The question
My children – 13 and 15 – have been with the same pediatric practice nearly since birth. We have an outstanding balance of$1,000 – $1,600 due to my medical condition and my husband's unemployment. We received notice we are no longer allowed to bring our children to their office. My 15-year-old has chronic asthma and I am trying to find emergency care for her; she is low on meds. I am upset because we had a very good doctor-patient relationship. Is this common practice? Is it legal?
The answer
Though it is not common practice, it is legal. What I'm wondering, though, is what's really going on: I sense the doctor terminated the relationship for another reason and used the unpaid bill as an excuse. If money was the main issue, he would have been on you long before the bill reached $1,000 or more.
I'm not alone on this one. According to Ailve McNestry, a deputy registrar for the College of Physicians and Surgeons of British Columbia, who deals with conduct and ethical complaints , "something was obviously wrong long before it hit that amount of money."
There are sure-fire ways to kill the therapeutic relationship that should be avoided by patients at all costs: repetitive no-shows, chronic lateness, waiting room disruptiveness and perhaps the worst one of all – being rude to office staff.
Right now, you have an asthmatic daughter with no physician and no clear understanding of what went wrong. I suggest you contact your family doctor – not the pediatrician who terminated the relationship – and see if you can get her into that practice, at least for a prescription; it's troubling she was left low on medication.
According to Dr. McNestry, "this college would be very critical of a doctor who pulls the rug from under a child, somebody under the age of 19 who has a chronic disease. Most doctors don't do that; they would continue to see the child in any emergency situation and probably until they had a new physician."
When she sees the doctor, ask if she should be referred to a respirologist, a physician who specializes in the treatment of respiratory disease. That might be a better long-term solution.
It shouldn't be a mystery when a doctor terminates a relationship. Ideally, the physician should explain – politely and concisely in person and in a letter – why the relationship is being terminated. Typically, a doctor will provide two or three weeks of coverage after lowering the boom.
Though the pediatrician may feel justified using the outstanding bill as grounds to terminate the relationship, I would have expected him to cut you some slack and be flexible given your illness and your husband's unemployment.
Medicine may be recession proof, but most Canadians working in the private sector have had a tough few years.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com