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  • Cash and out-of-network: good for medicine as free agency is for sports January 21, 2015
    Andrew Schlafly, J.D., General Counsel, AAPS, opens the 21st Thrive, Not Just Survive workshop held Jan. 9, 2015 in New Orleans, LA.
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  • My Direct Pay Practice January 19, 2015
    Brenda Arnett, MD http://arnettmd.com, talks about why and how she launched a third-party-free internal medicine practice. From January 9, 2015.
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    Dr. Josh Umbehr, founder of http://atlas.md speaks at AAPS XXI Thrive Not Just Survive Workshop, January 9, 2015 in New Orleans, LA.
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  • Ralph Weber Talks MediCrats with FreedomWorks – Part 1 January 16, 2015
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    Gerard J. Gianoli, M.D., F.A.C.S. of The Ear and Balance Institute, Covington, Louisiana, http://EarAndBalance.net speaks at the AAPS Thrive, Not Just Survive workshop held January 9, 2015 in New Orleans.
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  • Update on AAPS Legal Initiatives in War on Doctors and Patients January 15, 2015
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  • The Answer to American Medicine is NOT Coming from DC January 15, 2015
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    The patient-physician relationship should be balanced, not one-sided with physicians skimping on visit time and not allowing patients to ask enough questions or explain their symptoms well. Eighteen seconds is the average time a patient is allowed to talk before …
  • The Physicians Declaration of Independence in 2015 January 14, 2015
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  • Physicians & Patients: Take Your Power Back January 14, 2015
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  • Self-Funded Awareness & The Movie “Dune” January 7, 2015
    by G. Keith Smith, MD “The sleeper has awakened.” Anyone who has seen the movie “Dune” knows the scene where Paul Atreides proclaims his new awareness. Having recently attended the annual meeting of the Self-Insurance Institute of America I was …

Fired…By My Doctor in Canada!

As if it isn’t enough for Canadian patients having to deal with waiting lists for medical care, they also get to deal with the very real threat of being fired by their doctor. In a country where it’s difficult to find a doctor to begin with, (see Monday’s MediBlog), physicians can afford to be picky about who they see, and might have to do so out of necessity due to limited resources.

My doctor fired me – what can I do?

LISA PRIEST

From Monday’s Globe and Mail

Published Sunday, Apr. 17, 2011 4:00PM EDT

Last updated Monday, Apr. 18, 2011 5:49PM EDT

The question: I have had the same family doctor for 15 years whom I see four to six times annually. I recently received a registered letter from him stating I was too demanding a patient and that he will provide emergency service for the following 30 days only. Can doctors fire patients?

The answer: The short answer is yes, doctors can terminate relationships with their patients. But this case was handled in a callous way. I’m not alone in finding the doctor’s missive unsavoury. Sending a letter through the mail without any previous discussion was called as “tacky” and “not patient-friendly,” by Dennis Kendel, registrar of the College of Physicians and Surgeons of Saskatchewan.

In a telephone interview from Saskatoon he likened the doctor-patient relationship failure to that of a marriage, noting that “sometimes it just doesn’t work out between a physician and a patient.”

Here is what patients need to know: There are certain things that doctors are forbidden to do when selecting patients. And they have obligations to those patients whom they may want to eject from their medical practice.

The Canadian Medical Association code of ethics says physicians can’t discriminate based on age, gender, medical condition, sexual orientation and political affiliation, to name just a few. Doctors must provide “appropriate assistance” to any patient with an urgent need for medical care. Physicians should provide care until their services are no longer required, or until another suitable physician has assumed responsibility, or give a patient “reasonable notice” of the intention to terminate the relationship.

The provincial bodies that license and regulate doctors typically incorporate this code into their regulations.

If you get a letter like this patient did, chances are the relationship is too damaged to repair. You could contact the provincial college of physicians and surgeons and see if someone there can intervene, but think about it: Do you really want to force yourself on a doctor who doesn’t want you? If you get seriously ill, will you have confidence the physician will do everything possible to get you the best care?

If the relationship hasn’t soured too badly, see if that physician can help you locate another one who is a better match.

As a patient, you should reflect on what went wrong because you don’t want to go through this again. Were you too demanding on a doctor’s time? Did you keep going over the same issue repeatedly when the doctor felt it had been addressed? Were you going to the physician with a laundry list of medical ailments?

Physicians are paid a on a fee-for-service basis, which means they receive a fixed amount for each visit. Time is money. During a visit, they expect to hear one or two complaints; sometimes more if it’s an annual physical. The health-care system is flawed in that way, but it’s the best we’ve got.

That said, it’s a partnership, not a dictatorship. You have rights. If you go to your doctor with sheets downloaded from the Internet, does the physician bristle?

Dr. Kendel says patients have a right to ask questions about their condition. Some doctors welcome them but others “show antibodies” when presented with information culled from the Internet.

If you are not yet fired as a patient, but feel things are going off track, sometimes a call to the college of physicians and surgeons in your province may result in staff being able to broker a renewed relationship.

As Dr. Kendel points out, “Sometimes it succeeds, sometimes it doesn’t.”

Ultimately, no patient wants a doctor who doesn’t want them.

The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.

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