Walk-in clinics are considered as medical practices that provide episodic care to patients who are not required to have an existing association with the practice, and who may not be required to book appointments. In New Brunswick, they are specifically designated by Medicare for billing purposes.
The thoroughness of care provided and the quality of care expected from physicians is not defined by a chosen mode of practice. The following principles should be adhered to regardless of whether a physician is treating a patient based on an existing physician-patient relationship or at a walk-in clinic:
- The standard and quality of care physicians are expected to provide does not vary with their chosen mode or site of practice. A thorough evaluation of a patient's presenting complaints and needs is required in any and all practice settings. In fact, an episodic, one-time assessment must be as comprehensive, if not more so, than in a situation where the patient is well-known to the treating physician. Depending on the nature of the complaint, such an assessment would include a description of the complaint, past history, allergies, a record of medications, family history and a physical examination as necessary and appropriate. In situations where the patient cannot be properly evaluated, he/she should be so advised, and specific referrals should be made to an alternate individual or facility - urgently where necessary.
- A longitudinal patient medical record must be created, whether on paper or electronically, that details all physician-patient interactions so that the treating physician, and other physicians working at the same clinic, may access and benefit from the information documented in the record.
- The follow-up of test results and treatment is the responsibility of the ordering physician or an associate, unless other physicians involved in the patient's care have been informed and have explicitly agreed to assume this responsibility. Unilateral referrals of test results and any necessary actions or treatments to the "regular" physician, if one exists, are not appropriate.
- Patients attending walk-in clinics should be asked if they have a primary care physician. If so, the clinic should seek the patient's permission to inform the primary care physician of the patient's visit(s) and to share copies or summaries of the patient-physician interaction at the clinic, including copies of ordered tests. Sharing this information is not only a professional courtesy, but is also essential for ensuring comprehensive patient care.
- Any forms or documentation requirements regarding any care or treatment provided are similarly the obligations of the walk-in physician.
- If the physician is practising in a clinic which limits its care or services, the physician is responsible to make it clear that such services are limited by their episodic nature, communicate any limitations to patients, and provide appropriate next steps for the patient seeking care.
- Do not refrain from ordering necessary investigations or referral to avoid ongoing responsibilities for follow-up.
- Test results copied to another physician remains the responsibility of the first physician unless an agreement has been made otherwise.
Based on the Colleges of Physicians and Surgeons of British Columbia and Nova Scotia
3/12; 11/20
