# Patient Rights



## Mediman14 (24 May 2018)

Forgive me if this was already posted, I looked but did not see this.

Patients are entitled to an second opinion, but can that second opinion be a Doctor of your choice providing it is reasonable? For example, seeing Cardiologist referred by your primary care giver. Can you ask for a second opinion from a Cardiologist of your choice within the same geographical region?

I have seen for Orthopaedic surgeries, that some Dr's do not perform arthoscopies for whatever reason. They don't like it. However, in todays medical society, surgeries are becoming more advance. Does this make the Orthopaedic surgeon who doesn't perform Arthoscopy Biased?

Your thoughts?


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## Teager (24 May 2018)

This may help.

https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2014/when-a-patient-seeks-a-second-opinion


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## Armymedic (24 May 2018)

Answer A. You are, but you can not directly. This is something you either request from your primary care clinician to refer you to a different Cardiologist, or ask the cardiologist to refer you to a second specialist. Generally if you are not sure about the plan you are being presented, the clinician can, and generally will, on request, consult their peers or refer your case for another professional opinion. Such things are called getting professional consensus. This is common practice and usually done behind the scenes.

Answer b. No. There may be very good and clinically proven reasons why a specific technique is, or is not used in a specific case. There may a higher risk of complications, lower successful outcomes, lack of training or equipment.


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## medicineman (24 May 2018)

Mediman14 said:
			
		

> I have seen for Orthopaedic surgeries, that some Dr's do not perform arthoscopies for whatever reason. They don't like it. However, in todays medical society, surgeries are becoming more advance. Does this make the Orthopaedic surgeon who doesn't perform Arthoscopy Biased?
> 
> Your thoughts?



In the case of an orthopod that won't perform arthroscopies, I'd have to ask this question - did they say they just don't do arthroscopies flat out, or did they say they weren't going to do one on you because they felt it might worsen things?  The best surgeons are the one's that know when to cut and when not to - if they think that more harm will come to you by diving in and rooting around, they won't.  I ask it like that, because in my experience, people often only hear what they WANT to hear vice what was actually said OR what they really NEED to hear - they get it in their heads they need an operation and don't listen to the actual operator (sounds like many things military come to think of it).

As a general rule, if you want a second opinion, first ask the person that was consulted initially if they could recommend someone for a second opinion - if they're the least bit confident in themselves, they'll point you to someone else; if they're an ignoramus, well we know how that might end.  If you end up with the latter response, ask your doc if they recommend anyone or if they could refer you to someone of your choosing.  However, just keep in mind that could backfire if you go see someone you know will operate regardless if you need it or not.

 :2c:

MM


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## Gunner98 (24 May 2018)

If you are referring to a your rights as a military member seeking health care, the CAF Patient Partnered Care Policy states:

"As our patient, we want you to:...Be fully informed about all aspects of your care and be able to respect and receive a second opinion if desired."

5020-68 - Sharing of Information Among Health Professionals states:

7.TO THE GREATEST EXTENT POSSIBLE, WHEN MEDICAL SCREENINGS FOR OVERSEAS DEPLOYMENTS ARE BEING PLANNED, THE HEALTH PROFESSIONALS SCREENING A MEMBER SHOULD BE THE SAME ONES INVOLVED IN PROVIDING CARE TO THAT MEMBER. THIS WILL HELP INSURE THAT THE BEST DECISIONS, BASED ON THE MOST IN DEPTH KNOWLEDGE OF A MEMBER'S HISTORY, ARE MADE. FOR DIFFICULT CASES A SECOND OPINION CAN BE OBTAINED FROM AN IMPARTIAL THIRD PARTY".


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## Mediman14 (24 May 2018)

medicineman said:
			
		

> In the case of an orthopod that won't perform arthroscopies, I'd have to ask this question - did they say they just don't do arthroscopies flat out, or did they say they weren't going to do one on you because they felt it might worsen things?  The best surgeons are the one's that know when to cut and when not to - if they think that more harm will come to you by diving in and rooting around, they won't.  I ask it like that, because in my experience, people often only hear what they WANT to hear vice what was actually said OR what they really NEED to hear - they get it in their heads they need an operation and don't listen to the actual operator (sounds like many things military come to think of it).
> 
> As a general rule, if you want a second opinion, first ask the person that was consulted initially if they could recommend someone for a second opinion - if they're the least bit confident in themselves, they'll point you to someone else; if they're an ignoramus, well we know how that might end.  If you end up with the latter response, ask your doc if they recommend anyone or if they could refer you to someone of your choosing.  However, just keep in mind that could backfire if you go see someone you know will operate regardless if you need it or not.
> 
> ...


