Your stories (and some answers) about stupid health-care rules

Tara Horrill was surprised and more than a little annoyed to find out that her husband was turned away from their family doctor – essentially for being too healthy.

“We requested an appointment and because he hadn’t been in to see his family doctor for a few years – he had been fairly healthy – he was told he now needed to find a new family doctor. It had been too long since he’d been seen,” she told White Coat, Black Art‘s Dr. Brian Goldman.

Horrill’s husband suffered an exacerbation of his asthma. After being summarily dropped by their family doctor, they followed up with a walk-in clinic until they could secure a referral to a specialist.

“It’s been doctor-hopping since then,” she said.

Getting dropped by your doctor because you are too healthy might seem like a head-scratcher of a rule.

White Coat, Black Art recently asked listeners for their stories about encountering seemingly stupid rules in the health-care system. Horrill and dozens of others shared their tales of frustration, looking for answers.

Some may be more habit than hard rules, and the fact that they can vary from region to region can make them even more frustrating for some people.

Are you on the patient roster?

As Kim McGrail explains, the reasons for many of these seemingly stupid rules can come from a multitude of administrative – and sometimes revenue-driven – reasons.

“What it probably comes down to is a physician practice that once a patient hasn’t shown up for quite some time, perhaps they’ve moved, or they found another doctor,” said McGrail, who is an associate professor at the University of British Columbia’s School of Population and Public Health.

Kim McGrail says many seemingly stupid rules in the health-care system come from a multitude of administrative – and sometimes revenue-driven – reasons.(Abigail Torrijos)

The difficulty might in part be traced to the move from pay-per-service systems to a newer system known as rostering.

Way back when, you could see any doctor anytime, and the doctor would bill the province a fee. That can get really expensive.

Over time, provinces switched to a system where patients register with a family practice, doctor or team. Instead of getting paid each time they see you, they get a lump sum annual fee for being on the GP’s roster.

That roster has a limited number of spaces, so if physicians believe a client has moved on, they may be compelled to drop their name off the list in favour of a new client.

“What really should happen is that you wouldn’t be taken off the roster unless you ended up showing up in another practice,” she told Dr. Goldman. “So if you’re simply somebody who is healthy and hasn’t been using the system, you wouldn’t be kicked off a roster.”

Donald Lepp says parents should know when to press health-care professionals for more information about their kids’ treatment, but also when to ease off to avoid being a nuisance.(Submitted by Donald Lepp)

‘This drives me nuts’

Sandra Zelinsky has encountered a frustrating rule that makes her drive 12 hours every six months.

She visits a specialist for treatment for her Crohn’s disease – a six-hour drive from her home in 100 Mile House, B.C.

Sometimes, she feels that only needs to see the specialists once a year, but she was told that she has to get a new referral every six months – whether she needs treatment or not.

That means visiting her family doctor for a referral and then driving six hours to see the specialist. If she doesn’t, she will be dropped from the specialist’s roster.

“This drives me nuts,” she told White Coat.

“There may be times where I may only need to see him once a year but I actually go in twice a year because of this rule that is in place by the system.”

We have a one-size-fits-all solution to a situation that, clearly, is very different across patients.– Kim McGrail

McGrail explains that in B.C., specialists require a physician’s referral before seeing a patient. It’s meant to ensure patients visit a specialist only when a physician has deemed it necessary.

However, the rule is in place regardless if you’re in need of a one-time visit to a specialist or can expect to require visits or treatments on an ongoing, long-term basis.

“Somebody like Sandra who has a chronic lifelong condition … probably will need some routine ongoing interactions with the specialists,” she said.

“We have a one-size-fits-all solution to a situation that, clearly, is very different across patients.”

Russell Lepp’s parents were not allowed into the recovery room where he was being treated with anesthetics until his father Donald asked for access.(Submitted by Donald Lepp)

Concerned parents’ access

Rather than looking for administrative answers to the stupid rules he’d encountered in hospitals, Winnipeg’s Donald Lepp took it upon himself to make things better as a self-styled patient advocate.

Lepp’s nine-year-old son Russell underwent a heart transplant as an infant, and needs to visit the hospital every year for a procedure called a catheterization of the heart. It requires a general anesthetic.

Lepp and his family fell victim to a rule in which parents were barred from the recovery room — which means they couldn’t be by Russell’s side during the crucial moments as he emerged from his anesthesthetic state.

He described feeling helpless hearing his son cry out in distress as he woke up after the procedure.

“When you … hear a child screaming, and you can clearly identify that it’s your own son, it’s not happy,” he said. “We have heard that on several occasions. It’s been a real challenging time.”

After several similar episodes, one anesthesiologist let Lepp in with his son. He says she believed that it did more good than harm to have Russell’s parents in the room with him.

We need to be educated just for our own sanity.– Donald Lepp

Lepp strongly believes that patients – especially, as in his case, parents of young children being treated – should ask and learn as much about what health professionals are doing.

“We need to be educated just for our own sanity,” he said.

He cautions, however, that it’s important not to be too pushy around health professionals lest you be labelled a troublemaker – whether that’s a fair assessment or not.

“Ask questions and be respectful. There are a lot of very talented health-care professionals out there and it’s much better to have them on your side than against,” he said.

Got more stupid rule stories?

If you’ve encountered any of the rules mentioned in this story or on the show, let us know, especially if you found a solution.

White Coat, Black Art will continue to tell your stupid rule stories, so if you have one you didn’t hear or or want to comment on one you did hear, tell us in the comments section below, tweet us @cbcwhitecoat, email us at whitecoat@cbc.ca or post on our Facebook page.

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