pone Posted March 10, 2018 Report Share Posted March 10, 2018 I have a Canadian friend with a very sick child and a problem with a specific specialist. The specialist saw the child a few years ago and dismissed any diagnosis. Now the parents have other specialists who think the first specialist might be wrong who are requesting additional testing. In every case, the first specialist somehow learns about the activity of the other doctors. He then steps in and sabotages all of their efforts. He somehow intimidates the other doctors and they then back off the case. My friend wants the specialist fired. Not only does she want the specialist to not give an opinion to her, but she wants to forbid his participation in the child's case, and to strictly forbid his talking to any other doctors they go to. Does Canada have any administrative process to accomplish this? How is it done? Who should she speak with? How much bureaucracy and process is involved in getting a formal bureaucracy involved here to silence the troublemaker? Quote Link to comment Share on other sites More sharing options...
?Impact Posted March 10, 2018 Report Share Posted March 10, 2018 I would suggest filing a complaint with the College of Physicians and Surgeons in the respective province. This sounds like a case of unprofessional conduct according to the description you have given. Quote Link to comment Share on other sites More sharing options...
pone Posted March 10, 2018 Author Report Share Posted March 10, 2018 (edited) 5 hours ago, ?Impact said: I would suggest filing a complaint with the College of Physicians and Surgeons in the respective province. This sounds like a case of unprofessional conduct according to the description you have given. Maybe that has merit, but at best that results in a disciplinary action. That really isn't the desired outcome. She isn't trying to prove his incompetence. The desired outcome is to prohibit his further interference in her case. What they want is some kind of formal administrative ruling that removes him from the case so he can no longer block any action by a different doctor, and if he does intervene then he would be subject to disciplinary action in the future. I think they are totally okay with an outcome where no one questions his expertise but he simply is forced out of the picture. Is there any formal process to support that desired outcome? Edited March 11, 2018 by pone Quote Link to comment Share on other sites More sharing options...
eyeball Posted March 11, 2018 Report Share Posted March 11, 2018 What are the specifics of the case, the illness, diagnoses and results of treatment? I'm sorry for asking but are there any belief systems that might be influencing your friend and causing this apparent clash with the original doctor and diagnoses? The reason I ask is that I know a couple of people who have run into some serious resistance from doctors due to their beliefs about treatments etc. This appears to be a growing problem along with growing public mistrust of virtually all our institutions. Quote Link to comment Share on other sites More sharing options...
pone Posted March 11, 2018 Author Report Share Posted March 11, 2018 (edited) 1 hour ago, eyeball said: What are the specifics of the case, the illness, diagnoses and results of treatment? I'm sorry for asking but are there any belief systems that might be influencing your friend and causing this apparent clash with the original doctor and diagnoses? The reason I ask is that I know a couple of people who have run into some serious resistance from doctors due to their beliefs about treatments etc. This appears to be a growing problem along with growing public mistrust of virtually all our institutions. The child has problems with lethargy (semi-comatose and difficult to wake from naps), failure to thrive, leg pains, persistent vomiting. The child has seen multiple metabolic geneticists, and most of those suspect a metabolic disorder, and the details probably do not matter here. The problem doctor is convinced the child does not have a metabolic disorder, and he sabotages all attempts by other doctors to order additional testing or to recommend diagnostic approaches. A typical interaction is that doctor A writes a letter suggesting possible metabolic diseases and testing protocols and sends to doctor B (the bad doctor). Doctor B tells the parents "I disagree with everything she says" and then fails to follow a single recommendation of A. So there are no belief systems involved in this case. But if there were belief systems it should be the right of a parent or patient to decide that a particular doctor will no longer participate in their case. There shouldn't be a need to justify that decision to anyone. P.S., who in their right mind would trust the institution of medicine? Anyone who has a difficult diagnosis and who has been trying to work within the system cannot help but conclude that medicine - as currently structured - hates human beings and treats most of us with utter contempt. Edited March 11, 2018 by pone Quote Link to comment Share on other sites More sharing options...
