My doctor felt four inches above the lump, four inches below, then the same distance to either side. “I can find nothing anatomically wrong,” he announced, ducking his head to hide a guilty smirk.
My assertiveness worked in slow motion as I sought to align my thinking with the professional. I continued with a quietly messy conversation, trying to demonstrate that the lump had not been there before, made my body distinctly unsymmetric left and right, and caused so much pain I couldn't run the lasers in my physics lab. What hope was there to continue working?
A new light flickered in the doctor's eyes. He pressed on the bone very hard six inches from the visible lump and inquired, “Does that hurt?”
“Well, pressing anything that hard …” I frowned.
“There, you see? I am absolutely sure it is a muscle spasm!” Eyes now triumphant, Dr. Maticus spun stool to desk and scratched this novel conclusion into the chart.
All right, I know how to handle that type, I avowed silently. The consultation politely discharged, I headed back to my car, my plan already a taproot spreading runners through my mind.
The agenda starts with donning some anonymous non-trendy clothes and withdrawing a cash stash, I plotted. After all, my emerald-green flare coat might attract attention, and my customary banking procedures might end up blocked.
Hopping into my Honda, I patted the dashboard lovingly. A full tank of gas would be a good idea, too.
I went home to prepare and soak up some sleep. Later, chin resolute, I watched the sunset out my window. For hours beyond, sipped java until stars twinkled in a sooty sky. Finally the street traffic dwindled to nil – good, no witnesses. Gear gathered, I tiptoed outside, and drove in stealth to the secluded lane behind St. Décor Hospital.
Picking the right moment, I pedaled down hard and screamed towards the barrier. Just beyond, the car convulsed to a stop. Michael J. Fox is right – that re-entry is a bit bumpy.
Five years and twelve hours into the future, precisely, would make it open business hours in the hospital's records office. I headed over.
Applying for my health records was a familiar routine. Release signed, fee plunked, and fat file secured, I looked around for a sanctuary to begin work. The Lancet Largess Lodge looked a comfortable bet. Renting a room and settling in, I sat down to sift my future medical file.
My hand trembled under the weight of the next piece of paper. A death certificate dated 2020. But that's next year in my own world! Can't be … Letter by letter I studied the name; digit by digit I compared the health number. No mistake.
My heartbeat thudded in my ears. I fumbled open my laptop computer. The browser still worked, but my web search was bust, turning up simplistic narratives … duplicates by the score. The internet was well past its prime on the promise of ‘standing on the shoulders of giants.’ Even in my own year, most research papers were veiled behind subscriptions or exorbitant one-time costs. Scientists complained in undertones that they couldn't afford their own publications.
Snapping shut my laptop, I locked my room and sprinted to my car. My face and neck were flushed. My cashmere trench-coat grew clammy and clung to the back of the bucket seat as I careened around corners to reach the Health Sciences Library on our University campus. Still open to all public, bless ’em. There scowling fiercely I read journals. Five hours of frantic fieldwork, and my cloudy medical chart finally came into focus under the large lens of knowledge. My death certificate was no longer a mystery. My bafflement and fear dissolved.
My non-anatomical lump, it transpired, had conquered only because of ineffably dilatory diagnosis. The disease wasn't even new. Textbooks from the early ’90s established both the clinical picture and standard treatment protocols. Easy, easy, once the lens was in place. Digging in my purse for change, I made a circuit to the fusion-copier, using the options panel to block the dateline. Then, stuffing pencils, notes, and sweet life-savers into my coat pocket, I left the Library.
Walking through the teaching hospital, I passed a lecture theatre packed with students agog at a talk titled The Other Brain in the Exam Room. I couldn't resist. I slipped inside and took a seat near the door. The professor, standing before a blackboard, spoke gruffly:
“Today the media dub patients ‘the other brain in the examining room.’ It wasn't always this way. We leveraged our goals according to the social culture of the times. During the 1980s and prior, physicians were patriarchal figures. The public listened when we admonished: A little knowledge is a dangerous thing.
