Barrel Strength

An article by Randall Denley in the Ottawa Citizen reminds me of many things wrong with the current practice of medicine in Canada, which derive essentially, from a complete lack of computerization, and the coordination of services in time that computerization allows. Deeper still, it reflects the incentives of a socialist system of resource allocation, where rationing must occur by time, rather than by money.

His article was entitled “Ontario patients’ time is infinite, and worth nothing”. It related the fact that line-ups are used to ration medical attention for everything and anything. It is the soviet face of Canadian medicare. The patient’s time is worth nothing.

The failure to keep up with the business methods of even 15 years ago is more and more apparent. If the motor vehicle bureaus of  this country ran on the same paper-based record system, governments would have lost elections for the failure to modernize. Why does medicine get a free pass?

My own doctor is completely uncomputerized. This means that:

1) appointments can only be made by telephone. Lose the paper recording your appointment, write it down in the wrong place, call at the wrong time, and the appointment cannot be made or is lost.

2) reminders, if any, are by telephone, wasting the secretaries’ time and mine.

3) if my medical records are kept anywhere, they are on manuscript pages, or on  printed pages of  paper recording the results of medical tests .

4) results of medical tests are not available to me, in at least two ways. They are on paper, which makes copying more expensive than it needs to be. But, worse, I do not have a right them, it would seem. They appear to be property of the physician, rather than of the patient. Consequently, on the basis of records I have not seen, my physician might feel authorized to call for  dietary changes  (say). The validity of his advice cannot be tested against any other norms, opinions, or medical standards  unless I have the relevant information. All I have is his word for it. If I write down the test scores, say blood pressure and cholesterol, I had better bring a pen and paper. If I refer my case to another opinion, I suppose a physical transfer of paper files must occur, at further waste of time and money.

5) My doctor’s office has no way of taking money, except in cash.  The first thing that would be done in a capitalist doctor’s office, which you know from visiting your dentist, is to install credit and debit card machines.

Occasionally it takes foreign travel to make one realize what a backwater this country can be. Just as Cuba has gradually gone to ruin, the gentle pace of falling behind is imperceptible until some event forces one’s attention to our obsolescence. Even my lawyer will send me documents by email.  My doctor does not have a computer. Just think about that for a moment.

Moreover, why are there waiting rooms? Because waiting is a way of queuing for service, which is a way of imposing a user fee. It is rationing by way of wasting the customer’s time rather than by price.

Imagine medicine without waiting rooms.

That is medicine on a properly business-like basis.