Re: Walk-in problem

I would like to comment on Dr B. Toews (Coquitlam) letter published in the May BCMJ (2001;43[4]:195) and also correct an inaccuracy in his letter.

I believe that what we are seeing is a change in urban family practice and walk-in clinics are a response to this change. It is my opinion that they are neither good nor bad and they must provide a service that is in demand. This is attested by their popularity. We can debate the relevance of these clinics, whether they are an economic drain or needed service, and it is unlikely there would be a clear winner. What we are missing is the point that urban family practice is changing and we are in the midst of this chaos. We need to examine the change that is happening and plan our participation. This should be the challenge facing our leaders in the BCMA and the Society of General Practice. To date, I see no one trying to develop a new vision or paradigm. I see my colleagues working very hard trying to improve our present situation, but I fear they will never achieve the goal because in part money is not the total answer. We need to define how our work has changed, the new demands from patients, and the physician’s changing attitudes toward work. We need to ask the questions:

1. What do we want to give?

2. What is expected of us by society and our patients?

3. Are these reasonable expectations, and if they are, how can we deliver on them?

One of the main reasons people come to see their family physician is because he or she has knowledge about them and knowledge about disease and therefore is able to put the patient’s concerns into context. Perhaps another way of saying this is that family medicine is about teaching and we are all teachers. This is a role that many of us would find hard to accept in the present system because it is not valued by our current system. This is the new challenge in urban family practice.

The error that I feel obligated as the head, Department of Family Practice, VHHSC, to point out is the following: “...unless there is a policy at the local hospital which keeps out family doctors, e.g., VGH.” I would like to reassure my colleagues that no such policy exists nor has it ever existed. Any family physician who has a practice in Vancouver and who is able to provide 24 hour/7 day service to their patients is welcome to apply for privileges. Currently, the Department has 104 physicians with admitting privileges and a visiting staff of approximately 200. We have approximately 89 (VGH=64, UBC=25) acute care beds available for family physicians to admit their patients. At VGH in 1983, we developed the first palliative care unit run by family physicians. It currently has 17 beds. Plus we have a strong presence in the long-term care areas of the hospital. In December 2000, we were the first Lower Mainland hospital to institute a hospitalist program to support the ongoing presence of family physicians in hospital medicine. Family practice at VGH is active and dynamic, and I would like to dispel the myth that family physicians are not involved or are discouraged from attending.

—R.A. Bernat, MD 
Head, Department of Family Practice, VGH