From: brent@mikejag.wimsey.bc.ca (Brent Kennedy)
Subject: Re: Opting out.
Organization: mikejag (mike) is a private system in Vancouver, BC, Canada
Distribution: bc
Date: Fri, 2 Oct 1992 01:40:26 GMT

In article <1992Oct1.075016.7879@mikejag.wimsey.bc.ca> steve@mikejag.wimsey.bc.ca (Steve (PrettyBoy) Barclay) writes:
>
>There has been some talk in this thread about abuses to the system by users,
>but I have heard no talk about abuses by doctors.  For instance, a friend of
>mine who used to be an ECU nurse at VGH tells me that some doctors refuse to
>preform any surgury except emergency surgery during the day, and attributes 
>this to the fact that doctors get paid twice thier normal fee for working after
>hours.  Is this true?  Can anyone verify this or deny it?  I for one am 
>curious as hell.  Because if it's true it means that there are doctors out
>there who are abusing the system as well, and something should damn well be
>done about it, just the same as something should be done to collect from users
>who abuse the system.
>

Well I think you mean 'ICU' (ie Intensive Care Unit).  I'm not sure what
'ECU' stands for. As for the comment you made, first YES there are doctors who
abuse the system.  The difficulty here is how you define abuse.  BUT, as for
doctors not doing anything but emergency surgery during the day that's total
BS.  Surgical slates are finalized one day ahead of time and planning for them
starts over a week before that.  Surgeons are booked into their surgeries
then.  Emergency surgeries or urgent surgeries can bump the slate, but other
than that a surgeon has to go with the slate.  There are some surgeries booked
outside of regular hours.  This is not always true emergency surgeries, but
sometimes simply overflow from the regular booked surgeries.  How many should
be done outside of regular hours is an item of debate, as it can affect the
waiting lists for elective surgeries.  As for getting 'double the pay', there
are some provisions for doctors getting paid extra on stat holidays and such.
They do not get DOUBLE for 'after hours'. 

 One of the problems this all raises is the problem of what 'abuse by a doctor
is.'  Part of the problem is how much should be done for each patient as what
is called 'the standard of care.'  Wilson's disease could be picked up at an
early age if we screened everyone, and there is treatment available for it.
It can cause damage to the brain, liver, kidney and heart, if not picked up
early enough.  The difficulty is that the disease has an incidence of 1 in
100,000.  The test costs somewhere between $15 and $25 per person.  Should we
screen everyone??  IS a doctor 'abusing the system' if he orders this test??
How long should a doctor spend searching with investigations for the cause of
a patient's problem??  If it costs the health system more money each week, and
it may not affect the care given to the patient, or the prognosis for the
patient, should a doctor keep looking??  The problem here is often the
patients demand that they do, and keep going to more and more doctors until
they get an answer.  Some of these people do eventually get a diagnosis, and
it may even be treatable, but do we cut off the investigations at $1000 oe $1
million dollars??  In the US, patients are given an MRI scan with much higher
frequency than they are here, should we be doing more??  'Abuse' in this
enviroment is difficult to define. 

-- 
#     Brent Kennedy	      | The disease of "Trauma" is responsible for   #
#                             | more years of potential life lost than any   #
# brent@mikejag.wimsey.bc.ca  | other disease, yet it's also the most        #
#		              | preventable, does that make any sense??      #
Newsgroups: bc.general