Canada Values Health - Dialogue on Health Care -

Should the route to a specialist always be through a family doctor?

2009-03-09 09:23:18

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"Is always using a family doctor as gateway to specialist - a mistake? My daughter has a chronic skin condition. After five years of family physicians trying to guess at and prescribe prescriptions for it, she's no further ahead and thousands of health care dollars have been spent. My opinion is that we should trust Canadians to know when they need a specialist and education on when to see a specialist would cost less than family doctors trying to do-all and be-all."

- A CanadaValuesHealth.ca visitor

Your responses
Should the route to a specialist always be through a family doctor? Roto Posted: 2009-05-15 13:33:54 If one could self diagnose and pay for all services in a private sector health care, what purpose would the family physician have? As mentioned elsewhere we need a stronger Gatekeeper with more responsibility and resources to better manage the health of her/his clients effectively and efficiently. Skipping the gatekeeper would likely make the system worse.
Would private sector health care help? Art Campbell Posted: 2009-04-14 13:59:37 With private sector health care, the patient would bear the cost. See "Dissed in America"
Of Course! devildocs Posted: 2009-04-01 14:50:18 It is silly to consider allowing citizens to self refer themselves to specialist doctors. There are numerous causes of many symptoms, and it is the role of the family doctor to consider what the underlying condition may be. If he/she feels the condition may be outside the scope of their practice, then they should refer the patient onto a specialist colleague. The idea of patients referring themselves is basically saying patients are expected to self diagnose and refer themselves onto the appropriate specialist. However, unless they've gone to medical school, this is a dangerous practice. Some would say checking on the internet certifies one as being knowledgeable and all knowing. There are numerous unreliable websites and simply having one or two symptoms on a list does not mean you have that disease. As an example: - patient complains of abdominal pain. There are numerous possibilities here ranging from a bladder infection to a gallstone to a gynaecological problem or to a psychiatric condition. - the family doctor's job here is to take a detailed history to rule out possible causes and to elicit other symptoms as well as complete an examination. He/she may order some additional diagnostic tests to help in diagnosis. - it is crystal clear from this example that unless someone has proper medical training, they will not be able to come to a reasonable diagnosis/conclusion
Paternalistic burno Posted: 2009-03-16 08:18:13 Why do we need to go through a family doctor when we need a specialist... I believe we should be able to make the decision as to when and who we see as a specialist... In fact if we have a family doctor the team this doctor works in should be available to us to make our own decision... The system we have now is too paternalistic
This issue needs some thought bneuwelt Posted: 2009-03-14 04:57:28 I think this is an issue we should be looking at. I"m not sure what the answer is. It's true that if anyone could go to a specialist any time, we'd have huge wait lists. However, it happens often that people know a little more about their condition than their family doctor does. An individual can educate themselves through the internet, friends, colleagues. A family doctor can't keep up with all the latest details of all the health problems they see. And families see their loved ones much more often than the dr. does. So there needs to be some scope for people and their families to be able to access more specialized care, to avoid exactly what Tracey is talking about in the first response to this question.
Referrals to Specialist blynn Posted: 2009-03-12 11:43:08 I mostly agree that the physician needs to be a gatekeeper, otherwise who the heck can keep track of your health and what is already being prescribed, etc. That being said, I have had difficulties myself getting referrals to specialists that I know I should have seen years earlier and could have prevented deterioration of a condition. I work in health care, however, so have a better knowledge of a carepath. For others, they may overuse this privilege and then wait times will skyrocket.
Specialist via FP salee Posted: 2009-03-11 06:53:52 There's a shortage of doctors. Unless we can increase the pool, private healthcare won't solve the problem. Let's have competition in the healthcare sector - global competition. Let's allow patients the option to go offshore for treatment, paid for by OHIP. OHIP can put up a list of approved overseas hospitals.
wait times will go up realist Posted: 2009-03-11 06:48:52 The concept of a family physician as a gatekeeper helps limit unnecessary referrals. There is a shortage of specialists and a shortage of family doctors however. If access to a family doctor cannot be made then it is difficult to get a referral to a specialist. The simplistic approach is to allow other health providers to refer to specialists. However, despite the good intentions of doing this, what will result is increased wait times for more specialists (who are in short supply as previously noted). All that will happen is that the bottle neck, or constrained access point, will be shifted farther down the health care "pipe". So as much as this kind of attempt to improve access has good intentions, it is not likely to help patients. It may help politicians who want to be seen to be doing something about access. On the other hand, let's say for a minute that the specialist shortage does not exist, somehow rectified in some quick and mysterious way. If we allow more access through the referrals to specialists by various providers other than family physicians, then the cost to the system will increase as these services would have to be paid for. Even if the specialist is on salary somehow, it is not necessarily the payment to the physician that creates great expense to the health care system...it is the diagnostics and treatments that come from this access after the specialist is seen and determines what needs to be done. Anyway you look at it, more access means more health care costs. Even if you consider prevention as part of the solution, prevention costs money either from the government or from the patient or from private industry. What is really missing from the whole equation is more patient responsibility. Of course, sometimes patients are just dealt a bad hand in the health care gene pool and they develop diseases through no fault of their own. They still need care despite all kinds of upfront costs for prevention. Wait until the up front loading of the health care system costs increases with more genetic screening which will result in more preventative modalities for screening (all costing $$ throughout the patient's lifetime and some will get the disease regardless and still need treatment anyway). It all adds up to increasing costs to the system whether there are other routes to a specialist other than the family doctor or not. Family doctors would be the most efficient way of sorting out who needs to see a specialist and who doesn't . Of course, if patients wanted to pay for their own specialist referral as is done in some cases in France for second opinions then perhaps this is one possibility.
family doctor arthur Posted: 2009-03-10 16:18:17 Could it be that our good family Doctor's have to ration who they refer to a specialist due to our Public Health Care which understandably has FINANCIAL LIMITS....WAKE UP CALL TO CANADIANS our taxes can't pay for everything that each of us needs or wants in perpetuity... Why do we treat our health in lesser terms than our vehicles, houses, pets etc .... Perhaps those kidney diseases etc could be attended to in a system that actually cares about their patients, not just a number to be run through the mill.... Where is the debate for PRIVATE HELATH CARE....LETS HAVE IT....
Specialists Tracy Lister Posted: 2009-03-09 09:42:43 As a healthcare worker I see numerous cases every month where people should have been sent to a specialist but the physicians either have not suggested it or refused to make the referral. One area that is sadly under utilized is nephrology. I see dozen of people each month with failing kidneys and heading down the path of dialysis quickly and have never seen a specialist. Seeing a nephrologist may have saved many kidneys and prevented the waiting list for hemodialysis not to mention the savings in healthcare dollars and quality of life for people spending 12+ hours connected to a dialysis machine and feeling unwell the rest of the time.