Love them or hate them, walk in clinics are filling a growing gap in health care. We toured the hub of Appletree Medical Clinics, which operates 11 clinics in the Ottawa area that offer both family medicine and treatment for walk-in patients. A big feature of the clinics is that they post wait times updated every 15 minutes on their web site. Fifty thousand of the quarter of a million patients who visit Appletree Medical Clinics in Ontario each year don't have a family doctor. And a surprising number of people who visit walk-ins have a GP but choose not to see them. In the ER, I see patients like that all the time. Our show this week on the promise and the pitfalls of 'no appointment' medicine generated a huge response from you.
Click here to listen to our 'No Appointment' show.
Sheena Sharp of Toronto writes: "My "family" doctor is almost impossible to see. They have actually REDUCED their reception hours. I can only get an appointment for an annual physical in 6 months. I run a small business and I had to cancel the last one because a client wanted me to make a presentation in another city. They quit at 3pm, start at 9:00 except Fridays when they take calls for 2 hours in the afternoon. They don't have email. I have not had an annual physical in three years. I have a few problems I would like advice about but I just live with them. THIS IS GREAT CARE? You guys want us to rearrange the entire economy for the convenience of your businesses. Oh sorry, you are primarily concerned with our health. My mistake."
Kim Pittaway of Toronto writes: "I'm fortunate: my family doctor has an open appointment policy. I can book ahead for routine appointments if I like, and for immediate health issues, I can get in same day. Recently, though, I was referred by my optometrist to an ophthalmologist for a non-emergency issue. I had seen a sign posted by the receptionist that said: "Please do not ask the receptionist when the doctor will see you. This is a busy office. You should expect to wait two to three hours for your appointment. If you are not in the office when you are called, you will be placed at the end of the line." I reluctantly booked an "appointment." The day before my "scheduled appointment" I received a phone call telling me that the day was very booked up and I should arrive on time but expect to wait 2 hours, so I should clear a big window in my day. That's not an appointment--that's a cattle call. I cancelled the appointment and I found another specialist who makes appointments that are respected. I know that was a luxury available to me in Toronto that many in other parts of the country don't have. But wherever I can, I'll opt for doctors who respect me--and respecting my time is part of that equation."
Neil Coligan of Winnipeg sent us this: "I attend walk-in clinics because I have no access to a family doctor. For years I had a regular doctor but he retired and no one else in his medical centre was accepting extra patients. A friend suggested I try his regular doctor and I was able to attend that doctor's office for a complete medical as well as couple of unrelated visits. Within a year of this new relationship, the doctor closed his standalone office and moved in with a group of doctors. I received no notice of this change and when I finally located the doctor at the new clinic I was told I'd have to start a new file because my previous record of visits to the doctor were no longer available. More than a year later I've had no contact from the new office despite my own calls to see my previous physician. Since then I've needed medical services so I've begun attending to a nearby walk-in clinic that has at the very least treated me with respect and good care."
Jacqui Denomme of London, Ontario had this to say: "I wanted to take this opportunity to tell you about the medical centre I go to in London. My family physician practises in this clinic with 10-15 other family doctors. This practice has been in existence for years before I started on as a regular patient (20 years for me) and to me should be a model for what can work for other doctors and patients. It is a sort of half way between the walk-in clinic and a single family practice and has the advantages of each. I have one regular doctor who has had his own family practice within the clinic for around 19 years now, with his own regular scheduled hours. If I need a physician when he is not scheduled to work, I can see one of the other physicians who are scheduled. I never need to use a walk-in clinic and my records are accessible in the clinic so that if I need to see another doctor, he or she has access to 20 years worth of my medical background. The only disadvantage I can see is that perhaps my doctor, in choosing to work in this practice where after-hours visits are shared with the other doctors in the practice and limiting his own work hours, MAY not make as much money. Whenever I hear a discussion about walk-in clinics vs. private practice I always want to shout out 'but look at this system- it works!!!' Thanks for letting me have my say!
Carey Condruk of Embro sent us this: "I recently received a split lower lip and two pushed in teeth as the result of an errant elbow during a basketball game in Brampton. Not familiar with the area I was told to go to an Emergency Department to get it looked after. I walked right up to the triage desk and after a few questions I was taken to a room to be checked by a nurse. Within 60 minutes of arrival I had a doctor sewing me up and then I was on my way. I returned to the hospital a week later to get the stitches removed and found the same quick and efficient service. I asked one of the staff why I was able to get through the emergency room so quickly and she explained that they have a two-path system so that there are resources to deal quickly with minor injuries, like mine, and separate resources to deal with major issues. With this set-up, the treatment of minor injuries does not keep getting delayed due to higher priority major injuries. I was impressed that this hospital put in the effort to improve their service and probably did not spend more to do it.