?Impact Posted March 11, 2018 Report Share Posted March 11, 2018 Is this happening in a smaller community where there are limited specialists, especially in this area of pediatric medicine? The parents certainly should be asking for a more complete explanation of this opinion; are there contraindications, etc.? Certainly there is a level of arrogance among professionals when dealing with the public, but that doesn't mean they don't care and don't have value to share. If Doctor B is the go-to guy in their area, then you might have to work with him or go elsewhere. Doctors rely on each other to discuss cases, especially ones that are highly specialized. The symptoms you described can be associated with a large number of causes. Something you didn't mention is family history, which would be very important in this kind of diagnosis. I agree this is not the forum to discuss that level of detail, just pointing out its medical relevance. I understand the frustration with the medical system, that is fairly wide spread. The only advice I can offer is be as open and honest with doctors you approach, including the fact that you have been to others and disagree with their diagnosis. If you are seeking a second opinion, explain to them why. Quote Link to comment Share on other sites More sharing options...
pone Posted March 11, 2018 Author Report Share Posted March 11, 2018 2 hours ago, ?Impact said: Is this happening in a smaller community where there are limited specialists, especially in this area of pediatric medicine? The parents certainly should be asking for a more complete explanation of this opinion; are there contraindications, etc.? Certainly there is a level of arrogance among professionals when dealing with the public, but that doesn't mean they don't care and don't have value to share. If Doctor B is the go-to guy in their area, then you might have to work with him or go elsewhere. Doctors rely on each other to discuss cases, especially ones that are highly specialized. The symptoms you described can be associated with a large number of causes. Something you didn't mention is family history, which would be very important in this kind of diagnosis. I agree this is not the forum to discuss that level of detail, just pointing out its medical relevance. I understand the frustration with the medical system, that is fairly wide spread. The only advice I can offer is be as open and honest with doctors you approach, including the fact that you have been to others and disagree with their diagnosis. If you are seeking a second opinion, explain to them why. This is happening in Ontario, a large population with many doctors. This is not a place to do a medical diagnosis. Don't second guess symptoms here, please. I am deliberately not including relevant facts to the case. There are three metabolic geneticists who feel she has a metabolic disorder, and one of those is a nationally recognized, Harvard-trained expert. Let's not second guess them, and let's not change the topic. The original question was how do you fire a doctor. They could want to fire him for any reason they choose to. They don't have to justify that reason to you, to me, or to anyone else. I disagree with your advice to be open and honest and explain why you want a second opinion because they did all that already. Their specialist is a jerk with a personality disorder. They want him fired. How do they get him fired? Does Canada give patients any choice at all if you have the doctor from hell? Quote Link to comment Share on other sites More sharing options...
betsy Posted March 11, 2018 Report Share Posted March 11, 2018 (edited) 7 hours ago, pone said: The child has problems with lethargy (semi-comatose and difficult to wake from naps), failure to thrive, leg pains, persistent vomiting. The child has seen multiple metabolic geneticists, and most of those suspect a metabolic disorder, and the details probably do not matter here. The problem doctor is convinced the child does not have a metabolic disorder, and he sabotages all attempts by other doctors to order additional testing or to recommend diagnostic approaches. A typical interaction is that doctor A writes a letter suggesting possible metabolic diseases and testing protocols and sends to doctor B (the bad doctor). Doctor B tells the parents "I disagree with everything she says" and then fails to follow a single recommendation of A. So there are no belief systems involved in this case. But if there were belief systems it should be the right of a parent or patient to decide that a particular doctor will no longer participate in their case. There shouldn't be a need to justify that decision to anyone. P.S., who in their right mind would trust the institution of medicine? Anyone who has a difficult diagnosis and who has been trying to work within the system cannot help but conclude that medicine - as currently structured - hates human beings and treats most of us with utter contempt. Perhaps, tell your friend to go see her MP, and ask for the MP's help. Maybe some support groups will know where or how to go about it. There's no harm in approaching them and asking for advice. http://www.mpncanada.com/living-with-mpn/patient-support-groups/ ------------------------------------- Quote Make all complaints about Ontario doctors public: trial lawyers https://www.thestar.com/news/gta/2014/07/30/make_all_complaints_about_ontario_doctors_public_trial_lawyers.html You could also try to see if CBC's MarketPlace can help: http://www.cbc.ca/marketplace/contactus/ Edited March 11, 2018 by betsy 1 Quote Link to comment Share on other sites More sharing options...
