Guideline for walk-in clinics to fill family doctor role challenged

B.C. walk-in clinic patients who regularly visit one location, under new guidelines, now have family doctors — but not everyone is happy about it.

The updated guidelines mean patients without a family doctor who regularly use a walk-in clinic will now regard that clinic as their “primary care home” and the physicians serving that walk-in clinic as their collective family doctors, says the College of Physicians and Surgeons.

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As family doctors to these particular patients, the doctors are obliged to create for them long-term medical records and chronic disease management plans, perform or order regular screening tests, and keep track of medications and treatments.

“We are hearing from doctors that they have a number of concerns with respect to the revised guidelines,” said Dr. Charles Webb, president of Doctors of B.C., in a statement.

“Therefore, we will be meeting with the college to seek clarification so that there is a better understanding of the impact of these guidelines.”

Doctors of B.C., a professional association representing physicians, was not consulted during the development of the guidelines, Webb said.

The group is seeking a meeting with the college this month to clarify the regulatory body’s updated guidelines, released in June.

Dr. J. Galt Wilson, the college’s senior deputy registrar, said the fuss around the guidelines is based on misconceptions. The rules simply enhance “very similar” regulations in place since 2008, he said, and reinforce that there is only one standard of care acceptable — regardless of whether it’s provided at a walk-in clinic or at a family practice.

“Patients who attend the same clinic regularly as their primary care home must be offered ongoing care organized and delivered to expected standards,” the college says, “including the creation of a unified patient record which is reviewed at every visit.”

Most walk-in clinics with regular patients already keep longitudinal charts for them and perform or order regular tests such as Pap smears, blood pressure tests and diabetes screens, Wilson said.

“This is not new, it’s not onerous and it’s absolutely not a one-visit rule,” he said, referring to the belief that the new rules mean a patient can visit a walk-in clinic once and call it their primary-care home.

“But if you’re seeing a patient who you know only comes to your clinic and they are two years overdue for a Pap smear or blood pressure check, it’s just not acceptable to ignore that.”

Some doctors fear “aggressive, demanding, unpleasant people will come through the door and say ‘I’m in charge here and you have to be my family doctor’ and doctors fear losing control of their professional lives,” Wilson said of the new guidelines.

“But that’s not what it’s about,” said Wilson, a family physician for 30 years. “It’s about being thoughtful about what you’re doing — an acknowledgment that patients getting all their care at your [walk-in] clinic need to have their care organized with a longitudinal theme informing that care.”

Statistics Canada’s 2013 Canadian Community Health Survey reported an estimated 15.6 per cent of British Columbians were without a family doctor.

Doctors of B.C. estimates that fewer than four per cent of British Columbians — about 200,000 people — are currently looking for a family doctor.

Dr. Gary Leong, who has a family practice at Herald Street Health in Victoria, said when he opened up his family practice in December 2013 “we had a landslide of people wanting to come in, so clearly there is a shortage of primary-care physicians here.”

Recently, Leong temporarily reopened his practice to new patients. After a month, he had received 400 patient requests.

“People are desperate to try to find a family doctor,” Leong said.

The B.C. Health Ministry said Friday it’s too early to say how much of an impact the new directive from the college will have on its GP for Me program, which promises to match B.C. residents with family doctors. B.C. Health Minister Terry Lake has said the province isn’t likely to fulfill its promise that every B.C. resident who wants one will have a family doctor by the end of this year.

Health Ministry spokeswoman Laura Heinze said the ministry supports the college’s guidelines, but “we do not view these guidelines as a way to boost our numbers of patients attached to a primary-care provider — they are simply one piece of the puzzle.”

Nevertheless, those regular walk-in clinic patients will now be viewed as having a family doctor.

“We do not differentiate when a patient visits a walk-in clinic over other forms of primary-care practices,” Heinze said. “Instead, we look at whether they are getting continuous primary care from a practice, or from one family doctor.”

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