POSTED RESPONSE TO A COLUMN IN TORONTO'S GLOBE AND MAIL
"Please tell me
why I went to school for 10 years if I can be so easily be replaced by someone
with so little training in diagnosis."
Sorry, but the comment's author, a doctor, misses the point.
Pharmacists, under the policy, can renew only, and only for
a limited time.
No diagnosis is involved with established conditions.
As you may know, many doctors have seriously abused the
renewal of prescriptions in recent years, some demanding people return to the
office every three months to renew something they've taken for years.
When the patient gets there, he waits and then his blood
pressure is taken and the doctor writes a script (still usually paper, and
barely legible) - a total effort of 3 to 4 minutes.
No diagnosis, no investigation, no effort - just a quick
fee, a fair amount of inconvenience, and inefficiency of a high order.
For that he collects a generous fee from OHIP, which were it
an hourly rate for most working people would put them fairly high into the
middle class.
But it not an hourly fee, it is a four-minute fee.
On top of everything else, with the serious shortage of
doctors, such behavior simply clogs the pipeline for those without a doctor.
This behavior in the view of many borders on the unethical,
and it is at least certainly poor use of resources.
If our system is to become efficient, many changes are
required.
This is a step in the right direction.
It is the doctors who in fact block many genuine
innovations.
When I lived in Maine, more than a decade ago, the system
made extensive use of physicians’ assistants, highly trained people based on
the model of the military's medics.
They all worked under doctors - so that, if there was
uncertainty in a case, the doctor would be called in - but they had considerable leeway and could
prescribe a limited range of drugs.
The system worked beautifully, and the PAs took a great deal
of pressure off the system. It was a happy innovation.
But more than a decade later in Ontario, PAs are almost
unheard of. Why is that? The pressure of the medical profession.
Foreign-trained doctors, too, are given a hard time to
establish themselves here, again a result of pressure from existing doctors.
Of the several Ontario doctors I've experienced over the
last decade, only one even made use of a computer for prescriptions.
Hand-writing these important documents is 19th century. It leads to errors,
corrections, and it is just plain inefficient.
Further on the pharmacists: these people use sophisticated
computer programs that advise of things like interactions and lay before them a
well-organized view of a patient's history.
Pharmacists are likely more knowledgeable in chemistry than
most general practitioners, too, although the point is not essential to this
policy.
Any big system needs constant improvements and new
efficiencies to prevent its tumbling into economic backwardness, and OHIP has
been unbelievably slow to implement and promote these to a meaningful extent.
The average doctor, I'm sure, is quite happy with things as
they are. And why not? A line-up of patients, many for trivial purposes, but
that situation is stagnant and does not contribute to best use of human and
physical resources. Meanwhile, many
cannot even get a family doctor.
