This boot is made for walk-ins

More and more people are being turned away from walk-in clinics which now cater only to their own patients. Could turn out to be a good idea

By Madeleine Partous

When's a walk-in clinic not a walk-in clinic? When you can't just walk in. Sounds like a contradiction in terms, at least where patients are concerned, but for more and more GPs in group practice, maintaining a walk-in clinic for patients only is a way to improve accessibility to better care at a time when both patients and doctors are increasingly frustrated by long waits and overcrowded schedules.

A case point: Montreal's Groupe Medical Ste-Catherine clinic, in the city's burrough of Westmount, has walk-in clinic hours several mornings a week. Any patient with a doctor at the clinic can come in during those times and wait; the odds are they'll be seen by someone fairly quickly, thanks to this "members only " approach. With any luck, they'll even get to see their own doctor.

"It's a way to ensure that our patients have immediate access to acute care, " says one GP/ER specialist at the clinic. He's right -- the ER situation in Quebec has become almost unmanageable, as bad if not worse than in other hard-hit provinces like BC, Saskatchewan and Manitoba. Quebec government public campaigns push patients to see their own GPs -- without addressing the fact that an ever-increasing number of Quebecers can't find a GP -- before heading for emergency. The fact that overwhelmed GPs can't take on new patients is exacerbating the escalating ER problem and there's no relief in sight.

CONTROVERSIAL CONCEPT
Not everyone likes the trend, obviously. Advocacy groups see it as just another piece of elitist rhetoric, one which, as usual, benefits the privileged few. Low-income households, single-parent families, individuals on social assistance, psychiatric patients, aboriginal populations, the homeless and a slew of others who for some reason can't find or don't belong to a clinic, continue to fall through the cracks. As more and more walk-in clinics become for "clients only, " these groups will depend increasingly on ER service. To make matters worse, the Centre Local de Services Communautaires (CLSC) "public " clinic concept in Quebec isn't working as well as everyone hoped it would -- limited hours, long waits and overcrowding, along with fewer services than are available at hospitals, have resulted in their becoming a "poor man's " clinic, further segmenting along socioeconomic lines the kind of care patients can hope to get.

An FP in southern Ontario, whose clinic has also begun to offer patient-only walk-in hours, feels this view is unfair and simplistic. "Patients have a responsibility for their own health -- and I strongly believe that free healthcare is part of the problem. People think it's there so why not use it. " She admits it's getting a little better "because there's more in the media about healthy diet and exercise, but overall you still see a lot of people who never see a doctor until they're really sick. " She feels that prevention and healthy lifestyle are key -- but unfortunately the less fortunate segments of the population are often less likely to involve themselves in either. "That's true, " says the FP, "but with the crunch we're under, we have to focus on the needs of our own patients first. "

ACCESSIBILITY A STANDARD
Esther Tordjman, Coordinator of Individual Services at Montreal's Project Genesis, a community service organization which has worked on behalf of the city's neediest citizens for many years, sympathizes with the doctors' concerns. On the other hand, she says, "one of the five standards of healthcare in Canada is accessibility. " She adds that while "it's understandable that doctors are concerned about their own caseloads, an approach based on treating only your own patients is, in a way, a method of opting out of universal healthcare. "

The Westmount doctor disagrees. "It's about giving better healthcare at a time when our patients are understandably frustrated. You find out you can't make an appointment with your GP for months and you resent it. This way, you've got a very good chance of seeing him or her quickly. "

According to Ms Tordjman, all this does is to "further limit service to the poor who already have difficulty of access. " Physician shortages have led to some CLSCs, like Montreal's Cote-St-Luc clinic, having no doctor on staff at all. Patients requiring medical attention from a doctor are referred to area clinics, usually group practices. "What happens if these clinics close? " asks Ms Tordjman. "Where do these people go? " The answer's simple: their local ER.

Not surprisingly, most patients whose clinics have taken this step are delighted. A woman in the waiting room of the Westmount clinic didn't mince words: "We should come first. It took me two years to find a GP. I'd like to see her occasionally! "

What do you think of "patient only " walk-in clinics? Will they alleviate overcrowding and long waiting times at clinics, or add to the ER nightmare? Let us know by writing to editors@nationalreviewofmedicine.com