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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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