Belligerent Inefficiency

Every comment I have received on this topic has confirmed my observations and supported my critique. A number of them added to my list of issues with both the Medical Services Plan (MSP) specifically and the medical system generally. While I am not likely to make a great deal of headway in terms of reforming this sacred cow, I do intend to try and lobby for some changes: particularly in those areas that have impacted me personally and those that I see as egregious abuse of resources.

One relatively minor one that jumps out at me every month is the bill MSP mails me. Most invoices I receive on a regular basis have an option (usually offered with inducement) to convert to electronic billing - and correspondingly, my bank offers me the option of automatic payment, which in the case of MSP has been set up. On an annual basis, if just a portion of MSP subscribers converted and saved the postage, printing, etc., the savings would be significant.

A very common issue is the requirement that patients must return to their physician for routine prescription refills. One friend commented that she has been on the same thyroid medication for 32 years, and although she is able to schedule blood tests herself, she is obliged to visit her clinic for prescription refills - for which the clinic obviously invoices MSP. The same person reports that her clinic only allows one issue to be dealt with per visit, so if she needs a skin rash looked at it requires another appointment rather than dealing with it on her prescription refill visit. I can only quote her comment: "how stupid is that?"

On a personal basis, having just had the shingles inoculation, at a cost of $200 each for myself and my wife, after saving MSP the cost of several visits to the doctor, I have to ask why I am obliged to pay for this, when smallpox, MMR, and other vaccinations for children are fully covered? Is this not a clear case of age discrimination? I haven't reached that particular milestone, but I understand that the physical which is required for a driver's licence renewal (annually?) for drivers over 80 is also not covered. I presume this is principally because 80-year-olds are not aggressive enough to seek parity with younger folk and have no organized advocacy working effectively on their behalf. British Columbia does, in fact, have a "Seniors Advocate" with a supporting bureaucracy, but like every branch of government, this one has its own agenda and has show absolutely no interest in this issue.

Another particularly galling issue for me is the propagation of the myth of "free" medical services. This certainly works on a subconscious level with folk who see value only when a number is attached. I have to go back to the case of my late Father-in-law, when he was still mobile, and would think nothing of "dropping in" on his doctor because he happened to be in the neighborhood. The fact of the matter was that he was lonely, and any attention from a familiar face was welcome. In any event, I am convinced that had he been sent a copy of the doctor's billing to MSP, or had he been subject to even a nominal charge for a visit, the thought of casually dropping-in on his doctor would not even have occurred to him.

Meantime, I set up a paper trail to continue my quest.

Shingles vaccine is not covered...

Unlike my parents and their generation, who generally held their physicians in excessively high regard, if not awe, I regard the medical profession with what I consider a healthy degree of scepticism, and I am prepared not only to challenge their edicts, but hold them fully accountable for their actions. I recently had perfect vindication for my attitude, and I believe that our system would work a lot more effectively, and at less cost, if more of us adopted a similar posture.

My most recent experience was with my family doctor, to whom I relate fairly well, but with substantial reservations – to the point that I will only consult him if all else fails. A principal reason for my reluctance to deal with him is the unnecessary difficulty I find in arranging to see him. I don't know if it is a common physicians' failing, but my doctor's office refuses to arrange appointments by email. He claims that it's because his receptionist is not computer literate, but I believe there is more to it than that. In any event, one is obliged to phone for an appointment, and the process inevitably leads to telephone tag, because Lucy, his receptionist, spends much of her day on the phone returning missed calls. Also she has an interesting recorded message for calls after hours, which could have been lifted almost word for word from Joseph Heller's Catch 22. It states, and I am paraphrasing from memory: “We do not accept messages after hours, so please call during our working hours, which are...”. She does not specifically state that if you call during working hours you will reach an automated recording which asks you to leave a message, but the implication is clear.

In any event, my current interaction concerned getting inoculated against shingles, a precaution I had been considering for some time, but had deferred until now. My first instinct was to call the doctor, which turns out to have been misguided. As expected, I left a message to be called back, but clearly stated my purpose in calling. In the interim I was informed by a friend that a doctor's prescription is not required, and most pharmacies will provide both the vaccine and the service. So I did some comparative shopping by phone, and found every pharmacy I called had the vaccine on hand and the cost was mostly within a 12% spread. So I went off to the most convenient and friendly locale (the least cost, and least convenient, one - at Costco - was booked up for a couple of weeks and erroneously required a prescription), and half an hour later the process was complete. The following day, I finally had a call back from Lucy, who told me right away that the doctor said that I needed a prescription for the vaccine and would therefore need to come in and see him. I thanked her for calling back, and informed her that I did not need a prescription, and that I had already had the inoculation.

This leads me to a couple of comments about physicians' attitudes in general, my doctor specifically, and questions about accountability and transparency regarding our Medical Service Plan (MSP). First and foremost, one of my principal beefs with physicians in general is their absolute conviction that their time is many times more valuable than that of their patients. Perhaps the filthy rich and politically influential are able to avoid medical waiting rooms, but most mere mortals are very familiar with them. I appreciate that scheduling is subject to priorities and emergencies, but it seems to me that effective and efficient planning and scheduling should minimize wait times, and mostly eliminate them. I admit that I have never worked in a medical office, nor have had to interact with dozens of people in a day, but I firmly believe that a minimal time and motion study, combined with a healthy regard for the ever suffering patient's time would save a lot of frustration and waste.

Coming back to my non-appointment with my doctor, leads me to speculate on how much time I would have wasted on the consultation, purchase of the vaccine, second consultation to have the injection, and possible follow up. Further, what would it have cost MSP? Did my doctor deliberately try and mislead me about the prescription requirement, or is he simply ignorant? Either way, it does little for my confidence in the medical profession and the medical system in general.

I am not a frequent user of medical facilities, and therefore may not be the best informed on the processes of our MSP; but I can recall a good number of occasions when I have had medical services provided, and only one occasion on which I had any contact with MSP requesting tacit confirmation that a service had been performed. The lack of communication from MSP leads many folk to the misconception that medical services are “free” and the corresponding abuse of them. I do not understand why MSP does not provide patients with a complete accounting for, and of, services that have been billed on their behalf. The cost, done digitally, would be minimal; and although many, or perhaps most, patients would not scrutinize such documentation, it would certainly encourage the service providers to be prepared to justify their invoicing. I believe it would work much like a constant audit or double entry bookkeeping, and make the public much more aware of where its tax dollars are going.

In pursuing the issue further, I encountered the belligerent inefficiency of a system aligned to serve itself rather than the public.