“Then the internet caught fire in the 1990s. We tried a new tack: patients had morbid curiosity if they wanted knowledge. If you ridicule someone, they tend to back down. But the public was not deflected. Patients kept Googling their symptoms. The more we ridiculed patients, the more independent they became.
“Like a stale football team, we needed a fresh game plan. Therefore in 2010 we sponsored studies to announce that one in five Canadian adults suffer an anxiety disorder. The country became steeped in health anxiety.” The professor's piercing gaze roved the room.
A student raised her hand and asked: “What is the difference between an engaged patient, and a patient who has health anxiety?”
The professor tapped a book spread open on the podium. “We encourage patients to use the Internet to become engaged in their own disease management. But read your textbook The Secret Language of Doctors by Dr. Barry Goldman. He defines well the dividing line:
“Case File: A patient Iris, pregnant, asthmatic. Suppose Iris asks a question to which she already knows the answer because she looked it up online. Iris has set up the doctor-patient relationship on a patently false test of her own making. That's the test that demonstrates that Iris not only is pregnant and has asthma, but she has health anxiety to boot.
“Confused? Listen. On the one hand, MDs encourage patients to be engaged in their care; but on the other hand, if a patient knows enough to catch an MD flat-footed in a lie, then we use counter-transference to reassign the doctor's anxiety to the patient.” The professor gulped some water.
“Today in 2024, health anxiety is waning as a ruse. And so we invented the KeyTone Widget. It scans a patient's tablet computer or smartphone at a clinic entrance, to survey webpages the patient has downloaded. To each patient we assign a KeyTone Level – short for keyword tone. The important thing is, doctors find out in advance whether we can float a lie or not.
A loud bell rang; lecture over. Students rose, shouldered backpacks, became boisterous as they left the theatre. I slipped out, pensive, and walked measured steps down the long hallway. Outside I found my car in the rain-soaked parking lot and drove back to the Lodge. On the way I bought a newspaper to read in my room. Current 2024 headlines were riveting.
“Nurses Make Strides Forward,” I read on the front page. A new nursing contract had won the installation of micro-chip odometers in the odor-eaters of nurses’ shoes. The waning nurse-patient ratio meant distance walked on wards now eclipsed overtime as the preferred criterion for calculating above-base income.
I turned to the third page. In a large photo, a beaming physician stood beside the newest-model MediCull Door installed that week in his clinic. Ontario banned the machine, but sales were brisk in other Canadian provinces. Marketers tracked the changing tenor of the lists entitled Doctors Taking Patients published by the Health Ministry of each province. Saskatchewan still had no subtlety; there, most GPs were allowed to state they don't treat pain. Translation: they don't treat complex cases. MediCull reps flocked to that territory.
The MediCull was a revolving door that boasted three high-tech features: a programmable Cherry-Picker; the KeyTone Widget the professor had talked about; plus an Appointment Sequencer. I squinted at the grainy newspaper photo.
The Cherry-Picker, embedded in the door frame, was a set of tiny Excimer lasers tuned to the exact wavelength needed to vaporize ink from medical records brought in by patients. First, a sensor read the patient's health card and basic stats stored thereon such as number of diagnoses. The lasers activated when the disease count was too high (above a quota programmed by the clinic). The UV light was invisible. Oh, beauteous design! The Cherry-Picker evaded complaints to Human Rights Tribunals, since the GP could conceal his enmity to complex cases, could actually meet such a patient yet keep the moral high ground by offering this perplexed, polite rebuke: “Where is your medical evidence?”
Of patients okay to the clinic, the KeyTone Widget analyzed their level of engagement. It used a near-field RFID tracker disguised as a decorative plate on the door handle. As patients walked through the door, it scanned their smartphones and tablets, counting keywords on any webpages the patient had downloaded. It calculated two things: KeyTone Level was the number of different keywords having a relevant tone (medical words matching the patient's own case). And KeyTone Saturation counted the duplication of keywords.
A story titled The Human Side of MediCull relayed an interview with Dr. Debra Boyce, President of the Canadian Medical Protective Association. The normally pragmatic Boyce became impassioned: “Doctors will establish a professional relationship with their MediCull Door, a device guaranteeing their professional freedoms.” Boyce named her personal favorite: “The Appointment Sequencer has a new 7-minute option. Now that could sew up our future!”
