Today my doctor told me that pap smears are no longer included in annual physicals. This isn't the thing where pap smears are now once every three years, it means that they're apparently now considered a completely different test. Because doctors aren't allowed to bill for more than one issue per appointment, this means that if I want an annual physical and a pap smear, I have to make two appointments. Apparently OHIP is kind of cracking down on multiple issues in one appointment, and auditing doctors to make sure they don't treat patients for what they weren't booked in for.
I was googling around the idea, and apparently the intention is to cut back on the tests and examinations done during annual physicals because they've found that the tests have little to no benefit for healthy people. Apparently studies have found that the people who diligently go in for annual physicals tend to be a healthy demographic for whom the tests don't turn up anything because they're healthy. Meanwhile, the less healthy people are already going into the doctor regularly for all their various health problems, so there's little benefit to a schedule physical this month if they just saw the doctor last month and are going to see the doctor again next month.
Which I'm fine with. Because I don't actually want an annual physical. Or a pap smear. What I actually want is my birth control pills.
For my entire on-the-pill life, an annual physical and/or pap smear has been the gauntlet I have to run to get my birth control prescription renewed. This doctor books physicals far in advance, which I didn't know at the beginning, so I called when I had a month of birth control left and was told it would be six to eight weeks. When I told them I was running out of birth control, they booked me in for an appointment, where they gave me a three month prescription and then scheduled me for a physical, which I had to have before I could get a whole year's worth.
I don't think this is unique to my doctor. At various times I've read discussions about whether birth control pills should be available over the counter, and in them doctors have said one of the reasons they like them to be prescription is it gets a sizeable proportion of their patients in for their annual physicals. (You may remember we discussed how 1/3 of all Canadians use prescription contraception.)
Without getting into the (important) question of whether a physical is in fact necessary for birth control, this gave me a broader idea of how they can make the health system much more user friendly for patients and doctors.
Step 1: Completely abolish annual physicals
Step 2: Completely abolish the one issue per appointment rule
Step 3: Create a system where whenever you come into the doctor for a specific issue, you also get all the preventive tests and examinations you're due for, based on your specific medical situation, and any other care your doctor feels you need.
So, in my case, I'd call the doctor when I'm running low on birth control pills. The receptionist (perhaps with the assistance of a computer program designed to track these things) would see that it's been 12 months since I had blood work so I should probably get it done again, but it's only been 34 months since I had a pap smear so I'm not due for that. Then it would book appointment length accordingly. (Perhaps it could also add some extra time to the appointment if the patient hasn't been to the doctor in X months.)
The doctor then sees me to renew my birth control pills, and also offers all the tests and examinations for which I'm overdue, and offers any other care that he feels would be appropriate. And I am permitted to decline tests and care that are unrelated to the birth control pills and still receive my pills.
This will make things easier for the patient. No more having to keep track of your preventive care schedule and call the doctor and make the right kind of appointment. You just call the doctor when you need to go to the doctor, and they'll give you all the care you need, not just for this one issue but for everything.
It will also make things easier for the doctor. You treat the patient in front of you for everything they need treating for, without worrying about whether it falls under the issue for which they made the appointment. You can use your professional judgement without worrying about administrative matters.
And it will save the health system a little bit of money by creating a scenario where patients get their preventive tests and examinations sometime after their due, rather than right on the button of when they're due. The current system normalizes coming in every 12 months for various examinations. But if it's 12 months plus whenever the patient has an issue for which they need to see the doctor, some patients will be coming in after 14 months, some patients will be coming in after 2 years. The healthier the patient, the bigger the interval between when they come in. But it's self-selecting, so the patients are still getting care whenever they request care.
Of course, doctors can still have patients with chronic issues or high risk factors come in on a regular basis for monitoring. And they'd still have the option of influencing the frequency with which patients come in with the length of the prescription they issue.
This leaves the question of whether anyone would slip through the cracks. Under this model, anyone who wants to see the doctor for a specific issue will see a doctor when that specific issue arises. Anyone with a chronic issue or high risk factors or complex needs who needs regular monitoring will get regular monitoring as required by their doctor. Anyone who takes medication on a regular basis will see the doctor whenever they need their prescription renewed.
So that leaves people who don't have any specific issues for periods of over a year, don't have any ongoing medications, and don't have any conditions that need monitoring, as well as people who don't go to the doctor when they have an issue they need to go to the doctor for.
I think the people who don't go to the doctor when they have an issue aren't going to go for preventive annual physicals, so this wouldn't affect them. So that just leaves people who don't have any specific reason to go to the doctor during periods of over a year. Things They Should Study: is there anyone who's healthy enough to fall into this group but unhealthy enough that they have something just waiting to be caught by their annual physical?
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