Doctors sideswiped by critical commentary
Less time is being spent on patient care, but what are the causes of this situation?
Re: “New light on doctor shortage,” editorial, Dec. 2.
Iapologize for this being delayed, but I wanted to sit back and think (after running a clinic on Saturday to make it easier for my patients to access me, my seventh day of work in a row, putting in a 70-hour week) about my response, and your perspective, as you are right: There are two sides to every story. So in summary: You are right. Doctors are spending less time on direct patient care. Unfortunately, we have an increasing burden of paperwork, phone calls, patient care co-ordination and forms to spend time on.
Doctors do have smaller practices, as each patient demands and expects more than they did 20 years ago, and we are hoping to care for these patients to the best of our ability. Rather than BandAiding problems, we are trying to find solutions.
Female doctors might have greater child-care responsibilities than their male counterparts, except for those of us who are the sole income-earners in our families. We rarely get to see our families, unless we choose to work fewer hours. In speaking to older doctors who worked 40 per cent more, their biggest regret is working so much and not spending time with their families. So shame on us, you are right.
I suspect the health-care budget does go to running hospitals, paying physicians and drugs, but I’m not sure what else there is to pay for in our health-care system (as there is no support for allied health by the government). However, unlike many other professions, our pay has not increased with inflation, not even close.
GPs do consider themselves self-employed entrepreneurs, because we are. We pay rent, we pay our staff, we equip our offices, we have no benefits, sick leave, maternity leave (except for programs that we pay into ourselves). We are expected to work even if we are going through crisis, have sick children, as we cannot affect patient care by our absence.
We agree that additional training spaces should be funded, but this will only help so much, as people do not want to open their own practice, with 30 to 40 per cent overhead costs out of our pockets, when they could work in a hospital environment with much lower cost and responsibility to themselves. The only thing that will bring more physicians into communitybased care is support from the government, just as hospital-based physicians receive.
Online prescription renewal is a wonderful option, except that there are very few services that meet the standards for protecting patients’ information, and so we risk litigation if a patient’s health information gets out. Many of us provide phone-call availability, same-day access and emergency on-call phone lines to help our patients out. And frankly, most people on medication do need to see their doctor to ensure the disease and the medication are stable. Most of us do not like making extra work for ourselves or our patients, so will give out an appropriate amount of medication before we think the patient should be reassessed.
We would love to employ social workers and nurses to work with our patients, but unlike hospital physicians, we have to pay these practitioners out of our own pockets, further increasing our cost of running a business, and forcing us to work even more hours, or see more patients per hour to pay for this, neither of which is a sustainable long-term solution.
We, as family physicians, definitely do not deserve an appropriate balance of our work lives with our professional responsibilities. It is in the patients’ best interest for us to be working 60-plus hours a week, and not spending time with our families, or on our own mental health.
It is abundantly clear that overworked and stressed people make much better decisions, and really the decisions we as physicians make are not that important in the grand scheme of things. We are only talking about our patients’ well-being, health and perhaps life. (This is obviously not true and it’s completely ridiculous that we should be counselling our patients on self-care, work-life balance, diet and exercise, and not be allowed to do this ourselves.)
In conclusion, I agree with many of your points, but think that your discussion was a very perverse interpretation and a poorly executed editorial on the true issues that are affecting primary care at a community level. Perhaps if you took the time to discuss with a front-line family physician his or her interpretation of the problem, you truly would have a well-rounded discussion to present, and help the problem, rather than alienate us hard-working family physicians.