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I read with interest and agreement Dickinson et al's article titled "Screening: when things go wrong", which encourages family doctors to have transparent and evidence-based conversations with our patients about preventative screening. Rather than simply telling our patients to complete their screening, we should engaging with them in evidence-based shared decision-making.
It caused me to wonder what effect provincial bonuses to family doctors might be having on these discussions with our patients. As a family doctor in Ontario, I receive a significant annual preventative care bonus that is scaled to the percentage of my patients who have completed their breast, colon, and cervical screening. A patient counts towards my annual bonus only if they have decided to complete their screening. When I take the time to engage my patients in a discussion of the risks and benefits of screening, those patients who ultimately decide against screening will detract from my annual bonus.
What effect are provincial bonus structures like this having on our discussions with patients? As much as I'd like to think I will do the right thing for my patient regardless of how I get paid, we are all still financial actors. In my view the bonus structure incentivizes a paternalistic "just get it done" approach over the shared-decision making strategy Dickinson et al are advocating for.
Competing Interests: None declared.