When I'm writing a post, I tend to have a very good idea about what I'm talking about. Today I'm tackling a topic that involve certain areas in which even a polymath like me isn't that well versed in. I'm going to talk about Dr. Winston Tam from British Columbia (Canada) and the government healthcare system and try to propose solutions. Most of the health & pregnancy related information are taken from sources all over the internet. So if you see inaccuracies or if some of these things are edge cases, feel free to let me know in the comments. I know well about the economic aspects.

It's More of A System Than An Individual

We have to understand the distinction between bad actors in a good system and good actors in a bad system. A good system can even improve the services provided by bad actors where as a bad system brings out the worst in people. It's important to know the condition of healthcare in Canada. One source I can show you is this:

Moore uses way too much sensationalism in his films. I live in Quebec and here, you can wait up to 8 hours for a minor injury (like a cut on the achilles heel). Of course that's because they prioritize people in order of urgency but we're still WAY far off that 20 minute mark these people said. Still, even though we're heavily taxed, I'm glad to live in a place where healthcare is accessible to everyone. Our hospitals just need to be better managed that's all.

• Emnasty63

Michael Moore is a genius filmmaker with a socialist bias. So I consider the picture that is painted by comparing the 2 videos above to be accurate. According to this source 59% of the Canadians reported waiting more than four weeks for an appointment with a specialist. Personally I consider this inconceivable because I don't know about anybody in my life who had waited more that about a week.

So obviously there is a problem with the availability of specialists in the system. With low supply and high demand, the doctors tend to have far more power over the patients. If the patient could simply visit the next doctor immediately, the doctor's livelihood depends on taking the best care of patients and being extremely good at the job.

Winston Tuck Loke Tam

He was British Columbia’s top billing obstetrician-gynecologist making 1.7 million dollars a year (I'm assuming Canadian dollars) which in itself is great. But then you realize that he was seeing as many as 90 patients a day. The only way to have such high numbers is by either reducing the time and care given to individual mothers or simply working long hours which not only makes a person very exhausted leading to more negative/irritable behavior but also make the person loose a significant amount of sleep which can actually be as harmful as being drunk: https://steemit.com/science/@vimukthi/the-war-on-sleep-is-neurologically-stripping-you-of-your-humanity-mental-health-consequences-of-the-future

This doctor had even managed to do deliver 15 babies in a single shift. That's very little time per mother and obviously the process should have been a very quick and mechanical one. ^Source

The Investigation

I'll skip to the end. Investigations were opened in 2010 and they dragged on for 5 more years where at the end the doctor resigned and basically nothing happened. I'll add a small list of complains about the doctor which the disciplinary boards were not that disturbed by.

• He performed medical procedures, such as vaginal exams, without their consent and made disparaging remarks about their bodies. (although weight gain and getting fat is to be a common and obvious thing when it comes to motherhood)
• He performed unnecessary C-sections (there is money to be made in extra procedures even though it does't come from the patient's pocket)
• he had overbilled the province and was directed to pay $2.1 million in 2016 investigation
• His earnings had placed him in the top 2 per cent of doctors of any specialty in the province. Yet, it wasn’t until 2010 that Dr. Tam’s billing practices landed on the radar of the B.C. Billing Integrity Program. (Nobody even knows when the complains even started which leads me to assume ht there were complains from the early days of his career)

Reviews on RateMDs.com

According to Wikipedia, RateMDs.com is a free website allowing users to submit and read reviews of doctors, dentists, psychologists, urgent care centers, group practices, and hospitals. The site is free to use for both consumers and doctors. Any doctor may pay a fee of between US$119 and US$179 per month (between US$1,428 and US$2,148 per year) for the website's "Promoted Plan". This plan includes a variety of features, including the "Ratings Manager". "Physicians who have a paid plan are ... allowed to hide up to 3 RateMDs reviews 'deemed to be suspicious' and can select a featured rating to show up at the top of the reviews."

With That in Mind:

I saved the two best written ones (IMHO) for last

Read the final screenshot very carefully. What I see is not a person who is evil and full of malice but a person who is obsessive with filling up numbers regardless of the quality of work. Have you ever had to finish some homework or a project under a very small amount of time? Doctor Winston Tuck Loke Tam was putting himself through that everyday and imagine how you would have acted in under similar conditions. You wouldn't imagine yourself being this compassionate human being, do you?

Now imagine being at the receiving end of such and obsessive and irritated mood and this is a doctor who is the person who is going to be messing with your/ your partner's motherhood.

Incentives, Incentives, Incentives

In this case it mostly just comes down to seeing more patients and doing more procedures in a gamified system where citizens are taxed and the doctors are tapping into a pool of tax dollars with a statistics sheet of their "performance".

one of the women who had complains were named Charisma Jurica. Her experience lead her to a to post-traumatic stress disorder and, for years, preventing the couple from having more children. Ms. Jurica’s midwife called Dr. Tam for a consult because the baby’s heart rate had decreased. When Dr. Tam arrived, the midwife told him the heart rate had returned to normal and he wasn’t needed. Ina system of bad incentives, the doctor used this as an opportunity to justify a C-section. He also commented on her weight, calling her a “really big girl”.

