A few weeks ago, we asked you to send us your questions about the way the health care system runs. As usual, you teased and peppered us with queries via emails, phone calls, tweets and postings to our blog and our Facebook page. Welcome to our season-ending 'Ask Dr. Brian' episode.
Listen Saturday, December 31 at 11:30 am (noon NT) and again on Monday, January 2 at 11:30 am (3:30 pm) on CBC Radio One.
I'd also like to take this opportunity to thank all of you for listening to the show and for contributing to our blog and Facebook page. I will be continuing as CBC Radio One's 'House Doctor' on afternoon shows throughout the country. And you can always contact me on Twitter @WCBADoctorBrian.
Some patients find their doctors difficult to deal with. Turns out some doctors feel the same way about their patients. Check out thre first minute or so of this classic episode from Seinfeld.
The doctor in the scene is writing Elaine's epitaph as a patient. That's Seinfeld's version of how people like me handle difficult patients in TV land. Elizabeth of Halifax is convinced it happens in real life.
She writes: "Dear Brian: I am just wondering why blacklisting is allowed to go on in the Canadian health care system? If we had real privacy then this would not happen. "
Elizabeth, officially, it's considered unethical to blacklist patients for any reason. I've never worked in an emergency department that blacklisted patients, but I have worked in ERs that developed policies to deal with patients who are known to be disruptive. ERs used to keep a file of difficult patients -- for example, people who pretended to be ill to score narcotic prescriptions. More recently, the practice has been frowned upon because it violates patient privacy, is open to misinterpretation, and can result in patients being deprived of health care.
That doesn't stop MDs from unofficially telling colleagues what they think of patients. A geriatrician I know said oral blacklisting goes on all the time via phone and in person. The targets are patients who fire off lots of frivolous complaints to the College of Physicians and Surgeons, the doctor's licensing watchdog. He said it's especially prevalent among doctors who care for nursing home patients with families who frequently accuse the staff of physical and emotional abuse.
I do recall at least one fairly recent attempt at overt blacklisting. Back in 2004, the American Medical Association debated a proposal that MDs in the US refuse to treat malpractice lawyers, their families and their employees except in emergencies. Despite a good deal of support for the proposal, it didn't pass.
Health care isn't just about poking and prodding, ordering tests and prescribing treatments. It's also about documenting all of that - creating a record of what's been done to make sure no one missed anything and so that someone can step into your health professional's shoes if and when necessary.
That led Howard Kirsch of Montreal to 'Ask Dr. Brian' this question:
"What happens to patient records when a doctor either retires or dies suddenly? I had surgery 34 years ago and the surgeon passed away nine years later. At the time I didn't give it much thought. Now there is a problem in the area that was operated on and I would like to find the file that was in his office...but nobody has a clue as to what happened to it. Fortunately, I have the surgical records from the hospital which I obtained years ago in case I ever needed them. Why is there no protocol to keep patient records for as long as the patient lives?"
Howard, there's no such protocol because - right or wrong - the current system centres around doctors - not patients. As long as the physician is alive, he or she needs to keep your medical records for a certain period of time. In your home province of Quebec, doctors need to keep most records for just five years, after which they may destroy them. Operation reports for major surgery -- for example, the procedure you had -- as well as pathology and other kinds of reports must be kept in that province for ten years. Genetic test reports must be kept for a total of twenty years.
Other provinces have somewhat different rules. In BC, records must be kept for seven years. In Alberta and in Ontario, it's ten years, although regulators in Ontario say it's prudent to keep records a minimum of fifteen years because of delayed legal proceedings that can be brought up against the doctor.
When a physician practising in Quebec retires or dies, the records are transferred to a records custodian. In BC, the records must be transferred to another physician or stored; in Ontario, they're transferred to another physician at the same address and phone number or retained through a commercial record storage company. In general, the records must be kept as long as required were the physician still in practice or still alive.
In my opinion, we'll only see a cradle-to-grave patient record when we as a society demand it from the state.
As an ER physician, this next pet peeve posed by Josephine Grayson of Toronto was meant for me. She asks: "I've recently been in emergency several times with my father who is ninety-two. My observation is that a series of ER doctors came by and asked the same questions. Once admitted, he was then visited by another series of doctors who asked the same questions all over again. Other medical staff do this too. I appreciate that it was a teaching hospital, but why can't the information be recorded somewhere when it's first taken so that it can be reviewed by other medical staff?"
Josephine, I hear you. When I took my ninety-year old dad to an ER at a certain teaching hospital in Toronto last summer, we had the same experience. Your complaint is just one of many good reasons why Canadians need an electronic health record that is detailed and can go seamlessly from one health professional or one hospital to the next. Until then, the more printed information you can bring like a list of medications, letters from specialists and recent hospital discharge summaries, the less you'll have to keep repeating.
Still, doing all that will reduce but won't eliminate repetition. Nor should it. In some instances, repetition is good for your dad. I'd be worried if the nurse who is about to inject an antibiotic or chemo didn't ask to make certain you're not allergic to it. Trust me: lists of medication allergies can be misleading and sometimes downright incorrect.
Besides, when it comes to a history and physical examination, studies show there's no guarantee the person who first recorded their findings got them right. You want as many physicians, nurses, residents and students as possible to get engaged in figuring out what's wrong with you. You also want to be there to make sure each new health person understands the reason for the visit and what the treatment plan is.
Josephine Grayson also wondered if it would also be a good thing to leave an iPad or some other tablet at the patient's bedside to help cut down on the repetition of information. Lots of hospitals are experimenting with tablets. Still, there are a host of patient privacy and security issues that have to be worked out before they become standard issue at the patient's bedside.
Thanks to all of you for your fantastic questions. And from the many who sent us queries, we drew three winners. Elizabeth Martin, Judith Roux, and Susan Wells you'll each receive a copy of my book 'The Night Shift.
Before I take my leave, I wanted to thank the two talented people it's been my pleasure to work with last season and this. If you like a particular episode and you're not sure why, chances are, producer Kent Hoffman is the reason. He is a genius at putting voice, sound and music together like it was meant to be. And, if you liked our passion for everything from PSWs to hospital parking to our recent town hall Generation Rx, thank senior producer Jean Kim. The instant she gets behind a show, it will be done and done beautifully.
Have a safe, healthy and prosperous New Year!