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## Mediman14 (24 May 2018)

Simian Turner said:
			
		

> If you are referring to a your rights as a military member seeking health care, the CAF Patient Partnered Care Policy states:
> 
> "As our patient, we want you to:...Be fully informed about all aspects of your care and be able to respect and receive a second opinion if desired."
> 
> ...


 In my particular case, the orthopod who performed three surgeries on myself I trust and like. However the military does not like him because my primary care giver claims "we are only padding his pockets and we don't like the results". My personnel thought on this is that if the patients doesn't follow his recommendations then the outcome will not be as desired. I have personally seen this. 
    I have hip issues. I truly believe that the hip is one of those body parts that if you go in once, you will have to keep going in. One of the most common problems with hip arthroscopes are heterotropic Ossification/ Ossicles. Will unfortunately , I have a 6mm ossicle in the Hip joint with FAI and acetabular Cupping that is causing issues.


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## medicineman (24 May 2018)

Maybe you need to go out of province?


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## Mediman14 (24 May 2018)

He is from out of province!


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## medicineman (24 May 2018)

Mediman14 said:
			
		

> He is from out of province!



Exactly.


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## Mediman14 (25 May 2018)

Exactly.





			
				medicineman said:
			
		

> Exactly.



 ???


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## medicineman (25 May 2018)

Mediman14 said:
			
		

> Exactly.
> ???



I used to do bookings for stuff in my younger days - if it needs to be done, it’ll get done.

Usually.

MM


Sent from my iPhone using Tapatalk


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## Mediman14 (25 May 2018)

medicineman said:
			
		

> I used to do bookings for stuff in my younger days - if it needs to be done, it’ll get done.
> 
> Usually.
> 
> ...



Does the military have the right to deny you from seeing a specialist because they don't like his services?


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## Occam (26 May 2018)

Unrelated (somewhat) question:

If a member had a concern about the care (or lack thereof) for a condition they have complained about, but received nothing more than a "let's wait three months and see" when a specialist referral might be indicated, is there a mechanism at the various CF Health Services Centres for the member to raise their concerns?

Something along the line of patient advocates I have seen on staff at civilian hospitals?


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## Gunner98 (26 May 2018)

Mediman14 said:
			
		

> Does the military have the right to deny you from seeing a specialist because they don't like his services?



For you to be referred out, the specialist must be registered with Medavie Blue Cross which puts them on the "Preferred Provider List" that is maintained with the assistance of the Federal Health Claims Processing System.  The specialist must apply and adhere to the guidelines listed in the agreement.  So the answer depends on whether the specialist is on the list or not.  If he is not then you can encourage them to register.  Being on the list does not ensure a referral and pre-authorization for payment; however, not being on the list makes it impossible. 

Provider Guide is found here:  http://pub.medavie.bluecross.ca/pub/0001/PublicDocuments/Provider%20Guide-%20FINAL%20EN.pdf.  See section 3 of the guide.

As well the treatment being sought must be included in the CAF Spectrum of Care, more info here: http://www.forces.gc.ca/en/caf-community-health-services-benefits-drug-coverage/index.page


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## Gunner98 (26 May 2018)

Occam said:
			
		

> Unrelated (somewhat) question:
> 
> If a member had a concern about the care (or lack thereof) for a condition they have complained about, but received nothing more than a "let's wait three months and see" when a specialist referral might be indicated, is there a mechanism at the various CF Health Services Centres for the member to raise their concerns?
> 
> Something along the line of patient advocates I have seen on staff at civilian hospitals?



The avenues to lodge patient complaints in CAF Health Centres are the Commanding Officer, the Base Surgeon, Company Sergeant-Major or the Primary Care Services Manager. Contact numbers are available here: https://www.canada.ca/en/department-national-defence/services/benefits-military/health-support/medical-dental-centers.html 

Most clinics have a Quality and Patient Safety Committee that review patient feedback and patient safety incidents.  Not all currently have a patient representative on this committee. 

