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The question: My family doctor has just posted the following note: "Please note that we are not continuing to provide family medicine services to patients who chose to attend walk-in clinics for convenience rather than placing a call to our office for an appointment." Can she do that? She has a very busy practice that closes by mid-afternoon on weekdays and does not open on weekends. She is a great doctor, but what do I do if I don't have time to wait on her?

The answer: Without more details, it is difficult for me to comment on how an individual doctor chooses to practise. Let's work through the possible reasons why this may be happening and see what can be done to ensure that you are getting timely and accessible care.

To understand what may be happening, I called the Ontario Ministry of Health and Long-Term Care and the College of Physicians and Surgeons of Ontario to find out their thoughts on the matter. Both organizations stated that they get frequent calls from concerned patients with this same question, so it's clear that you're not alone on this issue.

It sounds like you are rostered to your family doctor's practice and she is a part of a provincial Family Health Team, Organization or Network. These types of clinics consist of a team of doctors and allied health professionals (nurse, pharmacists, social workers) that work collaboratively to provide comprehensive primary care to their patients in a timely and accessible manner, including after-hours and weekend care.

When you belong to this type of practice, you are part of your doctor's list of patients that she has a responsibility to provide primary care to. In this arrangement, you and your doctor both sign a contract that confirms you are in the practice. In Ontario, the contract is one that is created by the Ministry of Health. This being said, different doctors have different ways of practising, including the number of after-hours support they provide. It's important for patients to read the contract and ask questions of their physician so they know what is included and perhaps not.

For patients, signing this contract indicates that you will call your family doctor's office first when in need of medical care. While it may be convenient to see a walk-in doctor based on location or time of day, patients who are rostered are encouraged to see their own doctor for their acute and chronic needs.

For the doctor, the contract means that they will provide you with comprehensive primary care services and offer after-hours (including weekends) and same-day care as needed. They are encouraged – and compensated – by the government to provide timely care. When you go to a walk-in clinic, the government may see this as the rostering doctor not fulfilling the responsibility of caring for their patients. There may even be financial penalties levied by the government if practices aren't found to be providing adequate care.

According to the Ministry of Health, if either party violates the terms of the contract, it can warrant the end to the patient-doctor relationship or a derostering from the practice.

So what does this mean to you?

I suggest that you ask your doctor what the sign means, and to be honest about the challenges you've had in accessing her office hours. While it can be intimidating to discuss this with your doctor, it's within your rights to find out if there are other options for after-hours care when she's not available. You mention that she's a great doctor, so hopefully you'll be able to remain with her.

In these team practices, doctors will cover for each other on the days they are not available, in order to provide daily and after-hours services. For example, in our clinic, when I'm not available, my colleagues step in and vice-versa. Ask if your doctor works in a team setting and has after-hours care available to you.

In my practice, when a rostered patient goes to a walk-in clinic, we discuss what happened and what tests were ordered. When I ask why they sought out care from a walk-in clinic, rather than coming to one of our evening or weekend clinics, in the vast majority of cases, they were unaware of the after-hours option that we offer. The other common reason is that they live far away from our clinic and sought out a closer solution.

I then review the after-hours options and our available on-call doctor (reachable by phone), and encourage them to seek out our care in the future, so that their records can remain consolidated. My patients prefer this, as they know that regardless of which doctor they speak to at our practice, they will have their health history readily available for an easier and more efficient visit. Also, when a patient is seen at one of our after-hours clinics, my colleagues send me an alert so that I can do appropriate follow-ups as needed. With an Ontario walk-in clinic, this follow-up can often be missed as records and test results are not centralized and shared between practices. (Alberta is one province that does have a central system.)

If your doctor is not providing after-hours care or weekend coverage, and you are not well, sometimes you do not have any other option but to seek walk-in care. This is not ideal, but it is not your fault. If she has signed the contract and she is not providing accessible care, she may not be meeting the terms and conditions.

But the same holds true if patients choose to visit walk-in clinics out of convenience, rather than trying to speak to their family doctor's office first. Walk-in clinics provide important and convenient same-day care, and are especially important for those without a regular family doctor.

If you do have a family doctor, then it becomes a challenge to seek care in multiple places, as it means your medical records are fragmented instead of consolidated in one practice. This isn't great for patients because it creates potential for error. One clinic may not have your full medical history or medication list, or be aware of tests that have already been done.

Clear communication is important in this situation, so find out what is available to you as a patient. Hopefully with an open discussion, there will be a solution. If you still have questions about what it means to be rostered to a family practice, you can contact the Ministry of Health for more information.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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