Casting stones

The article provocatively entitled “Casting call”1 states its goal to be the initiation of a fruitful discussion regarding the practice of interviewing potential patients before the establishment of patient-physician relationships. Its emotionally loaded terminology, limited ideas, and arrogantly judgmental tone, however, do not promote constructive conversation.

The title and phrases such as “auditioning,” “application-and-approval process,” “physicians choosing patients to suit their own desires,” “dereliction of duty,” and “ethically abhorrent” are all inflammatory, diminishing the likelihood of achieving progress in this matter.

The article stresses the idea of duty, but misapplies and flogs it to the exclusion of other important, relevant ideas. Whereas the physician’s duty is to her patient, the article sounds as if the doctor’s duty is to accept everyone as patients. The article fails to recognize that a substantial part of family doctors’ work is in the areas of prevention, prospective care, and care of chronic conditions. In these areas, health optimization is a team effort with the patient as the captain. And it is especially in these areas that the doctor-patient marriage can either be a frustrating duel or a mutually satisfying duet. It makes every sense to have at least a rudimentary courtship before such long-term bonding. Even in less constrained physician-supply conditions, an interview to see how well the prospective partners would work together is sound.

Further, the article does not consider the complex mosaic of duties that those who practise family medicine must fulfil. The article fails to take note of the issue of physician burnout. It ignores the numerous health care system issues and duties. As the article lacks intellectual comprehensiveness and balance, it promotes polarization and politicization and inhibits problem-solving behaviour.

The article tenuously links distorted sketches of pre-commitment interviews, physician shortages, physicians’ desires, and marketplace maneuvering, among others, in order to arrive at the damning caricature presented in its final climactic statement. If this article achieves anything, it will be to cause medical students to eschew family practice.

During the days that this letter was percolating, Statistics Canada2 reported that people with chronic health problems by and large are connected to family physicians; it is the young and healthy who are not. So this “consternation of late” and this “palpable anger” are a bit overstated to start with.

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