Saturday, March 28, 2009

BCMA’s progressive addiction policy

The BCMA has done something good. It has called for accessible and publicly funded treatment for substance-use disorders and compulsive gambling. The inadequacy of treatment resources for people with addictive disorders is well known to patients and their families, and to physicians of British Columbia. The stigmatization of these disorders, however, robs patients and families of a public voice. Alcoholics Anonymous has its name for a reason. Physicians must be advocates for such people.

The BCMA published a policy paper which has received significant media attention, including a headline story in the Vancouver Sun. The summary of recommendations includes a call for the ministry of health to “recognize addiction as a chronic, treatable disease.” Furthermore, the BCMA asks the province to “ensure that access to addiction care is accessible without financial and other barriers throughout BC; this includes the elimination of per diem fees, minimization of language barriers, and access to inpatient addiction care.” The request goes further: “Create and fund” 840 new treatment beds.

Organized medicine in Canada seems ready to turn surgical care and imaging services over to for-profit enterprises. It is refreshing for a provincial medical organization to advocate for public delivery and funding of treatment for chronic diseases that devastate individuals and communities, and that place a massive burden on acute-care hospitals.

The deliberate inclusion of gambling as an addictive disorder that deserves publicly funded treatment is noteworthy. Although the policy paper does not point out government’s conflict of interest as the regulator and beneficiary of “gaming” revenues, the authors must recognize government's responsibility to those who become addicted. Lotteries in particular are a regressive, albeit voluntary tax that many North American jurisdictions rely upon. Perhaps it is too much to ask that the BCMA call for the elimination of government-sponsored gambling.

Randall F. White, MD

Saturday, March 14, 2009

Family physicians and patients need more information about specialists

Why can’t family physicians easily find the best specialist with the shortest wait time for a new consultation? In BC, information on wait time for certain surgical procedures is available on a provincial Web site. The figures, however, account only for the waiting time once the surgeon has determined that an operation is necessary. Wait times for the initial consultation with a surgeon or with a non-surgical specialist are unavailable.

Lack of coordinated referral networks is an aspect of the Canadian system which has led some to call it a cottage industry. Doctors work in their isolated offices, create local networks for referrals, and have little knowledge of or access to specialists beyond that. This, along with the low physician density in Canada, has contributed to the growth of specialist wait lists.

Without reliable information, family physicians cannot adequately help their patients find the quickest consultation and, if needed, operation. A BC business has exploited this situation and, for a fee, will match a patient with a specialist. The company’s Web site, though, quickly informs the reader that “the need for private medical services is thriving in Canada,” and that the company “is able to expedite most types of private medical services from diagnostics to virtually all types of surgery.” The option of having treatment in a public facility doesn’t seem to merit mention.

Vancouver Sun editorialists recently pointed out this company’s services and asked why the government can’t provide information on availability of specialists to patients and family physicians. Good question! The public is paying for the services, after all, and is entitled to some accountability.

Documenting wait times is a necessary aspect of quality improvement in medicine. Collecting and publishing such information for the public should be part of a universal health care system. Aside from patients, family physicians have the most to gain and should advocate for this despite any resistance from specialists. Commercialization will continue to gain ground in health care if obvious solutions such as registries of specialists’ wait times and pooled wait lists are ignored.

Randall F. White, MD