A final avenue to follow is to ask for a referral to see a Case Manager.  The Case Management Program is designed to help eligible CAF members identify and access health, pension and other related resources and to ensure continuity of care.  There are "more than 60 Nurse Case Managers across the country to provide you with the best care possible. A Nurse Case Manager is available at most Canadian Forces Health Services Medical Clinics." More info here: http://www.forces.gc.ca/en/caf-community-health-services-case-mgmt/index.page

*Medical Care Limitations*
Limitations on the type, level and frequency of services will be applied by the Senior Medical Authority based on selection criteria and guidelines developed by the Surgeon General. These limitations are designed to ensure that a comprehensive range of appropriate medical services are provided to eligible persons based on professionally assessed need. Source:  http://www.forces.gc.ca/en/caf-community-health-services-benefits-drug-coverage/limitations-medical-dental-care.page

The Senior Medical Authority at each Base is the Base Surgeon.  See additional policy here:
http://www.forces.gc.ca/en/caf-community-health-services-benefits-drug-coverage/coverage-eligibility-management-access.page

*Excerpt*
"Coverage
Within the limits provided in this document, CAF members and other eligible persons will be:

provided comprehensive coverage, whether serving in Canada or abroad, including:
hospitalization and physician services;
supplemental health benefits including drugs and health practitioner's benefits;
occupational health services; and
dental services.
excluded from any deductible fees or co-payments for care and services provided by or authorized by the CAF, except where otherwise specified;
provided emergency health services from the nearest appropriate military or civilian treatment facility; and
responsible for all costs related to health care services not authorized, or for services from sources other than those designated and authorized by the senior Health Services authority. *In addition, payment will not be made for treatments or therapies if they are deemed to be:
controversial;
not scientifically founded or proven;
not medically beneficial; or
provided solely for cosmetic purposes.*

Limitation: Health Services Outside Canada. Eligible persons residing in Canada will not be entitled to routine health services outside Canada.

Note: Consideration will be given for cost recovery for the fees that result from missed appointments."


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## Occam (29 May 2018)

Thanks for that, Simian Turner.  In this case I would think that a formal complaint to CO/BSurg/CSM is somewhat overkill.  The member wants resolution at the lowest possible level.

The member in question has suffered from hearing difficulty for a long period of time.  The member keeps being sent for a standard audiogram, which turns up normal.  However, the member continues to suffer from tinnitus, difficulty hearing while subject to any kind of ambient noise, and other suspicious symptoms that would not necessarily be picked up on a standard audiogram.  Member requested referral to an ENT or audiologist and was denied; told to wait 3 months and re-evaluate.  Member feels that condition has gone long enough that waiting 3 months will not result in a different outcome, and will only further delay possible treatment.

Does the member simply ask at sick parade for a referral to a case manager, and then explain the situation to them?  I wasn't aware that case managers could be assigned unless there were changes to medical categories involved, but then again I've been out more than a few years.


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## Gunner98 (29 May 2018)

Case Managers can often serve as system navigators for a patient who requires assurance or information about their health conditions.  Speaking to the Primary Care Services Manager should allow the individual to be directed to another physician or a Case Manager for a review of their concerns.  

I perceive that I have moderate hearing damage from 15 years in the Artillery and cannot hear well in a crowded room, bar or restaurant; but, my audiograms turn out just fine.  The interesting thing about tinnitus is that many medications cause it as a side effect.  In my case a combination of anti-depressant and anti-convulsion medications cause the ringing sensation to get higher or lower depending on my mood, stress level and the weather.  My chiropractor opens my hearing canals with a minor ear tug during visits and I regularly cleanse my ears canals with Murine ear-drops, followed by a syringe filled with warm water.  There is no fixing the condition in my case but all of my efforts assure me that I am mitigating it as much as possible.  Balancing the positive effects and the side effects has long been a challenge; however, going off my medications could have very adverse results.

If the individual has recently changed medications then a wait will be recommended to allow adjustment to the side effect sound levels and to the medications' affect on the condition.

No surprisingly these are possible issues, such as:

Age-related hearing loss

Meniere's disease

Middle ear damage caused by a sudden change in pressure (barotrauma)

Aspirin in moderate to high doses often causes tinnitus.

https://www.drugs.com/health-guide/tinnitus.html


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## Jarnhamar (29 May 2018)

[quote author=Simian Turner] .  My chiropractor opens my hearing canals with a minor ear tug during visits and I regularly cleanse my ears canals with Murine ear-drops, followed by a syringe filled with warm water.[/QUOTE] 

Do you find a chiropractor helps out quite a bit with your tinnitus?
I'm ready to try voodoo.


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## Gunner98 (29 May 2018)

Yes.  I never believed in chirovoodoo before I tried.  He has worked miracles on my ears, back and hips.  Since VAC pays for the treatments I gave it a try and now I go back for monthly sessions.  No major adjustments, he only uses a small activation hammer on specific joints, see attached.


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