The last issue of the College Connector included advice that it is unacceptable for physicians to use “meet and greet” sessions to screen out challenging patients, with a particular focus on the obligation not to turn away patients who are on long-term opioids or benzodiazepines (see "Can a physician turn a prospective patient away?"). The CMA Code of Ethics prohibits discrimination on the basis of medical condition, and chronic persistent pain and substance use disorders are both medical conditions. Patients with these conditions need primary care homes, so rather than turning them away, physicians must explain the need to adapt to evolving standards. That includes performing a comprehensive assessment over the course of a series of visits, and basing future prescribing on current findings and standards.
As the end of each year approaches, the College’s complaints and investigations department reviews statistical trends and notes a steady increase in complaints alleging discrimination and denial of access to care, many in the context of “meet and greet” protocols. No complaints of this nature were received in 2012; 30 were received in 2014; and 69 have been received this year. The Inquiry Committee concludes many of these investigations with criticism of the physician. Beyond refusal to abide by reasonable office policies and restrictions on the practice of the physician, there are very few circumstances where refusing a patient would not be considered discrimination.
In their responses to complaint investigations and in advice calls to the College, physicians offer a variety of explanations about why they conduct “meet and greet” interviews. Some are seeking to reduce their paperwork and wish to refuse patients with ongoing insurance claims. Others cite fear of College scrutiny in turning away patients on long-term opioids. Others have argued that they are insufficiently remunerated to accommodate patients with complex medical conditions.
The Inquiry Committee regards the care of individuals with compensable injuries, chronic pain, addiction, complex comorbidities and other challenges as part of the scope of family medicine. Physicians licensed for independent practice have the training and experience to manage these conditions. While the College may sympathize with arguments about inadequate supports in the system of care, these matters need to be addressed through organizations such as the local medical society, division of family practice, or Doctors of BC. The Practice Support Program of the General Practices Service Committee has a specific mandate in this regard. The College’s mandate, as set out in the Health Professions Act, is the regulation of individual physicians and the protection of the public.