Patient-practitioner 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.

Patients can also contact HealthLink BC by dialing 8-1-1 or 604-215-8110 for a list of walk-in clinics in their area.

Is a physician or surgeon obliged to treat a patient?

A physician or surgeon is only obliged to treat a patient if:

  • the patient has an established relationship with the physician or surgeon and their 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 or surgeon conduct a "meet and greet" interview prior to accepting a new patient into their practice?

Like any effective relationship, a patient-practitioner 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 a physician or surgeon to get to know a new patient and learn of their 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 or surgeon 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 or surgeon choose to stop seeing a patient?

There will always be some patient-practitioner 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 surgeon, or because of a difference of opinion, either with the physician/surgeon or with their office staff. In these instances, either the physician/surgeon or the patient may decide to end the relationship. If the physician or surgeon decides to end the relationship, they are obliged to consider the patient's safety and well-being first.

The physician or surgeon must ensure that the patient is not acutely in need of immediate care, and that they have been given appropriate notice to find another physician or surgeon. The College advises physicians and surgeons to provide a written explanation about the termination decision.

 

Are physicians and surgeons required to return patient's phone calls?

There are no guidelines directing physicians or surgeons to communicate with patients over the telephone. In fact, busy schedules often prevent physicians and surgeons from phoning patients back during the workday. In some instances, a physician or surgeon may prefer to discuss a medical situation with a patient in person, rather than on the phone, in which case their 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 or surgeon's discretion. Billing a patient privately for missing a scheduled appointment may be acceptable, assuming the patient has been forewarned of the physician or surgeon's policy, and the physician or surgeon 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 their medical judgement to determine if a referral to a specialist is necessary.

 

After-hours Coverage

Do physicians or surgeons 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 and surgeons 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 or surgeons at hospitals, those physicians or surgeons should have agreed to accept that responsibility. Arranging an on-call schedule with colleagues is the recommended best practice.

If a physician or surgeon is unavailable for an extended period of time (e.g. illness or vacation), where possible, they should arrange for a colleague (or locum) to assume responsibility for their patients. When the physician or surgeon 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 and surgeons at such facilities have confirmed their willingness to assume that responsibility.

 

Who assumes responsibility in smaller communities when there aren't enough physicians and surgeons 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 or surgeon'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 or surgeon renew a prescription over the phone?

A physician or surgeon is not obligated to renew a prescription over the phone; the decision to do so is entirely at their own discretion.

Why does a physician or surgeon provide a limited quantity of prescription medication when they know the prescription will need to be refilled?

There are a number of reasons why a physician or surgeon 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 or surgeon 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 or surgeon 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.