Patients troubled by doctor screenings

by Tom Blackwell, National Post

Teresa Evans knew that finding a new family doctor would be difficult, but she never expected to have to try out for the privilege.

The first doctor the 33-year-old approached made her fill out a detailed questionnaire on her medical condition, then rejected her application without any explanation. She soon discovered that all the other physicians accepting new patients in St. Catharines, Ont., had a similar screening process.

More and more practitioners across Canada are conducting one-on-one interviews and handing out questionnaires to sift through the many applicants who want to be taken on as new patients.

Amid accusations that overloaded physicians are cherry-picking only the healthiest of patients, Ontario’s medical regulator recently issued a draft policy that would restrict the screening process and recommend physicians take patients on a first-come, first-serve basis whenever possible. The province’s medical association has fired back, saying doctors are independent professionals who should be free to choose patients as they see fit.

Allowing them that freedom is especially important at a time when it is already difficult to convince medical students to specialize in family medicine, said Dr. Janice Willett, president of the OMA.

“There has to be that ability to have that introductory session, that discussion and turn down a patient if they do not seem appropriate,” she said.

The popularity of screening is the latest symptom of Canada’s chronic shortage of doctors, which by one estimate has left four million patients without a family physician. Defenders of the process say screening simply ensures physicians and patients are compatible, while weeding out doctor-shopping drug abusers and other undesirables.

Darlene Watters is not convinced. When the Wasaga Beach, Ont., woman needed to find a new family doctor a little over a year ago, a local hospital gave her a list of 12 physicians who were accepting new patients. Almost every one of them said they would have to conduct an interview first, something Ms. Watters refused to do.

One receptionist even said the office would not accept patients over age 50.

“I just don’t think it’s right,” Ms. Watters said. “They’re going to refuse you based on something — whether it’s being older or ill in some way or you’re on some medication.”

In Ms. Evans’ case, the screening questionnaire asked for a medical history, including what drugs she was taking, current health problems and any past surgery done. She has a thyroid condition and a serious back injury, and is taking three prescription medicines. A receptionist at the doctor’s office said she would be called back in two weeks if she was accepted; Ms. Evans never heard a thing.

“If what you put down doesn’t fit into the job description, they’re not going to take you. It’s the same thing now when you go apply for a doctor,” said Ms. Evans, a mother of three. “[But] this is not a job; this is health, and we should not be put in this position. I have health concerns that I need a family doctor for.”

A woman in Winnipeg complained to the Manitoba College of Physicians and Surgeons recently after being interviewed by a family doctor, then told she had too many health problems to be accepted.

Regulators are trying to decide where such screening crosses the ethical line.

Dr. Bill Pope, registrar of the Manitoba college, noted that doctors face an increasingly demanding caseload as the population ages and gets sicker.

“Some patients are extremely complex and if you filled your practice with those patients, you wouldn’t be able to see the other patients.”

Still, he noted, physicians “can’t hang [the sickest] out to dry.”

Kelly Eby, of the Alberta college, said there is nothing wrong with interviewing patients, but the process should generally not be used just to screen out the very sick, and results should be communicated clearly to patients.

“It can’t be used as a means to select easy patients,” said Susan Prins, a spokeswoman for the B.C. college. “Nor can it be used to screen out those with more difficult health concerns.”

In its draft policy, the College of Physicians and Surgeons of Ontario says doctors must not refuse patients based such on grounds as race, sex, age and religion. It also suggests doctors should not weed out people because they have a criminal record, have filed complaints or lawsuits against other doctors, are involved in workers-compensation claims or ignored past medical advice.

The medical association responds that doctors must keep the “absolute right” to refuse any patient on any ground other than those banned by the human rights code.

Screening patients with interviews or questionnaires seems the norm now, a function of the dire MD shortage and the fact new medical graduates are unwilling to work marathon hours, says Dr. Preston Zuliani, president of the Ontario college.

“Many physicians are just feeling overwhelmed, completely overwhelmed, and are trying to gain some control over their lives and practices.”

The line should be drawn, though, at routinely rejecting people simply because they are very unwell, Dr. Zuliani said.

“To exclusively not look after, say, diabetics or sick people doesn’t seem, somehow, to be the right thing to do.”
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