An elderly patient — new to Alberta — calls
up a physician said to be accepting new patients. After
a few moments on the phone with the receptionist, during
which some basic questions are asked, she is abruptly
informed that the GP will not, in fact, take her on. The
reason? She's over 70, and the doctor isn't taking on
any more elderly patients.
Depending on your point of view,
this story may smack of discrimination or it could be
seen as a shining example of responsible clinic management.
And it's precisely the kind of debate that's going on
in Alberta, where a severe shortage of family doctors
is forcing GPs to take the step of screening potential
patients before taking them on.
WHY
THEY'RE SCREENING
"Many patients don't have family physicians," says Dr
Karen Mazurek, Assistant Registrar of the College of
Physicians and Surgeons of Alberta [CPSA]. "They're
looking desperately for family physicians, and physicians
are so swamped. They want to provide the best possible
service to patients, so they have instituted a meet
and greet ... not so much for screening, but to make
sure that [the arrangement] best serves both physicians
and patients."
Nonetheless, when the CPSA began
receiving complaints from patients who felt they had
been unduly discriminated against, Dr Mazurek decided
to publish an article in the college's newsletter, The
Messenger, outlining some guidelines for doctors.
THE
RULEBOOK
The guidelines referred to the Canadian Medical Association's
[CMA] code of ethics, which states: In providing medical
service, do not discriminate against any patient on
such grounds as age, gender, marital status, medical
condition, national or ethnic origin, physical or mental
disability, political affiliation, race, religion, sexual
orientation, or socioeconomic status.
"We just wanted to remind physicians
of their ethical obligation, because we don't have any
[official] guidelines .... All we did was remind physicians
of their medical responsibility," says Dr Mazurek.
A
COMPLEX ISSUE
At one doctor's office in Calgary, which prefers to
remain anonymous, patients over the age of 70 were being
turned down — that is until Dr Mazurek's article
appeared. Now, the clinic is taking on anyone who calls,
but will be forced to close the practice to new patients
in the near future, because it is nearing capacity.
"We were very busy, and we had
two choices," says the clinic's receptionist. "We can
take only some patients, or we can close the practice
for everybody .... It looks we are going to be closing
the door soon."
But it's still perfectly acceptable
for doctors to limit the services that they will provide,
as noted in the CMA code of ethics: This does not abrogate
the physician's right to refuse to accept a patient
for legitimate reasons.
"Physicians have a right to tailor
their practices," says Dr Mazurek. "A family doctor
might say, 'I don't want to do obstetrics, so they will
limit their practice to everything but obstetrics."
SOME
SCREENING IS OK
Dr Albert Schumacher, president of the CMA, notes that
an introductory interview is beneficial to both patient
and physician, offering a chance to test compatibility
in personality and in treatment philosophy.
"It's probably a good idea for
a doctor and a patient to meet so that they can talk
about things like scope of practice, styles, expectations,
values, life decisions," he says. "You've got to be
extremely comfortable with the person taking care of
you, because they're helping you make some of the most
important decisions of your life."
Dr Schumacher also notes that some
doctors may choose not to prescribe contraceptives or
refer patients for abortions. "That's a pretty important
thing for people to know on the first visit," he says.
"You can call it screening, but it seems like a lot
of common sense stuff to me."
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