The other healthcare system
In Canada, the job of providing your family with a doctor belongs to the government, which guards this task jealously under the hallowed Canada Health Act. But does the government always fulfill each mission it undertakes, or manage every project the way you’d want them to? They do not. Look at the gun registry fiasco, and the RCMP scandals. Look at Ad-scam. Listen to Karlheinz Schreiber.

So, what happens if, despite its best efforts, the government should somehow hook you up with a doctor who is, at best, overworked, under-prepared, and distracted by heavy case-loads—or, at worst, incompetent?

You might die.

That thought will cross your mind as you listen to the all-news radio station in Toronto, which has been running advertisements for a service called “Best Doctors.”

The ads work the way effective advertising is supposed to work: they catch your attention. The spots describe a patient who was diagnosed by his GP as having an incurable pathology, but is later reassured of a more favorable prognosis by the wise counsellors represented by the advertiser.

A web site operated by the radio station, known as 680 News, elaborates on the principles behind this fascinating medical service: “Through Best Doctors, you and your treating physician will be connected to world renowned specialists to confirm the right diagnosis and the right treatment options, without you having to leave home. Over the past 20 years, Best Doctors has changed a diagnosis 22% of the time and has modified 61% of treatment plans. Discover why 4,000,000 Canadians are memebers [sic] of Best Doctors..."

These stunning claims are not substantiated by the radio station, which, on the one hand, is hardly surprising, in that they couldn’t be bothered to run a simple spell-check. However, 680 News is a corporate cousin of the Medical Post (both are operated by the Rogers group of companies), where you might have expected some journalistic follow-up to data, which implies that more than three out of five therapeutic regimens proposed by Canadian doctors are being revised or overturned through the efforts of a private service.

A glimpse at the service’s own promotional materials, available at www.bestdoctorscanada.com, fills in a few more details, and contributes a few more grammatical oddities—but fails to effectively answer certain obvious questions which may occur, starting with, “Who are these guys, and where do they get off making these claims?”

While the precise process by which physicians may be accredited as Best Doctors is not fully disclosed, the web site does make note of its “network of 50,000 world renowned, peer-nominated top specialists (including 1,300 Canadian doctors.)” This will interest the Royal College of Physicians and Surgeons of Canada, which has been operating under the belief that determining specialists is its bailiwick. 

At root, Best Doctors Canada appears to supply a service that will point you toward a second independent medical opinion, for an annual fee of $225. Seeking a second opinion, especially when the original diagnosis is dire, is typically a very good idea, although it represents an added step that primary care providers and the public health system can’t always readily facilitate. Presumably, that is where the private sector can step in to lend a needed hand—provided that its activities do not contravene the Canada Health Act.

However, because the public system is, for most purposes, the sole provider of physician services, and because the system is undeniably overburdened, and, most poignantly, because that fact is painfully apparent to all, there are bound to emerge schemes which test the core tenets of Medicare.

Uncomfortable though we are with several of the claims and promotional tactics made by Best Doctors Canada, we are not prepared to say that this group’s contribution to care is unwelcome. Indeed, the shortcomings of our public system, and government’s ineffective efforts at reform, should be seen as an invitation to innovative approaches from the private sector (although these should exclude physicians assessing fees for routine administrative functions.)

Nonetheless, third-party patient-advocacy schemes, conducted as profit-making ventures, should raise some justifiable concern. Any sort of private medical concierge service, affordable by some, but not all, may be seen as a challenge to the egalitarian intent of Medicare. It will be argued, although not by us, that this type of development sows the seeds of a parallel healthcare system serving the privileged: the “two tier” approach Ottawa has pledged to eschew.

That, however, is not the most disconcerting aspect of this issue.

Best Doctors claims its methods have “reduced invasive procedures by 67%.” That is an astonishing statistic, which, if factual, carries significant implications, and should be closely studied. Potentially, this finding may suggest that two-thirds of recommended procedures are unnecessary, a conclusion that would rock the world of healthcare to its foundations.

Conversely, it could mean something else: patients whose primary care doctors have determined, following a thorough set of diagnostic procedures, that invasive measures are required, may have been decided against complying, after a for-profit party inserted its opinions into the consultation. Either way, more study by credible researchers is warranted. Perhaps the crack investigative journalists at 680 News and the Medical Post may wish to look into the matter.