I received an email today from my family doctor's clinic telling patients to be less particular about whether they get to see their doctor or not when they schedule an appointment with... their doctor. The parts I take issue with are in bold. Here's the email body:
Good Morning <clinic> Patients,
A Reminder to Our Patients: <clinic> is Proud to Be a Teaching and Team-Based Facility.
Medical learners (students and residents, most of whom are training to be family physicians) are an important part of our team. Physician assistants, nurse practitioners, and locum/covering physicians are also crucial to our clinic functioning.
With the help of our team:
- We are able to offer non-urgent appointments usually within 1-2 weeks.
- We are able to offer same-day appointments for urgent issues.
- We are able to continue to provide care to our current <clinic> patients at a time when there are a record number of family physicians leaving practice.
- We play an important role in training the next generation of family physicians.
There have been an increasing number of patients requesting appointments with their provider only (and declining to see other members of the <clinic> team). This causes significant disruptions to the clinic and affects our ability to provide equitable care to all <clinic> patients.
Moving forward, when you book an appointment, you should expect that you may see a medical learner, physician assistant, nurse practitioner, or a physician covering for your primary family physician. For many appointments, your family physician will be available to see you after you have been seen by another practitioner, if requested or needed. Please be aware that learners and physician assistants are supervised directly by your physician.
This team-based model of care may not be the right one for you, and if you wish to transfer your care to another clinic, we will be happy to waive the usual fee for transfer of records.
We appreciate the important role you play in medical education and making practicing family medicine sustainable.
Sincerely,
The physicians and staff at <clinic>.
So basically, patients want to see their doctors instead of medical students and the clinic is telling the patients to fuck off with their standards and expectations. Instead of building rapport, confidence, and sharing personal vulnerabilities with your family doctor, you can now expect to do it with random, unqualified, inexperienced people who you'll never see again and who don't know your history. If you don't like it, despite paying these fuckers' wages, you can pound sand.
FYI, when this email says the students and assistants are directly supervised, it's figurative. It means the students and assistants report to the doctors, not that the doctors are in the room while the assessments and appointments are conducted. You're expected to meet with these unqualifieds one-on-one. There used to be supervised appointments where medical students would simply shadow the doctor with permission from the patient, but that hasn't been the case for years.
Also, moving to another family doctor is extremely difficult. Most doctors have a maxed-out roster and are not accepting new patients. There are 2.3 million Ontarians without consistent access to a family doctor in a province of 14.5 million.
Canadian tax dollars at work.
At least they're not telling you to kill yourself. By Canadian healthcare standards, simply not telling you to kill yourself is going above and beyond.
Oof.
Wait, if by directly they mean directly at that moment...why can't the physician do the thing, and the 'learner' watch and learn? People want to see their doctors, that's a basic part of the whole idea.
Obs are what you do in your first and 2nd year* (at least, in some systems/degrees/paths, a specific degree may be different, the point is that it is the first step in health learning)
Doing it while being directly supervised is the next step,
Then you fade that supervision away, and are under a more passive 'summary/reporting supervision'...
You don't just jump from doing obs to doing it independently. That's why. You need those intermediate steps where the learner is doing something with the other there, then they are doing it mostly independently just with backup/reporting requirements.
There is a tonne wrong with all of this yes, but not this.
It's a teaching clinic according to the letter. This is part of that.
Heads up, that's a shift from what they used to be. This is a bit of a rug-pull in that they haven't always done forced medical school student one-on-ones with patients. I also think they're leaning into that description more and more as a way to absolve themselves of the ever-lowering scrutiny and quality of care.
To be clear, I think there's a lot of merit to later-year students and residents getting the opportunity to pseudo-practice outside of immediate supervision. My problem is that patients of this clinic don't seem to have a choice over who we'll be seeing. We have to accept someone inexperienced or find a new doctor (almost impossible in urban areas). It's coercive and implies fault with us if we don't like it.
Anytime I went to the doctor and he was teaching a med student it was always "are you OK with a student being here?" and then "would you be OK with things being done twice?" Like, I'm going to take your blood pressure, but I want the med student to also take it to get experience. Never "hey, here's a dude, I'm going to dick off to another room now."
Exactly, there was a clear request for consent.
This is coercion. "Don't like our practice? Fuck off and go without a family doctor." Classic coercion, and coercion vitiates consent. What a farce.
That does change things somewhat yes.
But the point about 'why can't they just do observation work' to keinan still stands. That's just not how health learning works and there are those important intermediate steps where the student's/new grad's work is at various levels of supervision. Having your clinic change to start doing that though is a different matter, yes.