betsy Posted March 11, 2018 Report Share Posted March 11, 2018 13 hours ago, pone said: I have a Canadian friend with a very sick child and a problem with a specific specialist. The specialist saw the child a few years ago and dismissed any diagnosis. Now the parents have other specialists who think the first specialist might be wrong who are requesting additional testing. In every case, the first specialist somehow learns about the activity of the other doctors. He then steps in and sabotages all of their efforts. He somehow intimidates the other doctors and they then back off the case. My friend wants the specialist fired. Not only does she want the specialist to not give an opinion to her, but she wants to forbid his participation in the child's case, and to strictly forbid his talking to any other doctors they go to. Does Canada have any administrative process to accomplish this? How is it done? Who should she speak with? How much bureaucracy and process is involved in getting a formal bureaucracy involved here to silence the troublemaker? I found this: Quote I want to fire my family doctor The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to [email protected] . https://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/i-want-to-fire-my-family-doctor/article559515/ 1 Quote Link to comment Share on other sites More sharing options...
?Impact Posted March 11, 2018 Report Share Posted March 11, 2018 2 hours ago, betsy said: Perhaps, tell your friend to go see her MP, and ask for the MP's help. ... Maybe some support groups will know where or how to go about it. Excellent suggestions, although the MPP may be a better choice as health care is primarily a provincial matter. Quote Link to comment Share on other sites More sharing options...
cannuck Posted March 11, 2018 Report Share Posted March 11, 2018 Pone I can not offer the support of Betsy's link, but just a note of caution. I have done support for a patient's activist group and saw how the medical profession can throw up a "green wall" when defending their members. Also, the "popularity" of those members within the College of Physicans and Surgeons plays a big part. I have seen a totally incompetent surgeon who was caught drunk as a skunk in surgury - but the consequences were for the guy who turned him in to get run out of town, and he carried on as usual - part of being in the core of the "old boys'' club". You need to know your enemy better before you go after him. If they can afford it (and that really IS a big "if") diagnosis at its finest comes from the Mayo Clinic. We do NOT have anything equivalent in Canada and I don't think any health region will refer you there and pay the bill. I have seen some really incompetent attempts to diagnose in a few places in Canada, and the patients had gone from one quack...er "DOCTOR" to another within their health disrict and had HORRIBLE results (multiple ridiculous diagnoses WITH follow in inappropriate treatment - one of which was to cut off the patient's leg when an "out of scope" diagnosis and treatment had him walk into the meeting with Minister and our group all on his own). Pretty much every case I have seen that got to Mayo (including some referred and paid under our universal sick care system) has offered conclusive diagnosis and referral to the very best of people who specialized in treatment. Nothing is medicine is 100%, but there certainly are situations such as you cite that can be 99% wrong. 1 Quote Link to comment Share on other sites More sharing options...
betsy Posted March 11, 2018 Report Share Posted March 11, 2018 58 minutes ago, ?Impact said: Excellent suggestions, although the MPP may be a better choice as health care is primarily a provincial matter. Yes, MPP. Thanks for correcting that. Quote Link to comment Share on other sites More sharing options...
pone Posted March 11, 2018 Author Report Share Posted March 11, 2018 @betsy some great ideas there, which I would summarize as: * Contact your member of provincial parliament for advice and possibly for direct intervention in the case * Contact patient advocacy groups for different rare diseases (and there will be many) * Contact the press, to put an uncomfortable spotlight on the doctor 1 Quote Link to comment Share on other sites More sharing options...
