Patient-Physician Relationships

How do I find a new family physician?

Many patients will try to find a family physician through the advice or recommendation of friends, relatives, or work associates.

The online physician directory is available to assist patients in finding a new family physician who is accepting new patients.

Note: The information in the online physician directory is obtained directly from physicians and is based on the completion of an annual license renewal form and updates they make to their own profile throughout the year. Therefore, unless a physician has updated his/her contact information or indicated whether or not s/he is accepting new patients, the College cannot guarantee its accuracy.

 

Is a physician obliged to treat a patient?

A physician is only obliged to treat a patient if:

  • the patient has an established relationship with the physician and his/her failure to address an ongoing problem might be harmful (and/or when failure to attend might constitute abandonment); or
  • if delay in attending to a patient's problem might result in serious harm to that patient.

Can a physician conduct a "meet and greet" interview prior to accepting a new patient into his/her practice?

Like any effective relationship, a patient-physician relationship is built on principles of trust and honest two-way communication, which should be established at the first meeting. While a "meet and greet" meeting is considered acceptable for physicians to get to know a new patient and learn of his/her health concerns and history, it may not be used as a means to select the "easy patients" and screen out those with more difficult health concerns, such as chronic disease. In addition, a physician cannot refuse to accept patients based on human rights issues, such as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, or socioeconomic status.

 

Can a physician choose to stop seeing a patient?

There will always be some patient-physician relationships that, for whatever reason, simply do not work or become unproductive. Often the relationship ends because the patient no longer trusts the judgement of the physician or because of a difference of opinion, either with the physician or with his/her office staff. In these instances, either the physician or the patient may decide to end the relationship. If the physician decides to end the relationship, s/he is obliged to consider the patient's safety and well-being first.

The physician must ensure that the patient is not acutely in need of immediate care, and that s/he has been given appropriate notice to find another physician. The College advises physicians to provide a written explanation about the termination decision.

 

Are physicians required to return patient's phone calls?

There are no guidelines directing physicians to communicate with patients over the telephone. In fact, busy schedules often prevent physicians from phoning patients back during the work day. In some instances, a physician may prefer to discuss a medical situation with a patient in person, rather than on the phone, in which case his/her medical assistant should make every effort to book a timely appointment. Since time spent on the phone is not billable (i.e. it's not an insured service), some physicians may charge a nominal fee for the time they spend discussing issues with patients over the phone. The patient should be informed of this fee in advance of the conversation.

 

Is a patient obligated to pay for a missed appointment?

Billing for a missed appointment is a matter that is appropriately left to a physician's discretion. Billing a patient privately for missing a scheduled appointment may be acceptable, assuming the patient has been forewarned of the physician's policy, and the physician exercises judgement and compassion in requesting payment.

 

Referrals to Specialists

What is the process for seeing a specialist?

In British Columbia, patients require a referral from a family physician, or another physician, to see a specialist. This is a requirement of the provincial Medical Services Plan (MSP) for authorization of payment for specialist services. In some instances (i.e. for elective surgeries or cosmetic procedures), specialists will see patients privately and without a referral from a family physician. However, in these circumstances, the patient will be billed and must pay the specialist directly.

 

Are family physicians obligated to make referrals to specialists upon a patient's request?

No. A family physician is expected to use his/her medical judgement to determine if a referral to a specialist is necessary.

 

After Hours Coverage

Do physicians have to provide their patients with access to care 24-hours a day, seven days a week?

The College recognizes that providing round-the-clock coverage for patient care can be problematic. However, physicians do have a social and an ethical obligation to look after their patients on a 24-hour basis and should make the necessary arrangements to ensure that alternate medical care is available even if their office or clinic is closed. Arrangements should be "bilateral" and if patients are referred to other clinics or physicians at hospitals, those physicians should have agreed to accept that responsibility. Arranging an on-call schedule with colleagues is the recommended best practice.

If a physician is unavailable for an extended period of time (i.e. illness or vacation), where possible, s/he should arrange for a colleague (or locum) to assume responsibility for his/her patients. When the physician is not "on call," leaving an answering machine message stating, "go to the nearest emergency room or walk-in clinic," is not considered to be an acceptable practice unless the physicians at such facilities have confirmed their willingness to assume that responsibility.

 

Who assumes responsibility in smaller communities when there aren't enough physicians to begin with?

Problems can arise when medical resources are scarce, when a community is small and cannot support a large number of physicians, or where members of the medical staff are ill or away on holidays. In such circumstances, compromises must be made, which balance reasonable patient access and safety with the physician's need for rest and recreation. In some situations, after hour coverage may involve collaboration between neighbouring communities to ensure that patients have access to 24-hour care and emergency services. This may require patient travel or transfer.

 

Prescriptions

Can a physician renew a prescription over the phone?

In situations where the patient is known to the physician, where s/he has current knowledge of the patient's clinical status from previous encounters, or where s/he is able to accept an evaluation imparted by a colleague, a prescription may be renewed over the phone. However, the physician is not obligated to renew a prescription over the phone; the decision to do so is entirely at his or her own discretion.

 

Why does a physician provide a limited quantity of prescription medication when s/he knows the prescription will need to be refilled?

There are a number of reasons why a physician may choose to limit a prescription, including the nature of the drug, side effects, toxic effects, the need for follow-up based on the patient, etc. When a medication is prescribed, the physician has a responsibility to advise a patient about drug effects and interactions, side effects, contraindications, precautions, and any other information pertinent to the use of the medication. Before automatically renewing a prescription, a physician has an obligation to conduct a follow-up appointment, to assess the effectiveness of the medication, and determine whether a renewal is, in fact, necessary.