Walk-in clinics and care interruption

Some time ago, I took a few days off for a personal reason. I didn’t have coverage as the reason was so sudden. As a result of my absence, my patients visited a few walk-in clinics. The vast majority of them ended up booking followup appointments with me to address the same reason for their visits to the walk-ins. Some of the patients didn't know what medications they were prescribed or what tests were done. We had to contact their pharmacies and labs to get the test results and medications prescribed—which wasn’t easy and was time consuming. I remember Mrs. Y who is a severely anxious person with slightly elevated ANA. I thoroughly investigated her but all her tests were negative. I advised her that she is one of those people with normal high ANA and she accepted the reassurance. Mrs. Y, during my absence, developed muscle pain and went to a walk-in colleague who sent her for blood tests including ANA which expectedly came high. He then referred her to a rheumatologist who declined the referral as he didn’t see a reason for the referral based on these normal blood tests other than the slightly elevated ANA. Mrs. Y called our office, explained the situation and asked to be referred to another rheumatologist. The patient didn’t remember the walk-in doctor who she saw but remembered the clinic which didn’t respond to our requests to get the visit information It took us a considerable time and effort to put things together and reassure Mrs. Y again—or at least until she goes to another walk-in clinic. Challenging situation I used to work in walk-in clinics and I wasn’t aware how much family doctors suffer when their patients go somewhere else and have their care interrupted. I can certainly understand now if my walk-in colleagues are unable to imagine our struggles with that. Some of my colleagues may say: if you don’t want your patients to see other doctors and have their care interrupted then you have to see them. I understand that patients may tell walk-in doctors that they are unable to see their family doctors or nobody answers the phone or responds to their messages. Or even that their family medicine clinic asked them to go to a walk-in. I used to hear all these excuses before and used to believe them but now I know they are not entirely true at all. Mr. J. When I was a walk-in doctor I saw Mr. J, 47 years old, for fatigue. He stated that his regular doctor couldn’t see him. Now it happens that his doctor is my close friend and I innocently told Mr. J I would call his doctor now as he is my close friend and ask him to see him quickly as I feel he really needs to be assessed by him. He stopped me and said: “I actually saw him last week but he didn’t really give me enough time and didn’t answer all my questions; he only sent me for a blood test.” I value what walk-in doctors do but our care to our patients can be strongly affected by not knowing the details of the walk-in visit, the test results and the medications that were prescribed. I therefore hope this will change in the same way our referrals to other specialities have changed when the CPSO set a new policy and obliged them to contact patients for their appointment details—that lifted a heavy weight from our shoulders. So I am hoping that the CPSO does the same and mandates all walk-in doctors to routinely update the attending physicians about their patients’ visits and send them legible reports with all pertinent tests results similar to the ER physicians. I understand that wouldn’t be easy but by not doing it, the continuity of care is significantly disrupted and the patient care is negatively impacted. Dr. Jabir Jassam is a family physician who works at Health Treasure Medical Center in Ottawa.

Walk-in clinics and care interruption

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