pone Posted March 11, 2018 Author Report Share Posted March 11, 2018 (edited) 4 hours ago, cannuck said: Pone I can not offer the support of Betsy's link, but just a note of caution. I have done support for a patient's activist group and saw how the medical profession can throw up a "green wall" when defending their members. Also, the "popularity" of those members within the College of Physicans and Surgeons plays a big part. I have seen a totally incompetent surgeon who was caught drunk as a skunk in surgury - but the consequences were for the guy who turned him in to get run out of town, and he carried on as usual - part of being in the core of the "old boys'' club". You need to know your enemy better before you go after him. If they can afford it (and that really IS a big "if") diagnosis at its finest comes from the Mayo Clinic. We do NOT have anything equivalent in Canada and I don't think any health region will refer you there and pay the bill. I have seen some really incompetent attempts to diagnose in a few places in Canada, and the patients had gone from one quack...er "DOCTOR" to another within their health disrict and had HORRIBLE results (multiple ridiculous diagnoses WITH follow in inappropriate treatment - one of which was to cut off the patient's leg when an "out of scope" diagnosis and treatment had him walk into the meeting with Minister and our group all on his own). Pretty much every case I have seen that got to Mayo (including some referred and paid under our universal sick care system) has offered conclusive diagnosis and referral to the very best of people who specialized in treatment. Nothing is medicine is 100%, but there certainly are situations such as you cite that can be 99% wrong. 3 The idea to use Mayo is a good one but I sense my friend can barely afford to pay for some out of pocket testing. Mayo's tests could run up a $20K USD bill just for testing alone in a short period of time. Your post confuses me because you said at the start of paragraph #2 "...I don't think any health region will refer you there and pay the bill." Then the last sentence contradicts that and says "...every case I have seen that got to Mayo (including some referred and paid under our universal sick care system)...." I don't understand the structure of Canadian healthcare. Why are some of these cases never paid, and why are others fully paid? Is there anything she can do to get even a partial compensation? Is there any way to obtain a dollar-for-dollar tax credit against her Canadian income? I agree with the first part of your post that there may be problems trying to attack the doctor's treatment or credentials. That is why I want to find a way to fire him without attacking him. Edited March 11, 2018 by pone Quote Link to comment Share on other sites More sharing options...
pone Posted March 11, 2018 Author Report Share Posted March 11, 2018 6 hours ago, betsy said: I found this: https://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/i-want-to-fire-my-family-doctor/article559515/ Doesn't this article actually beg the question? The punchline here says "You can try to find another physician, at which point your enrolment with the previous one will end automatically. However, Ontario's Health Ministry encourages patients to end one relationship before starting another." Ironically, the article never tells you how to "end one relationship"!!! So, asking my original question in the language of your article, in Canada what is the formal process to end a relationship with a doctor? And does that process only apply to the main general practitioner? Quote Link to comment Share on other sites More sharing options...
cannuck Posted March 11, 2018 Report Share Posted March 11, 2018 1 hour ago, pone said: The idea to use Mayo is a good one but I sense my friend can barely afford to pay for some out of pocket testing. Mayo's tests could run up a $20K USD bill just for testing alone in a short period of time. Your post confuses me because you said at the start of paragraph #2 "...I don't think any health region will refer you there and pay the bill." Then the last sentence contradicts that and says "...every case I have seen that got to Mayo (including some referred and paid under our universal sick care system)...." I don't understand the structure of Canadian healthcare. Why are some of these cases never paid, and why are others fully paid? Is there anything she can do to get even a partial compensation? Is there any way to obtain a dollar-for-dollar tax credit against her Canadian income? I agree with the first part of your post that there may be problems trying to attack the doctor's treatment or credentials. That is why I want to find a way to fire him without attacking him. Most of the people I know who have used Mayo paid out of pocket. The sick care system does allow for referrals and full payment to just about anywhere in the world, but it very seldom happens for diagnostic services. The only one of which I am personally aware was a severely disabled fellow (due to work injuries) who was found by a person who is a very capable workers's comp adversary (advocate to those misstreated) who made such a compelling case for the abuses of this person's' rights that he embarrassed them into paying for a trip to Mayo, and the subsequent referral to a clinic in FL that did what is truly well out of scope for Canada and restored partial site from total blindness with some very advanced (at the time) stem cell therapy. We have universal insurance, and a few options on service delivery, but very few health regions will reach outside of the comfort zone by very much. MOST things depend upon procedures that are "insured" (i.e. approved by the provincial college of physicians and surgeons) at the prescribed rate of compensation. Reaching out to US is complicated and expensive (but still possible). Quote Link to comment Share on other sites More sharing options...
