How much time am I entitled to take with my doctor (in Canada), or how many issues per visit is reasonable to try to address?

March 24, 2006 2:07 PM

How much time am I entitled to take with my doctor (in Canada), or how many issues per visit is reasonable to try to address?

I guess there are appointment windows, but I was thinking of going to a walk-in. And doctors dont like it when I suggest that I might want to address multiple issues because they want to get me out and see other patients and make more money... So how much time / how many issues is reasonable so I can stand my ground when they try to finish their sentence while heading for the door?

posted by GleepGlop to health & fitness (20 comments total)

You know, this is one of things I disliked most about living in Canada. You have my deepest empathy; Gleepglop.
I can vividly remember the day in 1994 when one of the office workers in my GP's office said to me: " well, you're NOT allowed more than one doctor in Ontario"!
My best advice to you is to tell them: I don't care how many patients you have, you are not leaving this exam rm until you answer ALL of my questions and concerns and then you can bill OHIP without any guilt whatsoever, you money-grubbing, over rated, egocentric md. So stand up for your own health Gleepglop, because no one else will.
posted by GoodJob! at 2:24 PM on March 24, 2006

Ha, Goodjob!, thats certainly one way to do it... But providing the appointment windows are standard at say 30 minutes, I can live with only taking that long...
posted by GleepGlop at 2:33 PM on March 24, 2006

Any decent doctor will take the extra time depending on what the problem is, to reassure and educate their patients-- so GleepGlop, just go to various walk- ins if need be until you find a doc who isn't looking at his watch constantly. Without patients, the docs there ( in Canada they esp. think they're GODS because of the restrictions of socialized medicine) don't have a profession-- so keep that in mind and good luck.
posted by GoodJob! at 2:42 PM on March 24, 2006

It's probably doctor specific.

I had a great doctor (in Vancouver) who was more then willing to answer more then one question per visit and would take the time to make sure you understood the answers and your options. As GoodJob! said, take the time to find the right doctor. (Although, in all of my experience seeing doctors in canada, I never met one who thought they were a god.)
posted by kechi at 3:00 PM on March 24, 2006

Shrug. There are good doctors and crummy doctors in any country. If you have a decent doctor, book an appointment and ask the receptionist to slot you for an hour, or six hours, or whatever you think you need.

If you don't have a decent doctor, find one or go to a walk-in clinic. And talk to them. they walk in, you say, "Hi, I have a couple of medical concerns that I'd like to discuss. The first one is..."

I don't see what the problem is.

Also note that there are numerous telephone lines, such as this one, where you can just call and talk to some medically-trained person. The government runs these for *exactly* your problem - lengthy or mundane or sensitive question-asking. Take advantage.
posted by jellicle at 3:17 PM on March 24, 2006

kechi; I'm not some US citizen who had to see a CDN MD in urgent circumstances. I am Canadian and lived in Canada until 2003, so I know the CDN medicine system well and I can tell you by comparison, the MD's in Canada think they are fucking GODS. In the USA, people have choice ( within their insurance coverage) but also anyone here can also pay out of pocket. So the docs here value any patient because medicine is more of a business here. Doc's here want to earn and keep their patients or they'll lose them to someone else PDQ.
posted by GoodJob! at 3:19 PM on March 24, 2006

In Nova Scotia, I once went in for a prescription. The Doctor wrote it out, answered a few questions, and then we talked for 45 minutes about my life, university, what I might want to take, what he might do when he retires, what it means to me a doctor these days, the CBC...

..eventually someone from the lobby came in and said the other patients were about to stage a coup.

Anyway, the moral of that story is that it often depends on the doctor, and you might as well go in determined to get the information you need.
posted by stray at 3:26 PM on March 24, 2006

My doctor is up-front that he schedules from 10 to 30 minutes with a patient at a time. He will address two things per visit, but he doesn't like to go too quickly lest he make a mistake. If you mention three things, he will prioritize. It isn't hard to get an appointment with him, and I have seen him spend longer than his appointed time.

Doctors are busy; there aren't enough of them here. They need to budget their time carefully or the wait times would be even worse. They're not just in it for the money. They could make more in the states, and they would not have any problem moving there.
posted by gesamtkunstwerk at 3:47 PM on March 24, 2006

GoodJob!: I'm also a Canadian who now lives in the states (Canada for 23; US for 3; Elsewhere for a few). I've seen doctors and had surgery (non-emergency) in both countries. I'm not saying there aren't docs in Canada who think they are gods but it's a doctor specific thing and I don't think you can make a generalization that all MD's in Canada think they are *fucking GODS*.

And for the record: not everyone in the US has choices some 45 million (as of 2003) are entirely without insurance. Consider yourself lucky that you have good healthcare.