He chastised her for screaming as he put both his hands into her vagina without consent, Ms. Jurica alleges. The couple were confused. Ms. Jurica’s midwife had told her she wasn’t fully dilated. Ms. Jurica remembers that after only a few attempts at pushing, Dr. Tam cut the opening of her vagina without any explanation, inserted forceps without informed consent and pulled her baby out. Her husband began to cry. “I saw Ava’s head and I said, ‘Oh my god, my baby is deformed.”

The Juricas said the forceps had misshapen Ava’s head and her eye was swollen shut. Photos during the early part of their daughter’s life would be taken at particular angles to hide the damage. The shape of her head eventually returned to normal but she is left with a scar from the forceps.

As any sensible person would, the mother spent days writing complaints to the College of Physicians and Surgeons of British Columbia and the Fraser Health Authority.

Ms. Jurica sent her complaint to the medical college in February, 2013, and received an official response about a year later. The eight-page letter includes Dr. Tam’s rebuttal. Dr. Tam said his reason for the rushed birth and the forceps delivery was that the baby was in distress. He said he had examined Ms. Jurica’s cervix and it was fully dilated, and he claimed he had communicated clearly about what he was doing and the options.^Source

There is another case where the doctor was pushing for an emergency C-section using emotional blackmail.

When he said something looked off, she and her husband were confused. He told them that one of the babies was much larger than the other and she needed an emergency C-section. “Dr. Tam was pushy. He said, ‘Do you want your kids to die? Do you want your babies to die? They could die,’ etc. All I could hear was die,” Ms. Stewart recalled. She and her husband asked for another ultrasound but the doctor wouldn’t hear of it. “I thought, well you are in a hospital and they are really rushing us along, maybe there really is an emergency. You don’t know. You put your trust into these guys. We were scared,” Jeff Stewart said.^Source

This was at 34 weeks and the baby which was told to be "much larger than the other" only had and extra 0.5 pounds. One of her sons were blue, with his undeveloped lungs failing him.

Taking from The System

Auditors found various issues driving up Dr. Tam’s billings. For example, they found he was racking up charges for being called out to the hospital when he was likely already there, improperly billing around $100 extra in each case. He regularly billed for a urine examination involving a microscope, but when auditors visited his office they found he did not have the instrument. (The different billing code meant he could charge about $3 more for each of these routine tests.) The auditors also found Dr. Tam billed for an emergency C-section when the records showed it had been scheduled. The difference meant he could bill approximately $50 more.^Source

This money is collected from the very high tax rates of the country. The procedure of complaining is bureaucratic and this one doctor's abuse continued for over a decade and I haven't detailed all of the cases against the doctor. But the worst part here is that Winston Tuck Loke Tam is just one big easily noticeable fish. There could easily be hundreds of less worse cases within the system.

It All Comes Down To Choice

Would any of the abused mothers (or their families) would submit themselves to the situations described above if they had a choice? No mentally competent person would. But then again, how would they know about the nature of the doctor? I'd say reviews, word of mouth and reputation helps. When the state is the customer paying for the doctor, the process is a bureaucratic mess with nobody really in charge and change is almost impossible to accomplish. But when things are decentralized, patients have more power and doctors have a competition among themselves to be better human beings.

As a personal account I know occasions where a doctor had told my mother that certain expensive tests were not required and that the other doctor is just trying to make some money on my mother's insurance package. These things spread slowly but steadily and most of the people who talk with my mother wouldn't go to the money grabbing doctor ever again. Also note that the doctor would have been able claim money from taxpayers if the tests were to be done on a public hospital.

Here (Scandinavia) it works like this:
1. Wait 3 weeks for you MRI, nothing to pay.
2. Get MRI the same day and pay for it at a private clinic.
In the US you do not have a choice. I prefer having the choice.

• Helen E

Here in Canada we don't have a choice either.
It's wait 3 (or 6) months. Period.
If you want to pay for quicker service, Big Brother says "No you may not".
There is a way around this of course, and that is to cross the border to the USA and pay for it there. But I wouldn't be surprised if the current Liberal Government finds away to prevent you from doing that either.
Isn't it ironioc that the "Canada Health Act", the law that gives us the free health care but also prevents us from spending our disposable income on extra health care, came into law in 1984.

• Robert Scarborough

I consider the hybrid system of free and paid to be the best because poor people have some place to fall back to while those who can manage the pay can keep the incentives for a more efficient and competent system. The free doesn't have to be government. A charity funded by generous individuals could easily accomplish this. Money will go where it is needed and the good doctors could simply work choose to work for reduced or no fee at these charity funded hospitals.

Finally I'd like to re-emphasize that these accounts were simply about one bad actor among many who are sure to be gaming the system. Unless you fix things at the roots, these things will continue in one way or the other. Finally I'd like to end in a positive note by talking about Doctor Russell Dohner

Hats Off To The Good Doctor; RIP