Medic alert

>> Quebec health clinics are cut to the quick

by NOEMI LOPINTO

Drop-in clinics, at the forefront of Quebec's health-care system, are where doctors face the full spectrum of human ailments. Eighty-five per cent of health-care services are handled there. So why does it seem like the physicians don't know, or don't care about what they're doing?

Eriko Kato, a 30-year-old Japanese woman who immigrated to Quebec three years ago, sought treatment at the LUSO Clinic on Mont-Royal. "I had pain in my stomach for three or four days," says Kato. "The doctor looked me over for no more than a minute, and sent me to the Royal Victoria Hospital. He thought it was appendicitis." Both Kato and the doctor had difficulty communicating in English. She says she had the impression the doctor "wanted to get rid of her" because of the communication problem. The diagnosis at the hospital was an ovarian cyst, for which she was given medication and sent on her way. But not before she had spent eight stressful hours in the waiting room. "If the doctor at the clinic knew what he was doing," says Kato, "I wouldn't have had to do that."

Thirty-year-old "David" finds a lump in his testicle. Terrified he has cancer, he goes to his local CLSC. The doctor spends "20 seconds" examining him, despite the fact that he's in the highest age bracket for testicular cancer. The diagnosis is dismissed as a "probable cyst." He is told he will have to wait two months to see a urologist. The urologist confirms the diagnosis, but in the interim David suffers from insomnia, extreme anxiety and impotence.

Another young woman waits three hours to obtain the "Morning-After" Pill at a drop-in clinic. The doctor she sees is scornful, telling her there is no way she could be fertile at this point in her cycle, and sends her home without the drugs. Later she discovers she is pregnant.

Desperately seeking doctors

Experiences like these lead many patients to bypass clinics and head straight to the emergency room, a situation which further contributes to ER overcrowding. But Marc-André Asselin, president of l'Association des médecins omnipracticiens de Montréal, says you hear horror stories in every medical domain, including emergency rooms. "When a doctor sees 400 to 100 people a day he's going to make mistakes. Nobody is perfect," says Asselin. "The financing of these clinics has remained the same while the patient load has increased. At some point it would be nice to have some money for the doctors so that the services can actually work."

As part of its "deficit zero" budget cuts, the Bouchard government "encouraged" the early retirement of 3,800 nurses and over 550 doctors, with an influx of only 75 new graduates to replace them. This has left thousands of Quebecers without a family physician. Dr. Gordon Ruben runs a private practice in Montreal and a clinic in Kahnawake. He blames the government for eliminating the incentive to start new practices. "About 20 per cent of the phone calls I get at my private practice in the city are people looking for a doctor," says Ruben. "Most of us have had to close our practices because we cannot take on any new patients. We're all swamped."

Quantity not quality

Asselin concedes that clinical practice is one of the least sought-after jobs because of the fees involved. New physicians who wish to set up a practice face a sanction of 30 per cent of their starting salaries. But he denies that the quality of medicine being practiced in drop-in clinics is of a lower order. "The same doctors who work in the hospitals also work in the clinics, and there are the same requirements for them as for everybody," insists Asselin.

"As younger physicians don't stay or start new practices, and older doctors are retiring or dying off, those of us in the middle are asked to do more and more," declares Ruben. "If you go to a clinic where a doctor doesn't know you, that's okay if you have a sore throat. If you're an older person, have chronic illnesses, are taking multiple medications--what kind of care do you think you're going to get? It's crap."

Unlike physicians at the CLSCs, clinic doctors work on a fee-for-service basis, which means the more patients they can cram into the day the more they can pay their expenses. "It's not a good incentive to practice quality medicine," says Ruben.

Patients who believe they have been mistreated or misdiagnosed can file a claim with the Collège des médecins du Québec, where it will be evaluated by a discipline committee. In 2000-2001, there were 1,639 claims, of which 725 were rejected. "Health care occurs in the clinic whether the government looks upon it as important or not," says Ruben. "Personally I look forward to going to work, but there are days when I don't know how much more of this I can take."