Walk-in clinic doctors must take on patients if asked

The walk-in or urgent care clinic that you visited just once is obliged to be your “medical home” if that’s what you need and want, according to new standards set by the College of Physicians and Surgeons of BC.

Formerly, there was an expectation that such clinics became your primary care clinic of record after three visits.

Under beefed-up guidelines, walk-in clinics will be held to the same high standard as those where patients book appointments. That means doctors at walk-in clinics must keep excellent medical records, contact patients with lab or other diagnostic test results, send copies of reports to other doctors who need them, offer to be the primary-care clinic for patients who need a regular place to go, and schedule periodic screening and prevention checkups.

Dr. Heidi Oetter, CEO and registrar of the College, said professional standards and guidelines were updated with stronger language to let doctors and patients know there aren’t different standards of care for traditional medical clinics and walk-in clinics.

If patients have no other place to go, then walk-in clinic doctors must offer to be the patient’s primary care physician through a “verbal invitation.” They can no longer consider a patient’s visit as a one-off, she said,.

Oetter said the College hears regular complaints from the public that walk in clinics “cherry pick” the easiest cases. But even patients with complex or chronic illnesses should be able to depend on walk-in clinics for continuing care, she said. If it’s not offered, patients should feel comfortable demanding “what they need.”

The College also expects every walk-in clinic to have a medical director who is a doctor, not a business person, so the College can communicate “doctor to doctor.” The medical director must ensure compliance with College standards. Doctors at such clinics can’t delegate followup of medical care and lab tests to staff who are non-physicians.

The College is also insisting walk-in clinics provide after-hours coverage and have access to PharmaNet so they know what prescriptions patients are taking. Oetter said the latter rule arose after investigations which found evidence of prescription fraud throughout the Lower Mainland. One person got more than 250 prescriptions, from multiple physicians, and filled them at 34 different pharmacies from 2007 to 2013. The College found fault with 46 physicians who had deficient prescribing practices.

“This case serves to remind physicians of the important role they play in mitigating this public health problem, which starts with prescribing medication to patients according to current prescribing standards and principles. This includes taking the time to conduct an appropriate exam, asking the right questions, and checking the patient’s PharmaNet profile before issuing a prescription — especially for a narcotic.”

Dr. Chris Watt, a family doctor who owns three walk-in clinics in Vancouver and Victoria, said he agrees with the College’s goals of high quality care, but worries that an unintended consequence of the rule changes may be the retirement of older doctors at walk-in clinics. The new guidelines make the establishment of a doctor-patient relationship an automatic process, removing autonomy from doctors. Older doctors who’ve given up their practices but work part-time in walk-in clinics are a “rich source of manpower” — but they may just decide it’s too much of a burden to continue working, Watt said.

Dr. Charles Webb, the new president of Doctors of BC, said the College’s new standards are welcome and will improve the level of patient care.

Dr. John Sehmer, a Vancouver family doctor at a traditional clinic, also welcomes the new guidelines, saying they help hold walk-in clinics to the same standards as other clinics.

“I think citizens need to be aware that walk-in clinics have obligations to them in terms of following up on results they order, without necessarily requiring the patient come in to get the results, and that there is an obligation for walk-in clinics to provide continuity of care if the clinic, by default, is their regular health care provider.”

“I also think most walk-in patients are unaware that the same degree of documentation and medical record keeping is expected from a walk-in clinic as from a regular family physician.”

Sehmer said he knows of cases when patients are rushed to an emergency room and the hospital has no idea where to send reports because patients say they do not have a regular doctor even if they have repeatedly gone to the same walk-in clinic.

The new guidelines set by the College will ensure there is a central source for medical files, he said. Medical organizations don’t keep records of how many patients use walk-in clinics but more than 200,000 B.C. residents are searching for a family doctor, according to estimates from Doctors of BC.

Pamela Fayerman is a Vancouver Sun reporter.

For more from the Vancouver Sun, click HERE.

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