Posted by chris on March 3rd, 2008 | No Comments »

This week the National Post ran an article (here), and an editorial (here) on the topic of doctor’s being able to choose their patients.

This is one issue that I believe is tough to find “neutrality.” As I think is the objective of many editorial pieces, I think it strikes enough core beliefs that you have to be selective of those with whom to discuss the issue.

In the spirit of the right solution being able to sidestep all the noise created by conflicting philosophies and values, I wanted to bring light to the position put forward by a doctor in a letter to the editor by Dr. Susan Piccinin in Ancaster, Ontario.

She talks about insistence on narcotic-based medication being a “red flag” for physicians when talking to patients. The ensuing dialogue in an initial meeting might look something like this:

Patient: I have a back problem and I have been taking [narcotic-based medication] for it. Can I get some of that from you?

Doctor: Using that kind of medication for any length of time is going to build up dangerous addictions and won’t help your back at all in the long-term.

Patient: I am not addicted; it’s just the only thing that works! Please, give me the prescription.

Doctor: Sorry I don’t prescribe these medications, and for that reason we a not a good match.

Note: The last line is a direct quote from the letter to the editor.

There would have to be a fairly involved exchange of information between the doctor and the patient to get to the above dialogue. For this to work the patient would have to be open and trusting with the doctor (Will this happen if the patient feels a danger of being screened out?), and the doctor would have to devote the time to probe the right information, in a fairly sophisticated manner. (Do doctors have the time? Do they have the skill?)

If this doesn’t work, emotions will cloud the exchange long before we arrive at the “I need the drug/You can’t have the drug” impasse, which, I believe, is a legitimate position for the doctor to hold. Objectively, a doctor should be able to refuse care to a patient who will not allow care to be delivered. (e.g. You are not going to listen to me, so why should I talk to you?)

If this is indeed the case, I think the “selecting patients” issue becomes quite simple, although a number of other complicated issues arise, such as “how does this patient get the treatment they need?” The follow-on issues are much better fodder for articles and editorial pieces, which would create more practical discussion.

 

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