When Your Doctor Wants To Fire You
Clearly you hold all the cards given the provincial medical health landscape when it comes to doctor access, so yes, using your position as a doctor to tell me you’ll drop me as a client does seem like a threat

What happens if you’re not feeling well and your family doctor, if you have one, isn’t available? You’re left with a couple of choices. The first and obvious choice for some is to go to a hospital emergency service, until they start to process that they may be there upwards of six hours or more. The other option is to go to a walk-in-clinic.  While the walk-in clinic is usually a much shorter wait, many family doctors don’t like it when patients go there because their patient fee (how much the get paid per patient, a model in Ontario Canada) gets deducted.


The Absent Family Doctor

It was a Wednesday morning when Tom woke up feeling ill. He’d been coughing all night, felt a little dizzy, and his blood pressure was higher than normal. He decided to call his family doctor and when no one answered, he left a voice message. The day passed without a returned call. On Thursday Tom still felt ill, his cough had worsened, and his chest was hurting. He decided to call his family doctor again. For a second consecutive day, he could only leave a voice message. Friday morning came and Tom thought he should try his family doctor one more time before he sought out an alternate option as concern for his health was growing. This time the receptionist answered the phone, “Tom, you’re on my list of people to call,” she said as she explained the office had been closed for a couple of days, something that wasn’t evident from their voice mail greeting when Tom was calling. After she put Tom on hold, she came back and said, “The doctor doesn’t have any openings today, but I’ll see what I can do and call you back.”


The Decision

Tom wasn’t certain that he was going to get a call back, even though the receptionist said she would, because she’d said that in the past and then didn’t call until sometime late in the day, or the following day. He had a decision to make. He felt ill and he’d waited over two days already without any help from his family doctor. He waited an hour after speaking with the receptionist and when there was no call back, he decided he’d waited long enough. His family doctor’s office was over an hour away and if he waited any longer and then couldn’t see her, he’d be cutting it close with the clinic waiting line. He also consulted other advice options. Then, he decided to go to a walk-in clinic for his healthcare.


The Angry Family Doctor

Eventually Tom’s family doctor found out that he went to the clinic. Tom didn’t hide the fact he went, in fact in the best interest of continuity for his health he asked the clinic doctors to forward the test results and notes to his family doctor. Following that clinic visit, his family doctor left him a nasty voice mail, followed by a nasty email, both passive aggressively threatening to fire him as a patient for violating her office policy of no walk-in clinics. Neither the voice mail nor the e-mail asked Tom how he was doing. The doctor’s only concern was her loss of income due to Tom going to seek care at the clinic. She said his alternate option was to attend her after hour’s clinic instead and that if he had called, he would have gotten that information. Even when Tom tried to explain that her clinic doctors weren’t available, she was neither interested nor apologetic.


The Value of A Patient

A family doctor is paid a flat rate annually, per patient. If the patient goes to an emergency room, it does not impact the doctor’s income for that patient. If the patient goes to a walk-in clinic, the doctor gets billed or has their annual flat rate reduced for each clinic visit. While there are different tiers of income a doctor may receive depending on a patient’s age, some assessments estimate the average income per patient to be around $200 per year. If a patient goes to a clinic, their family doctor may have their annual income for that patient reduced by up to approximately $34 per clinic visit. That fee is what made Tom’s doctor care more about her office policy than his healthcare.


Quoting The Policies

When Tom asked his doctor what he could have done differently, her reply was a lengthy e-mail response that outlined her view of events, dismissing his question and saying that “My practices are well within the outlines of the medical regulatory bodies; I have done everything within the regulations and rules set forth by Ontario. If you feel these services are not suitable to your needs, then my practice may not be the best place for you.” He didn’t receive a further response when he rebutted her statement, “Clearly you hold all the cards given the provincial medical health landscape when it comes to doctor access, so yes, using your position as a doctor to tell me you’ll drop me as a client does seem like a threat in respect of conduct in the context of the last few weeks of our patient/doctor relationship, outside of any education about your clinic policies. “ He also offered her the $34 she’d caused all of this exchange over.


What Is The Right Decision?

Tom and other patients who might find themselves in similar situations have a difficult decision to make. The Ontario web site on Walk-in Clinics suggests that “Walk-in clinics provide medical care for people who do not have a family doctor or have one and are unable to reach them.” Arguably, Tom could not reach his family doctor for over two days and when he finally did, he didn’t receive a call back in a timely manner that would have allowed him the health care he needed. He also didn’t receive a call back from the doctor’s after-hours clinic. When Tom’s wife called Telehealth Ontario, they also recommended that he should go to a clinic given this circumstance. With all his family doctor options exhausted and on the advice of two other provincial health organizations, Tom made the best decision he could have made in the interest of his health.


How Did It End?

The walk-in clinic visit helped Tom get through his illness. He also kept his family doctor, only because he didn’t have another family doctor, but has lost trust in her as a professional. He hasn’t seen her since that incident and worries about the next time he needs to. The family doctor never followed up with Tom with respect to his health.


While Tom is a fictitious character in name, this article is based on a verified set of events in Ontario, Canada. Tom and the doctor’s names are withheld for privacy purposes.


This is an opinion article by Guido Piraino of  The Monthly Social Podcast. It may also be heard on The Path Radio Mix Online. You can read other opinion articles on the blog page.


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