Profits Before Patients? The Corporate Push into BC’s Primary Care System

Big business sees opportunity in replacing the family doctor with corporate clinics or virtual care. Advocates see peril. First in a series.

Licensed practical nurse Anita Dickson had a firsthand look at corporate-delivered telehealth care. She didn’t like what she saw.Photo by Jeff Bassett.

Andrew MacLeod
September 7, 2020
[Excerpts] Anita Dickson recently saw the kind of primary health care one corporate provider is delivering in British Columbia. And it scared her. 
Dickson is president of the Licensed Practical Nurses Association of BC. She has worked everywhere from emergency rooms to hospices and knows the kind of attention that goes into providing careful, personalized health care.

Not long ago she was with a family member who was using Babylon, a service that Telus offers through its health division. “See a doctor from your phone,” Telus promises, with the cost covered by the province’s medicare plan.

Dickson could see that the service was convenient. But she was concerned about what she witnessed — and the risks to patients.

“There’s no connection. It’s just being able to call up and get a prescription, and that’s how [the patient] sees it, and that’s the scary part,” Dickson said. The Tyee is supported by readers like you Join us and grow independent media in Canada

“What I saw was this female doctor gave a prescription for several months of birth control — not knowing [the patient] hadn’t taken her IUD out,” Dickson said. The patient wanted to alter her menstrual cycle and didn’t tell the truth when asked key questions about the IUD. The pill and some types of IUDs both affect hormone levels; using both could create risks for the patient.
A doctor who had been providing care to the patient for some time would likely have identified the risk. But it would be difficult, if not impossible, for a doctor dealing with the patient for the first time, on the phone, to recognize the complication.

The BC Family Doctors, which represents doctors providing primary care, recently released a statement urging caution in the adoption of telemedicine and calling for closer scrutiny of the involvement of corporate care providers.

“The encroachment of private, for-profit telemedicine needs to be regulated and controlled,” the statement said. “BC Family Doctors calls on the B.C. government to regulate and control the expansion of private, commercial interests in for-profit telemedicine in B.C.”

Dr. Toye Oyelese says corporate care undermines the relationship between patient and doctor. And that means lower quality care. Photo by Jeff Bassett.

The statement argues that telemedicine is best when used as a tool within a long-term patient-doctor relationship. One-off episodic services “should only be provided as an intermittent and infrequent alternative to a patient’s family doctor,” it says.

Corporatization was pushing care in the other direction, it said, with a growing number of British Columbians using telemedicine and losing continuity of care.

The doctors’ group also said private companies should be required to meet the same conflict of interest standards accepted by family physicians and other regulated health professionals. It warned, for example, that pharmacies shouldn’t be allowed to gain by entering partnerships with telemedicine providers that agree to drive patients to them.

“These changes are necessary in order to provide for the protection and safety of patients,” it said.

Some worry the government will be reluctant to take steps that would hamper Telus’s business. 

To read the full article, click on: Profits Before Patients? The Corporate Push into BC’s Primary Care System

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Where Telemedicine Falls Short

Mike Kemp/Getty Images

by David Blumenthal
June 30, 2020

[Excerpts] Telehealth use has surged during the coronavirus pandemic, with the technology spreading far and fast. Doctors and patients alike must be wondering if this is the beginning of a whole new kind of doctor–patient relationship, one that might totally transform our health care system.

I am not skeptical because of the technology: I am a strong supporter of health information technology and believe new IT holds huge benefits for patients and their caregivers.

But I am also a primary care physician. I know that trusting relationships between patients and clinicians can be a boon to giving and receiving care.
I also know that well-trained clinicians use all their senses — not just hearing and vision. They appraise the whole patient: Is there a new limp, a shift in posture, a new pallor?

And there is no diagnostic test more cost-effective than the laying on of hands. I have found treatable cancers multiple times in routine exams that would be impossible to replicate in the virtual world.

There are times and places where virtual care makes perfect sense. During the pandemic, when in-person exposure has to be limited, it has been crucial for keeping doctors and patients And in parts of America where no alternatives exist, telehealth has been a lifesaver — especially in enabling the delivery of scarce specialty services to support family physicians in remote areas.

There are also situations where virtual connections deliver excellent care with greater convenience and lower cost than in-person visits. Examples include routine and repetitive issues like monitoring blood pressure or mild respiratory symptoms (Covid-19 notwithstanding). 

There is  growing evidence that virtual care for some mental health conditions works well, too. And virtual care likely works better for the young and healthy than the elderly and sick.

The past few months represent a crash course in telehealth for doctors and their patients, and this exposure will undoubtedly leave us better positioned to use the technology moving forward.

But telecare will work best when it is adapted to humans and their needs rather than the reverse. It should be one more tool that builds upon, and promotes, the human relationships and caring clinical eyes, ears, and hands that have always sustained us when we are sick.
To read the full article, click on: Where Telemedicine Falls Short

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Some family doctors in B.C. now accepting new patients
Penny Daflos

Multi-media journalist, CTV News Vancouver
June 27, 2020

VANCOUVER — For the first time in years, if you ask a family doctor in Metro Vancouver if they can take you on as a patient you actually have a good chance of hearing “yes.”

Several general practitioners and the professional association Doctors of BC all tell CTV News that patient rosters are opening up for the first time in years due to two factors: a slowdown in visits to doctors overall, and the efficiencies found in virtual health-care services that expanded during the COVID-19 pandemic.

“There have definitely been some anecdotal stories that (telehealth and virtual health) are increasing the number of spaces and that may be true or not, it’s too early to tell, because unfortunately not everyone is seeing their physician,” explained Doctors of BC President, Dr. Kathleen Ross, who says doctors can handle more patients in the day via phone or video chat.

While all health-care providers are urging people needing medical attention to call in advance to determine if a virtual appointment is sufficient, doctors are still seeing patients in their offices for assessments that need the human touch. That dual approach is allowing multi-doctor clinics like Aquarius Medical to treat more patients than before.

“Before, we were limited in available (space) and weren’t taking new patients, but now … the space isn’t such a problem, so we are able to once again take new patients,” said Aquarius medical director Dr. Linda Jando. “We are seeing a lot of mental health issues through the pandemic, but we’re seeing a lot of our usual patients coming in for headaches, backaches, bladder infections, skin rashes — the typical stuff we usually see.”

Doctors have been urging people who need immediate medical attention, medication or continuing care to see their physician or attend a walk-in clinic, urgent care centre or emergency department as needed. Visits are down across the board, with doctors blaming nervousness to be around sick people during a pandemic and the misplaced belief that doctors are too busy with COVID-19 patients to see anyone else.

So many people are staying away, medical professions in a range of fields worry there may be collateral damage of the pandemic as chronic health conditions go untreated or minor issues develop into complex, long-term problems.

At the same time, the Canadian Medical Association recently conducted a nationwide survey that found about half of Canadian have had a virtual appointment, with 91 per cent satisfied with the experience.

Ross suggests anyone looking for a family doctor approach their local primary care practice or ask a doctor they like during a virtual or walk-in clinic visit if they’re taking new patients. She’s also urging anyone hesitant about a remote appointment to at least call their family doctor to discuss any health issues they may have.

“As physicians, we miss that hands-on, face-to-face connection with our patients, as well, using only virtual care,” said Ross. “However, that’s where we are for the moment, so I encourage patients to reach out, speak to their family doctor if they have one, or to contact their local division of family practice if they don’t have a family doctor and are looking for one.” 
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