With mirthless eyes I sought international news. Aha! Here's the ticket! A press release described the Little Dodge Pill – the new magic bullet – which was prescribed for patients vexed by the revolving-door protocol. Through a little-understood mechanism, this agent made the patient believe even the most serious medical complaint to be a problem the patient had to solve (stress, spasms, depression) rather than a problem the doctor had to solve.
The press release – sponsored by pharmaceutical giant Eurasia Ichor Co. (EuRICO) – was printed on lenticular paper, allowing animation. A tiny SolPod cycled it perpetually through its ten layers. No way to turn it off the animations … headache.
I needed a break. Crossing the room I dialed up some music on SatRadio. Retro jazz, nice. Inspired, I swayed my shoulders. Memories of healthier times rose up. My mind in another place, I segued into an aerobic dance. Kick left, kick high … then I crumpled to the rug. When the pain subsided, I snatched up the next section of the newspaper.
A bold headline trumpeted a new CMPA subsidiary company named Saegis. It had glossy goals: Its vision, to turn the medical community into a Just Culture. A tingle ran down my spine. Could it be? Is this the first step toward the CMPA ushering in No-Fault compensation in malpractice cases? Or is it a new cult, verging on a religion, giving MDs permission to care for themselves first?
Opening my laptop, I browsed recent CMPA Annual Reports. Financial pie-charts showed negligence complaints on the rise – up by 20% during the past five years. The CMPA responded with a program to increase physician wellness. That was Saegis. I sought their site and clicked a Just Culture training video. Radio off, laptop volume high, I leaned forward to absorb every nuance of the presentation.
Actors simulated a hospital adverse event; scowls prevailed as dialogue failed. Then the actors, with jejune smiles, showed the correct way to handle the event. Doctors and nurses are to ‘blame the culture’ or ‘blame family interference’ and evade blaming their own conduct or attitudes.
The topic was myopic – though very enthusiastic. The actors, bobbing their heads from side to side, Hare Krishna smiles in place, taught us that hospital IV infusion bags, when prescription names are similar, need different-colored labels plus unique bar-codes to prevent medication errors. Frabjous idea … when it was new.
How long has the world known this? Fingers drumming the keys, I found the site National Coordinating Council for Medication Error Reporting and Prevention. This consortium is a joint effort from 25+ major organizations including the AMA, FDA, and Federation of State Medical Boards. Their founding report is dated 1995. Their current report, dated 2024, was solid and vibrant, covering three decades of coordinated medical safety efforts.
I mused for a time. If the CMPA is truly serious about Just Culture, why don't they extend No-Fault to the patient realm? If ‘fault’ is too heavy a burden for an entire hospital care team during their private probe of an injury, then why are patients burdened with proof of fault in a courtroom?
Suppose malpractice lawsuits were shed of the need to establish or apportion blame. Then court would be a venue for calm exploration of facts to prove the injury alone. No more battle royal; no more scorched earth. Patients with similar injuries could be compensated quickly and equally, via No-Fault insurance.
Did this happen in Canada? I raced to CanLII and skimmed new court rulings. My frown turned to grimace. No … med-mal is more adversarial than ever. I slid my laptop into its TimeSleeve and kept musing. I got it! Documents are front and center. The Saegis fad is about sanitizing documents.
Any admission of fault, any hint of it, spells doom to a doctor or nurse in court. From today, after an error, neither the word ‘fault’ nor any attempt to assign fault, will ever appear in the records. Hospital charts, administrative files, memos – all will be free of any remarks that may later make a practitioner vulnerable in court.
Stiff from sitting, I stretched and gathered up the newspaper, rolled the sections and slid the lot into the RecycAll chute. Feeling a twinge of sentiment I added my futuristic coins and receipts. Then I caught sight of the darkening window. Evening's gloaming had crept over. It was time to check out.
I drove to my secluded lane. Tense, I waited while an elderly couple strolled past. With delicate fingers I pulled a slim lever to open the Klein Manifold. My foot teased the accelerator pedal for ten seconds, then I stamped and and revved the motor. When the tachometer red-lined, at that split-second I cut in the auxiliary tachyon burner.
