Doctors call for return to family-based healthcare

| 27/11/2011

the-doctor (216x300).jpg(CNS): Two of Cayman’s medical practitioners have called for more focus on the relationship between patients and family doctors and less on specialists referrals for every medical need. The local doctors said that family-based medicine was the cornerstone of healthcare and could help to reduce escalating healthcare costs. Dr Steve Tomlinson said patients should only be going to the ER if they had a real emergency and should not be hopping from physician to physician and demanding procedures that they did not need, while Dr Virginia Hobday, vice president of the Cayman Islands Medical and Dental Society, said that quality care was not always expensive and that change was needed.

She pointed to the spiraling cost of care, particularly obstetric and tertiary level care, combined with exponential medical malpractice coverage. “At some point a breaking point will come,” she warned at the Healthcare 20/20 conference, held last at The Ritz-Carlton earlier this month. “The CIMDA does not want to see doctors forced out of obstetrics in the Cayman Islands, as has happened in other countries.”

Dr Hobday said that even though tremendous research had been undertaken, modern healthcare systems did not consistently deliver safe, effective and affordable healthcare. “In the US, spending is twice that of other developed countries, yet key quality outcome indicators lag behind international benchmarks,” she said.

The doctor used the example of palliative care as a good indicator of quality and cost effective healthcare, stating that as the medical director of Cayman Hospice Care she saw patients, as in other parts of the world, incurring huge bills pursuing aggressive treatments and debilitating chemotherapy, which their doctors had advised.

“Some of these are futile and can cause unnecessary suffering at a stage of disease which cannot be cured or the patient even given useful time,” Hobday said, adding that there was also excessive use of technology to investigate when the outcome of these tests would no longer make any difference to the care the patient receives.

Palliative care had been proven to be cost effective globally, because it was community-based, nurse-led and low technology.  It avoided patients being admitted to hospital which saved money and kept them at home where they wanted to be, she said.

Looking at medicine as an art as well as a science might help to reduce costs, Dr Hobday suggested.  “Robust primary care, preventative-based healthcare and family based medicine are the cornerstones of healthcare systems, rather than open access and specialist-led care, would reduce costs. Practicing defensive medicine never will,” she said.

Engaging the consumers by providing information on conducting healthy lifestyles was also necessary and providing programme options to allow them better access to services based upon their personal needs was also crucial, she said.

Dr Steve Tomlinson, founder and physician at the Chrissie Tomlinson Memorial Hospital, said that the increases in costs for healthcare in Cayman were caused by a number of factors, including importation of commodities mostly from the US, a lack of benefit from economies of scale, escalating malpractice premiums, utilities among the highest in the world and immigration costs.

“We know that healthcare is costly and every effort must be made to stop it spiraling out of control,” he said, stating that a country’s healthcare must rely on its economic model. Dr Tomlinson said that health began with being healthy and that all health professionals could help more with this. He said patients should avoid the over utilisation of healthcare services and only go to the ER if they had a real emergency.

The doctor told the audience patients should stop jumping from doctor to doctor when they could not get a 24 hour service and stop demanding procedures from their doctors that they did not need. He also warned patients to only sue a medical professional when it is absolutely necessary and not simply because they did not like the doctor and wanted some extra cash.

He urged patients to use local services whenever possible. “Too many consumers use overseas services unnecessarily, even for a Pap smear,” he confirmed and referred to Dr Hobday’s speech when she said family-medicine ought to be the cornerstone of healthcare, using specialists only when necessary.

“Properly implemented this will reduce healthcare costs,” he agreed. “The more specialists in Cayman the less patients have to spend on going overseas.”  

Print Friendly, PDF & Email

Category: Health

About the Author ()

Comments (7)

Trackback URL | Comments RSS Feed

  1. Slowpoke says:

    Dr. Hobday touched on a very important subject, which is that some physicians have struggles with end of life issues.  As she correctly stated, they subject patients to costly and wasteful procedures, including air ambulancing patients overseas, when there is clearly no benefit or hope.  Many procedures simply extend pain and discomfort.

    This is not a criticism of the doctors – they are people too and in spite of all their scientific training, they hold personal, moral and relgious beliefs that sometimes prevent them from providing the best care for the patient and their family.


    There needs to be more open dalogue between all the healthcare providers involved, patients, families, and the community as a whole, in order to address this issue.

  2. Real World says:

    Healthcare in the Cayman Islands is very competitively priced as far as Doctors' fees are concerned. The "reasonable and standard" fees set by the Health Insurance Commission (  have not changed for many years.  The real fact is, Doctors have not had a pay rise for years!  They're still working for the same fees set around 5-years ago.  The problem with healthcare in Cayman is NOT the cost of medical services, it's the extortionate cost of medical insurance; and the real fact that many insurance companies do all they can to avoid reiumbursing their carriers' reasonable claims.  If we want cheaper healthcare costs, the insurance companies must be taken to task about their administrative inefficiciency, their policy of not covering "pre-existing conditions" (among other issues) in order to bring down the cost of medical health insurance in Cayman. 

    Whatever you do, do not believe that  insurance companies will reduce their fees if the cost of treatment is reduced in Cayman!  They'll just soak up the finanacial benefits and NOT pass them on to patients.

  3. Concerned Caymanian says:

    The biggest problem is those persons who fly to Miami for every little medical problem, because they have no faith in the local care.  I don't know how they'd know as they never take advantage of local physicians and medical testing procedures.  all this does is push up the insurance costs for allthe rest of us.

    • Anonymous says:

      Or, on the flip side, there are many people who had to go off Island to treat and resolve serious medical issues that would have not become that serious if the problem would have been detected by the respective doctors on Island in a timely fashion and been dealt with accordingly. There are two sides to each story.

      The problem I am finding here is that the GPs and specialized doctors do not communicate properly and effectively with each other. Often the GP refers a patient to a specalist or orders test and he never gets the results passed back to him and he fails to follow up as well, leaving the patient somewhat hanging in the middle.

      Ofcourse the insurance companies with their foolishness trying to slow down the payment process aren't helping matters either.

  4. davidmcgill18 says:

    Healthcare is not subject to normal market forces! Anything that you have to buy at any random moment in order not to die is not something to which a rational supply/demand calculus can apply. Check out "Penny Medical" articles on how to reduce the cost of insurance.

  5. B.B.L. Brown says:

    My hat's off to both Drs. Tomlinson and Hobson.  I would very much like to see their suggestions put into effect, and enjoy the savings on my medical bills.  It's shameful that the representatives in governments do little or nothing to make healthcare more efficient and affordable.  It's also shameful that some practitioners want to see how fast they can become millionaires.





  6. Anonymous says:

    A return to sanity in how health care is utilized could help reign in the spiraling costs that threaten to price our children and grandchildren out of access to affordable helth care.

    Using the A & E for non-emergency matters is but one example.  Perhaps an after-hours clinic, accessible to all insurance plans, could help eliminate some of the needless and costly use of A&E for more trivial matters better handled in a typical doctor office setting? While such an idea may run counter some some of the ideas presented by Dr Tomlinson and Dr Hobday I think it would be preferred to using A&E for evaluation of a routine rash or earache visit.

    Further waste and abuse comes in the form of persons using the ambulance as a taxi for transport in non-emergency cases. I would encourgage a nominal out-of-pocket charge, specifically not eligible for reibursement by insurance, for every ambulance ride that does not result in the patient being admitted to the hospital. Make the charge more costly than a taxi or bus ride but not by much.  Those "frequent flyers" who see an ambulance as a "free" taxi ride might be more inclinded to use cheaper public transport options for their needs.