betsy Posted March 11, 2018 Report Share Posted March 11, 2018 3 hours ago, pone said: @betsy some great ideas there, which I would summarize as: * Contact your member of provincial parliament for advice and possibly for direct intervention in the case * Contact patient advocacy groups for different rare diseases (and there will be many) * Contact the press, to put an uncomfortable spotlight on the doctor Yes. I don't know the details of the problem....but if you think there is merit to go to the press (like Marketplace, and the column from the Globe and Mail), publicity will apply the pressure. Who knows, maybe there are others who's got complaints about this specialist and they might come forward. Quote Link to comment Share on other sites More sharing options...
betsy Posted March 11, 2018 Report Share Posted March 11, 2018 2 hours ago, pone said: Doesn't this article actually beg the question? The punchline here says "You can try to find another physician, at which point your enrolment with the previous one will end automatically. However, Ontario's Health Ministry encourages patients to end one relationship before starting another." Ironically, the article never tells you how to "end one relationship"!!! So, asking my original question in the language of your article, in Canada what is the formal process to end a relationship with a doctor? And does that process only apply to the main general practitioner? Here is how a doctor is supposed to end the relationship with his patient. It's best to read it ....because it might be advisable to do some of the same things (if applicable). Also you get to know your rights as a patient. I think it's still best to end it as diplomatically as possible. http://www.cpso.on.ca/Policies-Publications/Policy/Ending-the-Physician-Patient-Relationship Here's a recommendation how to end the relationship with your doctor. https://www.verywell.com/how-to-fire-your-doctor-1942906 Quote Link to comment Share on other sites More sharing options...
betsy Posted March 11, 2018 Report Share Posted March 11, 2018 (edited) 3 hours ago, pone said: So, asking my original question in the language of your article, in Canada what is the formal process to end a relationship with a doctor? And does that process only apply to the main general practitioner? I'm assuming you've got the right to seek a second opinion.....so it shouldn't matter whether it's a General Practitioner or a Specialist. At least, that's what I think. But I could be wrong. You can ask those who are experts in dealing with our HealthCare system (advocacy groups). Here, read this case from the Globe and Mail column. It gives the rules about second opinion in Ontario. Quote For the benefit of those who did not read last week’s blog, let’s first recap the rules governing second opinions. In Ontario, the province’s Ministry of Health and Long-Term Care doesn’t place a limit on the number of second opinions patients can seek for a medical condition. But patients must first get a referral from their family physician or a specialist they have seen in the past year. This essentially means physicians act as the gatekeepers to other doctors. The Code of Conduct of the Canadian Medical Association instructs doctors to “respect your patient’s reasonable request for a second opinion from a physician of the patient’s choice.” http://healthydebate.ca/personal-health-navigator/youre-doctor-wont-send-second-opinion Is it still possible to talk diplomatically with this Specialist, or has the relationship deteriorated in a bad note?? Edited March 11, 2018 by betsy Quote Link to comment Share on other sites More sharing options...
