M.D. can do - including surgery of all kinds. Please enlighten me as to what the difference is between an MD and a DO. Are both equally qualified and can I have the same confidence in a DO as an MD? Does Canada have D.O.s? How would you suggest I find a dependable doctor in in the US? Thanks. Max

Max Morgan, September 13, 2009 2:41 AM

NP session!

As an SP (Standardized Patient) at Memorial's medical school, I was asked to do a session with the NP's here in St. John's re: the respiratory system. I was introduced by Heather (one of the instructors with the NP program) as being an SP and the three NP's involved in this session wanted to know what an SP was as they had never heard about us. They thought that I was a "real patient" off the street and were pleasantly surprised on how much I knew about the respiratory system and I proceeded to explain to them the SP program at MUN's medical school. I think it would be a good topic for one of your podcasts as there are probably a lot of people, healthcare workers and others, who don't know anything about this particular program that is part of the med school program in a lot of med schools across both Canada and the United States. Just a suggestion from one of your loyal podcast listeners. Warmest regards, Peter

Peter Geary, September 20, 2009 6:25 PM
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