What does PDQ stand for?
posted by kechi at 3:55 PM on March 24, 2006

pretty darn (damn) quick?
posted by folara at 4:04 PM on March 24, 2006

kechi, ok ALL doesn't necessarily mean 100%. That's where your age is showing. I mean there's a general feeling in Canada where patients there are made to feel like seeing their doc is a godly experience and you better damn well not question your doctor's magical wisdom and u are damn lucky to have this doctor in the first place
( I am keenly aware of Canada's doctor shortage) so it all adds up to a really negative experience for a Canadian patient.
ps- PDQ is commonly known as pretty damn quick. Don't most people know what PDQ means?
posted by GoodJob! at 4:11 PM on March 24, 2006

It's definitely Doctor-specific. I've had one that have told me in no-uncertain terms that it was one concern per appointment, and another (my current doctor) who is very reasonable with multiple concerns per visit.
posted by Elpoca at 4:18 PM on March 24, 2006

Toronto Life's March 2006 issue had a really informative cover story titled "How to Find a Good Doctor" by Vincent Lam, MD, that addressed your question and many related others. (It doesn't look like old articles are archived online so if you want complete details, you should try checking your local library to see if they subscribe.)

According to Dr. Lam, since most doctors are still being paid on a "fee for service" basis, they will often limit you to one problem per visit for the simple reason that the amount your family doctor can bill OHIP for a typical visit is $29.70. This amount must cover overhead like rent, equipment, insurance, and other professional and administrative expenses before s/he gets a cut.

It typically takes 10-12 minutes to properly assess a problem and recommend treatment so if you show up with multiple problems, your doctor may be irked since s/he continues to incur these overhead costs long after your scheduled appointment is over. It's advised that you book a separate appointment for each issue so that you're not rushed through a single one.
posted by phoenixc at 4:24 PM on March 24, 2006

Yeah I was popping in to mention that Toronto Life article. They can bill so little per visit that they need you to make that second appointment for the second issue. Although presumably if they're quiet enough and don't have another appointment for half an hour sometimes they'll be courteous enough to do it.
posted by jamesonandwater at 4:27 PM on March 24, 2006

In BC, doctors get about $28 per visit and they're not supposed to see more than about 6 patients per hour, on average. This means they're allowed to bill a maximum of $168 an hour if they see six patients (assume 3 some hours, 8 others, etc). Out of that comes their receptionist, after hours call service, rent, office supplies, equipment, continuing education, etc. I'm not saying doctors are poor (they make it up on sheer volume/demand), but this isn't a crazy hourly rate. There's only so much you can expect a doctor to cover in 10 minutes.
posted by acoutu at 4:43 PM on March 24, 2006

Oh, as a matter of interest, apparently you can't see more than one doctor about the same issue in one day. After getting a contraindicated prescription from a walk-in doctor on my regular doctor's day off, I called my doctor's office, explained the situation, and went to see my doctor's practice partner. She explained the billing issue to me. We came up with a way to deal with the situation so that I got help and she got paid. However, it was a shock to me. (And I stilll remember this doctor being very concerned about her $28. She was only working a couple of days a week and said she couldn't afford to lose $28. Then she spent 30 minutes on the phone to the pharmacist on my behalf.)
posted by acoutu at 4:57 PM on March 24, 2006

I was wrong--the Toronto Life article mentioned above is available online here.
posted by phoenixc at 5:03 PM on March 24, 2006

My doctor asks that we limit issues to two per visit which seems resonable. If only because I don't feel like waiting in the waiting room while some hypocondriac bush man discusses the 35 issues he's saved up in the last year he's been manning his trap line. I never feel rushed during the appointment.

GoodJob! writes "In the USA, people have choice ( within their insurance coverage) but also anyone here can also pay out of pocket."

Within their insurance coverage is a pretty big caveat, most people have very limited choices. Some of the HMOs my wife had to deal with restricted coverage to a single clinic.
posted by Mitheral at 5:13 PM on March 24, 2006

they will often limit you to one problem per visit for the simple reason that the amount your family doctor can bill OHIP for a typical visit is $29.70.

Or, perhaps, your doctor is trying to be equal and fair to all of his patients and respect everyone's time as best he or she can, as well as document everything, fill out every form that has to be filled out, write medications, review previous charts and labs and radiology reports. If your appointment is for 15 minutes, rank your questions/concerns by priority, and don't necessarily expect to get everything answered in one visit, especially if you're a new patient. Also realize, for everyone question one asks, there's a series of follow-up questions a doctor will usually ask--often medicine isn't yes/no, it's maybe.

If your doctor thinks multiple issues aren't too time consuming, it should be fine; personally I think a strict "one issue per visit" rule is kind of silly.
posted by gramcracker at 9:14 PM on March 24, 2006

The absolute worst way imaginable to deal with multiple minor health issues is to go to a walk-in. They've got a room full of patients waiting, most of them for things with some degree of urgency, and someone wants to talk about the mole on her arm and the rash on her legs and the weird noise her heart makes when she runs and the status of her asthma and the reasons why she's fat and...

If you really need to deal with that many health issues, make an appointment (many walk-in clinics allow you to use their doctors as regular doctors and make appointments to see them) and make it clear that you have multiple issues to deal with. They may ask you to make multiple appointments (see: billing reasons listed above, and see also: not likely to have multiple consecutive appointment slots available in a day), or find a way to do things together as much as possible, but you have to give them at least a bit of a chance to manage these things and not spring it on them unexpectedly.

(Please note: all medical issues described above are taken from my own laundry list of things I might wish to speak with my doctor about, eventually, and are not, in fact, meant to constitute a list of things that might or might not be wrong with GleepGlop.)
posted by jacquilynne at 9:26 AM on March 25, 2006