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Winnipeg Free Press - PRINT EDITION
Only one symptom, please
The story of the woman who was not allowed to complain to her physician about chest pains -- one problem per visit, she was told -- seems apocryphal. It is, after all, the antithesis of good medicine. But it is not impossible, nor improbable because medicine is also a business and doctors charge fees for service on a per-visit basis.
Indeed, the Manitoba College of Physicians and Surgeons is getting increasingly worried about the practice followed by some doctors, often posted on office walls, that restricts clients to a "one problem per visit" rule. In the case of a Selkirk resident, the rule allegedly had devastating effects.
Bruce Angus says his wife Samantha, 60, died of a heart attack last week, two weeks after she went to see a doctor in Selkirk, complaining of back pains. When she tried to speak of her heart problems, the doctor interrupted her and told her she'd have to make another appointment: "One appointment, one problem." That's bad medicine.
Physicians are paid by tariff for types of appointments; some have a time element attached. A regional intermediate visit, the type in which investigation of a health ailment is accommodated, pays $31.85 for a minimum 10 minutes of a family doctor's time. It has no maximum time tied to it.
The college says physicians are asking how to square their professional responsibility with the guidance from the Canadian Medical Association, which suggests doctors tell clients there is a limit to the time and number of complaints that can be handled in a visit.
It's one thing to make an appointment for a broken finger and then ask for a complete physical. But it is risky to diagnose a health ailment when limiting a discussion to what is likely one symptom only -- a back problem may mean something about a heart problem, particularly for a woman. Mr. Angus is asking the college to investigate the incident.
Manitobans can relate to someone who has felt short-changed after being rushed through a medical appointment. Manitoba Health says it puts no maximum on visits, but the tariff must recognize that some patients and conditions will take much more time to diagnose. Doctors must be compensated reasonably for the time, but a dispute over fee for service cannot be waged at a patient's expense.
The college is digging deeper, to review whether it needs to issue a practice directive to nip in the bud a growing problem of "one complaint per visit." Most immediately, doctors must be reminded that they are professionally bound to deliver good medicine; that involves listening respectfully to clients who cannot know, but might suspect, that a number of aches can be tied to an unsuspected and potentially serious health problem.
Republished from the Winnipeg Free Press print edition May 5, 2012 A16
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