The College and orphaned patients. College replies
The College remains very concerned about the circumstances of people who are unable to access a primary care physician. However, the College’s legal authority and mandate are limited to the conduct and performance of individual physicians. Its role in promoting system improvements is supportive.
It is important to consider Dr Keith White’s quote from the College standard, Access to Medical Care, in context. The advice not to charge for initial visits appears in a section headed “Refusal to Accept a Patient,” and refers specifically to introductory meetings with prospective patients for the primary purpose of determining whether to accept them.
The Inquiry Committee of the College does receive complaints from patients who have been rejected by physicians on the basis of screening visits, usually alleging discrimination. Article 16 of the CMA Code of Ethics outlines the requirements, which must be met when physicians establish fees for uninsured services, including consideration of both the nature of the service provided and the ability of the patient to pay. On that basis, charging for screening visits may be considered unprofessional.
The College recognizes the significant upfront investment required when a new patient joins a practice, but must look to Doctors of BC and the Medical Services Commission to ensure that this is adequately compensated. Attachment fees seem to be a step in the right direction. Charging privately for screening visits, perhaps contrary to the College standard and CMA Code of Ethics, cannot be a substitute for thoughtful amendments to the insurance payment schedule to support continuity of care.
—Gerrard A. Vaughan, MD
President, College of Physicians and Surgeons of BC
—Heidi M. Oetter, MD
Registrar and CEO, College of Physicians and Surgeons of BC
Gerrard A. Vaughan, MD, Heidi M. Oetter, MD. The College and orphaned patients. College replies. BCMJ, Vol. 59, No. 2, March, 2017, Page(s) 82 - Letters.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org