Carey, most Emergency Departments sort patients into major and minor sections. It works as long as both sides are adequately staffed and neither gets inundated.
Robert Wilson of Sherwood Park sent this email: "The interview that criticized walk-in clinics missed the point that many of these clinics ARE the continuing care point for many people. As long as people consistently use the same walk-in clinic then the clinic has the ongoing records and knows how many times the patient has been in over the same complaint in the last year and what treatments are working."
Kathleen Grant of Calgary contributed this: "My husband and I used a walk in clinic because we were both relatively healthy and he had yearly physicals done through his company doctor. Concerning the wait times, it worked well because we could simply go in, register, ask how long it would be, then leave. We could go home or run errands until it was time to go back to see the doctor. It was healthier as well because we did not have to sit in a waiting room filled with sick people. If we had a preference to which doctor we wanted, we could call in and find out when that doctor was working. I can see why these clinics are becoming more popular. I believe walk in clinics are the answer for people with minor complaints. However, the quality of care isn't adequate for serious illness. My husband recently passed away from cancer that wasn't detected until it was terminal. This was in spite of his yearly checkups with the company doctor, physiotherapy, and doctor visits with the same doctor at the walk in clinic, who told him he was "getting old" or had a herniated disc. The x-rays and blood tests apparently didn't even pick it up. I don't think it's necessarily the fault of the walk in clinic, but a comment on the state of the entire health care system."
Jane Lowery of North Vancouver, British Columbia had this to say: "Something that perhaps was not addressed is that my family doctor is well worth waiting for. I do not have to wait all the time for her but when I do see her, I know she has completely devoted her time to my well-being. She is a patient, compassionate woman who talks about my quality of life and covers everything both physically and emotionally in my life. She is very funny, loud, and has acted as my advocate on more than one occasion."
Warren Bell of Salmon Arm, BC sent us this: "I was fascinated by Appletree Medical Clinics in Ottawa with their high tech approach to reducing wait times, and the pride of their practitioners in being able to see people in large numbers and pack their schedules without messy "interruptions". Michael Rachlis' comments about restructuring were interesting. But what about continuity, intimately adapted care to individual nuances, or the system which delivers better "health", i.e. reduced use of the "system" because people don't need it? Is it the fastest care (care delivered as soon as it is sought)? Is it the most care (i.e. the most patients seen in a given time span)? Is it the highest level of care (i.e. most patients get referred quickly to a specialist)? Barbara Starfield at Johns Hopkins has reviewed the stats: primary care - direct care to patients who walk in the door unselected -- is the most efficient form of care. It's on the spot, it's direct, and it's far better than care from specialists. But within primary care, continuity yields spectacular gains in terms of efficiency (more appropriate care for less money producing better outcomes). And who delivers that best? It's solo practitioners, that "dying breed" that not composes only 30% of the physician workforce. I'm one, and have been for most of my 35 years in practice. We know our patients, we are usually more accessible than our clinic (and especially walk-in clinic) colleagues, and we can usually respond to a call or visit far more efficiently than our more distantly connected colleagues, because we know our patients' STORIES. And who do patients like most? Every study shows the same thing: patients prefer the doctor they know, who knows them, who understands that their problem isn't just a homogenized version of everyone else's problem with the same name. This is the way medicine should be."
Brenda Berck of Vancouver sent us this: "What was missing from this morning's program was recall notices reminding me that it's time for a Pap smear or a mammogram. If I left it to my own initiative, would I even think of those tests? I know they're important so when I get a recall notice, I do the right thing. I pay attention and make an appointment to have whichever test it is. Left to my own devices--and forgetfulness--who knows what cancer might go unnoticed--until it's too late? Thanks for all of your programs; they're provocative in the best sense of the word--and enjoyable, besides."
Brenda, walk-in clinics that do family medicine also provide recall notices for periodic tests.
And finally, Joelle Rudick of Ottawa sent this email: "I have a great family doctor who always sees me more or less on schedule. It's very impressive. However, to make an appointment with her or even to leave her a message takes about 15 minutes of waiting on hold and, in the case of the former, usually yields appointments that are weeks away and at inconvenient times. Couple this with the fact that her office is far from my home and that parking is an issue, and the result is that my children and I regularly use our nearby rural emergency room as a walk-in clinic. Usually we need something simple, like a throat swab or a prescription for my asthma inhaler. These are hardly emergencies but services that are still needed within a day rather than a week. If my family doctor had online booking or some of the other technological efficiencies that the Appletree walk-in clinics had, I would definitely be seeing her rather than a different ER doctor each visit. This would likely be better for me and the ER that I visit.
It's clear from the emails that you are quite passionate about access to family medicine aka primary care. It's something we'll come back to later this year.
Thanks for your many emails.