Greed, Betrayal and Medical Misconduct at North York General | Hacker News Reader

Greed, Betrayal and Medical Misconduct at North York General

torontolife.com

36 pointsaxiomdata31610 comments

There is a good podcast with a similar bit of greed called Dr. Death. Highly recommend if this article interests you.

One common thread is how bad misconduct can be deemed “personal” and hidden from public view with internal hospital panels. In this story it happened at the same hospital - But a Doctor can do a horrible job, even as far as resulting fatalities, be asked to resign, and go join another hospital with no repercussion.

We are quick to blame government healthcare or insurance companies for healthcare issues while leaving this important loophole wide open. When confronted by reporters or investigators, the members of these internal medical boards either remain silent or hide behind the “I’ve been an admin at a prominent hospital with years of medical experience, I know better than you.”

"He was taking advantage of peculiarities in OHIP’s billing system, which encourage all sorts of chicanery that, while not always illegal, can tempt doctors into bending the rules"

This explains a lot. If you have two issues they really do make you book again. They send you for unneccessary tests and refuse necessary tests. Everything is setup to beat the system. What you really need (medicine wise), getting better, safest choices are not really part of it anymore.

I think Ontario needs to move away from fee based billing. It seemed like a quick way to inflate how many people have a family doctor. Doctors see more people but appointments are 10 minutes of less. Pay doctors an annual salary and force them to work for the government as an employee and impose standards with customer service in mind.

Ontario isn't 100% fee-for-service. GPs are capitated, they are paid by how many patients are enrolled on their roster. It's the specialists who are paid fee-for-service - but yes your point stands, perhaps its not the best model as it incentivizes this sort of chicanery.

In what industries or occupational areas has forcing people to work for a particular entity and imposing standards on them improved quality and/or efficiency?

Many in healthcare see fee for service giving way to value based care but it isn’t a simple knot to cut.

http://www.hl7.org/about/davinci/index.cfm

Fee for service increases the amount of services performed. On the surface that provides additional value in terms of more services performed so greater coverage with fewer doctors.

That goes against the government who may want to limit the number of services because of budgets. So services not under government watch are over ordered and services under ration are underordered.

On the patient side you are not getting the best medicine you are getting medicine that pays the most fees.

Somewhere along the line of acquiring mountains of school debt and being squeezed by insurance and hospital administrators a lot of doctors stop caring about patients and focus on "efficiency".

This is in Canada where most health care is covered by the province and medical schools don't cost nearly as much as US medical schools.

I wonder if he wanted to make money, it would make sense for him to try to move to US? Not sure though how easy it would be to get a US licence for a Canadian doctor.

I wonder if he wanted to make money, it would make sense for him to try to move to the US? Not sure though how easy it would be to get a US license for a Canadian doctor.

If you look down the list of deliveries included in the article, you will see that at least one of the other doctors has an unusually low rate of weekend deliveries, but that they peak significantly on Thursday and Friday.

This is likely because many OB-Gyns induce labour for the opposite reason to that which is alleged of Shuen: so their weekend golf game doesn't get screwed up by a delivery.

In truth, there is little difference between inducing labour for financial versus personal reasons. No doctor ever said to a patient, "I have a tee-off time at 9:30 Sunday so we have to get this baby out now."

This means that the issue of consent is identical in both cases. Consent means "informed consent". It doesn't matter if you're trying to get the extra billing for a weekend delivery or if you are trying keep the weekend call schedule quiet; it doesn't matter if you pop a misoprostol in during a vag exam or go through the formal induction process with the hospital. If the patient doesn't know the REAL reason, it's still a crime because of the absence of INFORMED consent.

This has been happening as long as there have been OB-Gyns. Babies come when they want, and doctors have always tried to manipulate that for their own preference.

Shuen's crucifixion is therefore more the result of his motivation than the fact of his behaviour. He was apparently doing for money what almost every OB-Gyn does for reasons that we consider more noble, or at least understandable, but which are actually no different because they prioritize something other than the health of the baby and the mother.

Even if doctors were truly altruistic, reality would still require inductions for the banal reason of hospital staff scheduling or resource availability. We are fools if we think this is any different from what Shuen did.

Any system motivated and rewarded by money will always suffer from these sorts of imperfections, as will any system that is not motivated by money.

It is the height of naivete to think otherwise. Shuen just flew a little closer to the sun than everyone else.

Also, the article neglects the obvious problem with chain of custody. Once you throw an exam glove in the garbage, it's gone. If Shuen ever got his day in an actual court, his lawyer would tear that evidence apart to the point where it would have to be disregarded by a judge or jury. It's not fair to trot it out now in this hatchet piece as if it is the smoking gun.

Keep in mind that the nurses justifiably hated Shuen because he (admittedly) behaved like a complete asshole to them. Nurses are really good at finding clever ways to take you out under those circumstances. You have to interpret that piece of evidence in light of the unbridled hostility of those who collected it.

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