Doctor’s choice

The worst-kept secret in the provincial health care system is that doctors have the right to dismiss patients any time they feel like it. The reason is simple – doctors aren’t employees of the provincial government or Northern Health, like nurses or other health providers. Doctors are private contractors, who bill the Medical Services Plan for services they provide to their patients. With what they receive in payment for those services, doctors have to pay for office space, equipment, staff, insurance, professional dues and other operational costs. What’s left is their income. That’s why they call it private practice. The doctors are their own bosses, with oversight from the College of Physicians and Surgeons. And when you’re your own boss, you set your own hours (and for most doctors, that means working a lot more than just eight hours a day, five days a week) and you decide who your clients are. Patients who are rude to their doctors under the mistaken belief that doctors are government employees receive quite the shock when their doctor abruptly fires them and the patient finds out they have little or no recourse but to get another doctor, which is no easy task in Prince George and even harder to do in northern rural communities. That’s especially not a smart thing to do for people seeing a specialist of which there may only be one or two in all of Northern B.C. And lipping off the doctor’s assistant at the front counter isn’t a smart idea, either – that could be the doctor’s spouse or other family member. In Saturday’s front page story, Vivian Gowrie, a local woman suffering from a variety of chronic conditions that requires her to be taking a daily mix of prescription medication, expressed her outrage at being dumped by her general practicioner, Dr. Iftkhar Khan, in a random lottery of all his patients. Gowrie has the same right to be outraged as Khan has the same right to reduce the number of patients he sees in his practice by any way he sees fit. “Why didn’t he take the time to go through his patient list and let go the people who weren’t as ill?” Gowrie asked. It’s a fair question (and Dr. Khan didn’t return a call from The Citizen to answer it) but he doesn’t have to explain himself to either Gowrie or to this newspaper. Under the rules set out by the B.C. College of Physicians and Surgeons, doctors can end a relationship with a patient so long as doing so doesn’t put the patient’s life in jeopardy. While Gowrie’s health issues are serious, her life does not appear to be in immediate danger, despite her belief to the contrary. She has easy access, as we all do, to the walkin clinic and the emergency room at University Hospital of Northern B.C. Doctors are required to give enough notice for patients to find another doctor and Khan, in a letter to Gowrie, said he would provide emergency assistance for up to two weeks while she looks for a new doctor. This doesn’t quite meet the recommended three to four weeks of care the provincial guidelines suggest doctors give before releasing a patient but this is the only area where Dr. Khan is even close to being in the wrong. Gowrie was a patient of Dr. Khan’s for four years (and she had no complaints of the care he provided for her during that time) and now she has to search for a new family doctor but her situation, while serious, is no different than others who have had to find new doctors after their G.P. abruptly retired, moved or took an extended leave to address their own medical or personal issues. The method Dr. Khan used to reduce his patient load is also irrelevant. Doctors don’t have to make that choice based on the needs of individual patients. Dr. Khan could have done it by throwing darts at a dart board or by keeping only the patients whose last names started with B. It’s obviously not a perfect system but it has its merits. Paying doctors only for services provided is designed to reward doctors for providing as much care as possible, while keeping costs directly linked to service received. Having doctors as salaried health employees would give them no incentive to do more than provide a minimum level of service and punch a clock. Hopefully Gowrie finds a new local doctor quickly to help her deal with nagging health issues while Khan continues to practice medicine in Prince George, providing the best level of care possible to the largest number of patients he can.