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The Code of Ethics and one issue per visit

An elderly patient sees their physician for a prescription refill. During that visit, the patient asks them for a lab requisition form. The physician tells the patient that they'll need to book a second appointment to receive the completed form. Is this in the best interest of the patient?

Limiting patients to one issue per visit is a growing trend. While balancing time constraints with patient needs is challenging, it is equally challenging for patients to determine what is most important in the short amount of time they see their physician.

Consider the well-being of the patient first

The Code of Ethics & Professionalism identifies a compassionate physician as one who recognizes suffering and vulnerability and seeks to understand the unique circumstances of each patient. Limiting patients to one topic per visit creates risk when patients feel responsible for triaging their concerns, as they are not typically trained to detect serious health issues.

In the example above, asking a patient who may have trouble attending multiple appointments to return for a relatively straight-forward request is not in the patient’s best interest.

Take all reasonable steps to prevent or minimize harm

In some circumstances, it may be reasonable to prioritize the concerns of patients with several complaints, to address those that need immediate attention and suggest future appointments to address others. However, there are risks involved, such as missing serious health problems, misdiagnosis or patients finding the policy insensitive. Patients must be advised that this is the recommended approach or plan. It remains up to the physician to use their clinical judgement to determine which health concerns may be deferred to another visit, as having an incomplete picture could lead to improper diagnoses or treatment.

Always treat patients with dignity and respect

Limiting patients to one issue per visit may cause them to feel that their physician does not care about their well-being, especially if the policy is rigidly administered. A better approach may be to encourage patients to respect the time of others who are waiting and also need care.

Another option would be to discuss the patient’s concern when the appointment is scheduled or at the beginning of the visit, as this allows physicians to prioritize treatment based on a more comprehensive account of the issues.

Questions? Contact Chantelle Dick, Standards of Practice Coordinator, at Chantelle.Dick@cpsa.ab.ca.

From CMPA’s “Limiting discussion to one medical issue per visit: Know the risks