The Honda leaped, wheels spinning, but soon it wasn't ground I was covering. A whine rose in pitch, a sting to the ears. Outside the window, normal color turned to chiaroscuro, then blurred to a gray landscape pulsing in tune with day and night. Through the roiling mists of time I hurtled, back to the present.
Bypassing mention of my time trek, I presented to Dr. A. Maticus the information gleaned from the library's textbooks. It took four appointments:
Returning home, I flicked den lights on and sank deep into my tweed chair. Warming myself with a cup of java, elbows square on my desk, I resolved to record the medical system in satire, society's unintimidated medium for truth.
In September 2014, Tuum Est first published Medi-Caper (though we annually update the ‘current year’ and the five-year-distant ‘future year’ of the story, to keep it fresh for new readers). From the outset, our satire critiqued the Doctors Taking Patients lists from the province of Saskatchewan.
In April 2016, the College of Physicians and Surgeons of this province sought a legal opinion from the Saskatchewan Human Rights Commission regarding the format of the Doctors Taking Patients lists published by various Health Regions in the province. To read the full discussion, click the link for the CPSS Newsletter DocTalk. Below that, we provide a succinct excerpt:
April 2016 / Human Rights Commission: Opinion Written for the College – “Case authority (or case law) recognizes that physicians have considerable discretion in determining appropriate patient treatment. However, there is some risk that the practice of purporting to limit treatment options prior to attending on a patient would be considered discriminatory.” This would include restrictions published on Doctors Taking Patients lists.
CPSS Code of Ethics (¶17) – “In providing medical service, do not discriminate against any patient on such grounds as … medical condition or physical disability. This does not abrogate the physician's right to refuse to accept a patient for legitimate reasons.”
Saskatchewan Human Rights Code – “Medical services are public services under section 12 of the Code. Public services must be provided without discrimination based on a prohibited ground. Subsection 14(a) of the Code prohibits publications which “tend to deprive, abridge or otherwise restrict the enjoyment by any class of persons, on the basis of a prohibited ground, of any right to which that class of persons is entitled under law.” Prohibited ground includes disability. Disability means any degree of physical disability, infirmity, malformation or disfigurement.”
July 2016 / College Advisory – “CPSS has noted from lists of Family Physicians Accepting New Patients, maintained by various Health Regions, that an increasing number of clinics state they will not accept patients (with serious diseases). CPSS is currently writing to all physicians who have been identified as stating they will not (accept such patients), to express concern this may breach the Saskatchewan Human Rights Code and the CPSS Code of Ethics.”
Doctors Taking Patients lists are compiled every few months by the various Health Regions in Saskatchewan. Tuum Est analyzes the worst offender, the Saskatoon Health Region (SHR). We look only at non-specialty family physicians (these are grouped at the top of each list):
SHR / Doctors Taking Patients: February 2016
This list names a total of 27 physicians who take new patients. Among those, 23 physicians (85% of the total) openly state they do not treat pain, which rules out treating most patients who have a serious diagnosis. This is one way doctors ‘cherry-pick’ light and easy cases.
SHR / Doctors Taking Patients: September 2016
After the College advisory, the Saskatoon Health Region updated its list, naming a total of 24 physicians who take new patients. Restrictions against pain patients have vanished. There is considerable overlap in names between the Sept and Feb lists. Is this real progress? Note the subtle difference known to ancient philosophers: The College is not training MDs to ‘become fair-minded,’ but instead tells them to ‘avoid actions that bring censure.’ The question is open: Will MDs find other ways to pre-screen patients?
SHR / Doctors Taking Patients: Current List
Click this link to view developments over time on the Doctors Taking Patients lists.
Tuum Est - It Is Up To You
Artist Fritz Beinke
O Pope, had I thy satire’s darts
To gie the rascals their deserts,
I’d rip their rotten, hollow hearts,
An’ tell aloud their
Jugglin hocus-pocus arts
That cheat the crowd.
Epistle to the Rev. John M’Math
Copyright © 2008-2019 Georgena Sil. All Rights Reserved.