Reading Between the Lines

Health care seems to have taken a prominent position in people’s minds these days. In Alberta the news media complain that there is little information forthcoming on Ralph’s “third way”. In Ontario there seems to be an issue with a “French only” community clinic and its refusal to give service to an ill, English speaking Canadian citizen. And in the halls of our esteemed Canadian Medical Association, there seems to be a problem with free speech or something to that effect. The truth is the average citizen hasn’t a clue what is going on and neither the powers that be, or the news media (as I referred to in yesterday’s blog), or both, are too keen on informing the average “Joe”. So let’s speculate.
First it’s not surprising that nothing is forthcoming about Alberta’s third way. How do you bring forward anything in health care that cannot be misconstrued? It reminds me of the commercial of this fellow who is trying to quit smoking; every time he tries to take a cigarette from the package he gets “zapped with an electric shock. The harder he tries the more he gets zapped. I really don’t see much on the horizon from Ralph that is going to make much of a difference, but you can be sure it will be blown up into some kind of “beginning of the end” of Medicare. Now that the election is over we have to fill the newsprint, and after all, Prime Minister Harper said he would protect Medicare, etc, etc, etc. Ralph is going to get “zapped” no matter what he comes up with!
The bloggers have been onto the Ontario lady being turned away from a “French Only” Medical clinic for the past two days. Incredibly, most thought it had to do with language (as did Don Martin in today’s Calgary Herald), when in fact I would think it has primarily to do with money; the very thing that in Canada is NEVER to influence the medical care we receive. Although this clinic was probably set up as a political “show piece” to show how much the Ontario Government Values its Francophone population, it is probably one of our new innovative “globally funded” health care units. These units are provided a fixed amount of money annually by the government or Health Region based on the number of people who have registered (signed up) to receive medical care from the clinic. In effect it functions much like a very elite private clinic but is taxpayer funded. Various formulas exist to calculate the funding based on age and other criteria. Usually those criteria are medical and it would indeed be interesting if one of the criteria is “language”. It would appear in this particular case the Medical Clinic (often called Community Health Care Organization or some other politically acceptable name) may not have had a provision in there agreement with government, to be funded for people that were not registrants, or perhaps the clinic deemed it too much trouble doing the paperwork. In any case, I’m sure the Clinic, in their agreement with government, has the right to reject “Non Members” irrespective of language. Allowing direct payment by a non member would create even more of a stink.
One has to keep in mind that few politicians who have any experience in the health care field, are going to say anything bad about the above scenario. The have been sold on the idea of these clinics being the salvation on the cost part of the health care equation. If all of the public were signed up with Government Health Clinics they could calculate an annual budget for health care. People could not “shop around” or “double doctor” and the responsibility for containing cost will fall on the providers. In many of these arrangements, the provider may be put in the situation “Do I order this test and X-ray or do I give myself a raise this year?” The appropriate term for this is: “Conflict of interest”.
It is interesting that Dr. John Hoey, editor of the Canadian Medical Journal, was recently fired (in spite of ten years of extra-ordinary work) along with his assistant, by the owners of the Journal---the Canadian Medical Association. He apparently had accused the Canadian Medical Association of censorship. It would appear that Dr. Hoey had some interesting information on the new process whereby pharmacists are prescribing the “morning-after-pill”, and wasn’t allowed to publish this information (it’s called censorship in my dictionary). I strongly suspect he may have had some negative comments about the process, such as questions asked about frequency and when the patient last had unprotected intercourse, and the privacy in which these questions are being asked. The issue would go to the relevance of the questions asked and the privacy concerns of the patient. I would suspect the question is being asked in an attempt to determine if the patient could already be pregnant, and therefore the pharmacist may wish not to dispense the morning-after-pill. I would think combined committees of the Canadian Medical Association, the Canadian Pharmacy Association and the Federal Department of Health should have determined the appropriate questions to be asked, and assured privacy during the interviews. Unfortunately, there is no medical evidence to suggest that taking the morning-after-pill is in anyway harmful to the fetus or mom if taken when she is already pregnant. In short, this looks more like delving into personal sexual “history taking” for reasons that are not clear. Exposing this would not speak well for our federal bodies involved, and represents a set back for one of the new bright innovative ideas of making primary care a multiple personnel contact sport! It seems obvious to me this is medical news and should be printed; the Canadian Medical association thought otherwise for obvious reasons and fired an extremely capable editor.
During the hepatitis blood scandal one member of the investigative panel said “When doctors become business people who do we turn to for medical advice?” Now we can ask another question: “When reporters and their publishers become politicians, who do we turn to for medical news?”