The Americanization of Canadian medicine involves more than privatized clinics

“More tests, Doc? That lawyer is watching!” Below: More unhealthy things than unlicensed automatic firearms slip across the Medicine Line at the Ambassador Bridge and other entry points from the Republic to the south.

Are Canadian physicians and other health care professionals practicing “defensive medicine,” paying more attention to the legal risks they face than to the wellbeing of their patients? And are patient-care dollars being diverted by university hospitals to academic pursuits such as esoteric research and teaching?

We on the Canadian left have been very quick to assail plans by provincial governments to experiment with American-style, market-based health care delivery systems – and rightly so. The additional costs to taxpayers and the potential to harm the ability of the health care system to deliver care to everyone are well established in two-tier market-based systems, no matter what the Wildrose Alliance has to say about it.

But is anyone paying attention to the Americanization our health care system when it comes to aggressive civil litigation and the importation of American-style regulatory bodies to Canadian medicine?

In other words, there is more than one pernicious import from the United States slipping across our undefended Medicine Line that can have a nasty impact on our health care costs, and I’m not just talking about automatic pistols sneaking across the Ambassador Bridge!

Physicians will tell you privately that the impact of aggressive U.S.-style civil litigation on our health care system has been a dramatic – and expensive – increase in what they term defensive medicine. To avoid the potential for litigation, physicians will order every test known to medical science, or at least every test the doctor concludes a lawyer or judge would like to see. And then maybe some more after that. If the testing doesn’t produce satisfactory results, they’ll recommend a hospital admission where one really isn’t necessary.

Results still inconclusive? Well, leave the patient in hospital. Never discharge anyone until you’re rock-solid certain there’s a cure for whatever it is that ails them.

Obviously, in an uncertain world, this is going to have an impact on the cost of operating the entire system.

Worse, though, I have heard physicians discreetly suggest that close to a third of the time medical professionals take up preparing for operating room procedures goes to making sure a perfect medical legal document exists – rather than ensuring the patient’s wellbeing. Reduced to its cruelly absurd endpoint, the survival of the patient is unimportant as long as the documentation achieves perfection!

Apparently nowadays there’s a need to drape more than the patient during preparation for surgery – the surgeon’s butt and those of other OR staff need covering too!

The danger is that without adoption of a new model of medical litigation and regulatory enforcement, the efficiency of our health care system will continue to grind down, and costs will continue to rise.

Another cost factor little commented upon by anyone on the left, or anywhere else in the political spectrum for that matter, is the diversion of funds earmarked for patient care to academic pursuits, particularly at hospitals affiliated with university medical faculties. Universities are burning through patient-care funding to finance academic research and education.

Influences like these mean that whomever you put in charge of Alberta Health services – even if he or she has sworn off oatmeal-raisin cookies for a lifetime – their chances of success are slim when two out of three of the significant problems they face are outside their jurisdiction.

This post also appears on rabble.ca.

2 Comments on "The Americanization of Canadian medicine involves more than privatized clinics"

  1. jerrymacgp says:

    Well, David, this time you've done it. while normally I agree with you on many issues, you're way off base on this one.

    Firstly, the field of negligence law (which is what health care malpractice litigation actually is) in Canada law is dramatically different that that in the US, due to fundamental structural differences between our two respective legal systems.

    Secondly, with respect to your comments about OR safety initiatives, it's important to remember that no person is more vulnerable than when undergoing a surgical procedure under a general anaesthetic. You are essentially in an induced coma and completely paralyzed, unable to move, blink or even breathe for yourself. You are completely dependent on the surgical team for your very life. Modern safety initiatives, including checklists and "time-outs", are designed to prevent such catastrophic horror stories such as: sponges and instruments being left inside people; wrong limb being amputated; wrong surgery being performed; breasts and testicles being removed unnecessarily; awakening during surgery but while under chemical paralysis; and drugs being given to which the unfortunate patient is known to be highly allergic.

    Finally, as a Registered Nurse with over a quarter-century of experience, and with the abysmal practices I have seen some incompetent or careless physicians engage in over the years, I say we need more litigation, not less: more patients and families need to report poor physician practice to the College of Physicians, and more need to sue. It isn't about picking on the many good doctors, its about weeding out the bad ones. As independent practitioners, accountable to no manager or supervisor, physician oversight has been completely delegated to the College and the courts.

  2. Mark says:

    Interesting take. A law prof told us that Canadian doctors (as a professional group) have self-insured themselves to the hilt against litigation and never settle. In his view, patient claims are a lost cause since most patients with a legitimate complaint can't afford to win. If my professors view is correct I suspect that if the doctors have any trepidation, it's because they are concerned about their rates.

    And to jerrymacgp – it's not just negligence – battery is also a common one, and a more straightforward than negligence. Negligence claims are often difficult to prove, no matter the field.

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