After Hours Coverage

Providing continuity of care for our patients including after hours and on weekends is one of the responsibilities that goes with the privilege of practising medicine. It is a requirement of the Code of Ethics1 and to be in compliance with the policy of the college of Physicians and Surgeons of Saskatchewan.2 Of course, no one can, or should try to be, available 24 hours a day, every day all year; that is why we should practise in groups with peers.

Unfortunately it has been an observation of the Practice Enhancement Program that some doctors do not have such arrangements whilst others do, but there is no way that patients can know that high standard of care being provided.

For those who do not have such arrangements you must make them. It can include participating in a group or a mutually agreed and documented reliance on coverage of the emergency department, principally the case in smaller communities. Having made such arrangements it is then necessary to be sure that patients calling for assistance after hours are informed by the answering machine.

For those physicians who have appropriate arrangements, which is many of us, too often the answering machine message for after-hours simply says, if it is an emergency call 911 and then may only provide clinic hours.  The patient is left adrift and uninformed.  It does not tell a patient calling the office how to reach that doctor, or designate, with a concern that is not an emergency but cannot wait until the next clinic day.  Having all of these patients approach the emergency department over burdens already heavily burdened resources.  For many patients the opportunity to speak with the doctor or someone covering for that doctor can provide an assessment of the problem and then provide informed and educated advice as to actions to take and/or the need for an office appointment very soon.

Consider setting up your answering machine as follows:

Please listen carefully until the end of this message for all of the options.

This is the office of Dr. ___________.  The office is now closed.

If this is an emergency call 911.

If your concern can wait, please call back during regular clinic hours, which is

e.g. Monday-Friday from 9:00 – 4:30.

If your concern cannot wait, and you need advice or to talk to a doctor before the next regular clinic day, then call       (insert phone number)      to reach the physician on call.

    1. CMA Code of Ethics and Professionalism, 2017 Canadian Medical Association
    2. College of Physicians and Surgeons of Saskatchewan.  Policy: Medical Practice Coverage

Walk-In Medical Clinics

Over the course of a number of assessments carried out in walk-in medical clinics the Practice Enhancement Program (PEP) has identified a number of issues that have, up till now, reduced the effectiveness of the Program. The most important component of PEP has been, and remains, its ability to offer “enhancement” to the practices which it assesses. Management arrangements in some, though by no means all, walk-in clinics have thwarted this enhancement process.

Two major deficiencies that PEP has found are:

  • Failure to identify the patient’s family doctor and to provide information to that family doctor about the walk-in clinic visit – this results in a deficiency of follow-up and loss of continuity of care.
  • Failure to provide the components of the optimal care for chronic conditions for patients who make repetitive visits to a walk-in clinic and receive little or no care elsewhere. Some patients choose to make repetitive visits to a walk-in clinic, rather than establishing a relationship with a family doctor. Some physicians who work in walk-in clinics will make arrangements for repetitive visits by their patients. This results in some patients not receiving the benefit of periodic full assessments and target organ review as recommended by practice guidelines. (There are patients who do not use a walk-in clinic only for episodic care and presumably assume that, because they are “going to the doctor regularly”, they are getting comprehensive care. They are not.)

The majority of walk-in clinics that have been assessed have dealt very well with the two above noted issues. This is commendable. Furthermore it demonstrates that these deficiencies are not inherent in walk-in clinics and can be solved. Therefore, they can and should be dealt with properly in every walk-in clinic.

In some walk-in clinics the physician being assessed is virtually an employee of that clinic. These physicians may have little influence or input into clinic policy. On occasion the Practice Enhancement Program has noted, during a standard assessment, a number of issues that it has brought to the attention of the physician. If that physician had control over the practice, the PEP Committee would have expected that those issues would be the subject of enhancement with expectation of beneficial change.

PEP believes that an inability to make such change, as a result of circumstances beyond the physician’s control, should not adversely affect that individual’s personal assessment. Perhaps the most common such issue relates to policy on notification of the patient’s family physician of his/her attendance at that walk-in clinic. Neither PEP nor the medical profession should accept the persistence of deficiencies of care.

In direct response to the concerns raised by the Practice Enhancement Program, a meeting was organized with representatives of the Practice Enhancement Program and its three governing bodies: the Saskatchewan Health, the Saskatchewan Medical Association and the College of Physicians and Surgeons of Saskatchewan. We reached an agreement that in such circumstances, the Practice Enhancement Program’s mandate would be expanded to permit direct discussion of any such issues with the clinic’s manager. This decision was unanimous and is backed by the legislative authority of the three parent bodies.

It is anticipated that this change will improve the Practice Enhancement Program’s ability to carry out its mandate. The appropriate Bylaw amendment supporting this change will be available for review shortly. This extension of PEP’s mandate responds to the recognition of a deficiency in the original mandate and is entirely consistent with the original and continuing purpose of PEP, which is to improve the care provided by all doctors for all citizens of Saskatchewan.

Approved and submitted by:

  • College of Physicians and Surgeons of Saskatchewan
  • Practice Enhancement Program Committee
  • Saskatchewan Health
  • Saskatchewan Medical Association

March 22, 2005