?Impact Posted March 11, 2018 Report Share Posted March 11, 2018 31 minutes ago, betsy said: I'm assuming you've got the right to seek a second opinion.....so it shouldn't matter whether it's a General Practitioner or a Specialist. The issue with specialists, is that they are often the go-to guy/gal for other practitioners on certain types of cases. It kind of sounds like that might be the case here, but it is hard to tell without really knowing a lot more details. That is why I suggested going to a different area to get a second opinion. Metabolic genetics is a relatively new field, and pediatrics adds yet another specialization. Sick Kids certainly has a large department, although I suspect there is a hierarchy there; it is still small enough that they would all work with each other on a regular basis. Additionally cases are often reviewed in group settings in institutions like that, while there are some negative of that approach there are also a lot of positive outcomes that make it worthwhile. Smaller institutions and geographies will have smaller groups of these specialists so I wouldn't be surprised for similar situation; I doubt any hospital or geography in Canada would be bigger than the group at Sick Kids. My advice on being open and honest was rejected, so I don't have a simple solution here. Quote Link to comment Share on other sites More sharing options...
betsy Posted March 11, 2018 Report Share Posted March 11, 2018 1 minute ago, ?Impact said: The issue with specialists, is that they are often the go-to guy/gal for other practitioners on certain types of cases. It kind of sounds like that might be the case here, but it is hard to tell without really knowing a lot more details. That is why I suggested going to a different area to get a second opinion. Metabolic genetics is a relatively new field, and pediatrics adds yet another specialization. Sick Kids certainly has a large department, although I suspect there is a hierarchy there; it is still small enough that they would all work with each other on a regular basis. Additionally cases are often reviewed in group settings in institutions like that, while there are some negative of that approach there are also a lot of positive outcomes that make it worthwhile. Smaller institutions and geographies will have smaller groups of these specialists so I wouldn't be surprised for similar situation; I doubt any hospital or geography in Canada would be bigger than the group at Sick Kids. My advice on being open and honest was rejected, so I don't have a simple solution here. I think it best for them to seek advise from those who deal with our Healthcare system - like those groups. Quote Link to comment Share on other sites More sharing options...
pone Posted March 11, 2018 Author Report Share Posted March 11, 2018 1 hour ago, betsy said: http://healthydebate.ca/personal-health-navigator/youre-doctor-wont-send-second-opinion Is it still possible to talk diplomatically with this Specialist, or has the relationship deteriorated in a bad note?? I think all diplomacy was tried and exhausted and now the doctor's only function on the case is to act destructively and to impede the efforts of other doctors. The fact that he is a gatekeeper is exactly the reason they want him fired from their case, so that he can be prohibited explicitly from acting as a gatekeeper again. Quote Link to comment Share on other sites More sharing options...
pone Posted March 11, 2018 Author Report Share Posted March 11, 2018 2 hours ago, betsy said: Here is how a doctor is supposed to end the relationship with his patient. It's best to read it ....because it might be advisable to do some of the same things (if applicable). Also you get to know your rights as a patient. I think it's still best to end it as diplomatically as possible. http://www.cpso.on.ca/Policies-Publications/Policy/Ending-the-Physician-Patient-Relationship Here's a recommendation how to end the relationship with your doctor. https://www.verywell.com/how-to-fire-your-doctor-1942906 The first article is an instruction sheet for the DOCTOR about how to leave the patient! Nothing about the reverse process is described. The second article is for US citizens, not Canadians. Quote Link to comment Share on other sites More sharing options...
betsy Posted March 12, 2018 Report Share Posted March 12, 2018 (edited) 1 hour ago, pone said: I think all diplomacy was tried and exhausted and now the doctor's only function on the case is to act destructively and to impede the efforts of other doctors. The fact that he is a gatekeeper is exactly the reason they want him fired from their case, so that he can be prohibited explicitly from acting as a gatekeeper again. Try your MPP. I've learned something from this. being gatekeepers, I didn't know they got this much power. Btw, who referred them to this specialist? Their family doctor? If they have a family doctor, maybe they should talk to him too, and explain the problem. Edited March 12, 2018 by betsy Quote Link to comment Share on other sites More sharing options...
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