MDs told to bolster care after hours

Recorded messages after 5 p.m. are inadequate, college warns

Alberta doctors have been ordered to step up their performance to ensure afterhours care is provided to patients.

New regulations from the College of Physicians and Surgeons that came into effect Thursday make it clear doctors’ offices must do more than provide an answering machine message directing patients to call 911 or go to the nearest hospital or walkin clinic after 5 p.m.

College registrar Dr. Trevor Theman said access to after-hours care has been a long-standing expectation for physicians, but a recent survey of offices across the province found less than 30 per cent complied with the rules.

The new “continuity of care” regulation makes the expectation more explicit and comes with a warning that the college will step up enforcement, he said.

“We recognize the changes we want to see happen won’t happen overnight, so we are going to give people time and we are going to help them understand what options are available,” Theman said. “But we are committed to this. It’s the right thing to do and it’s the right thing for patient care.”

He said the new standard does not mean each doctor has to be on call 24 hours a day. But they instead must make sure there is a way for patients to get necessary care on weekends and nights.

This could be by making themselves available by phone, lining up an on-call physician to respond, or by making arrangements ahead of time with a clinic or emergency department.

Many doctors who have joined a Primary Care Network or work in smaller communities take turns as the on-call physician.

Theman said after-hours care is particularly important for patients who might need followup after being discharged from the hospital, or those waiting for critical test results. Such results are often best received and interpreted by the doctor who knows the patient’s medical history, or by another designated doctor who has been properly briefed on the situation.

“Part of this is making sure that whoever is available knows about what can be predicted,” he said.

“Maybe it’s a case of, ‘I saw a patient earlier today and I’m worried about him or her. I asked him or her to call if the condition worsens.’ ... There has to be a transfer of information that somebody who is going to cover can make reasonable decisions and can provide reasonable triage and reasonable advice.”

The new regulation should not give licence to patients to call doctors in the middle of the night about trivial matters.

Theman said physicians should use this as an opportunity to educate patients on the types of issues that are appropriate for seeking care after hours.

The college is still working on its enforcement plans, but expects to make spot checks and do surveys of its members. In the future, visits to doctors’ offices may be done to ensure compliance with the rules.

“It’s the right thing to do and it’s the right thing for patient care.”

Dr. Trevor Theman