Reducing disability paperwork and family practice visits

Issue: BCMJ, vol. 61, No. 7, September 2019, Page 277 Letters
By: Paul Winston, MD, FRCPC

I am inundated with requests from my patients to refill medications and assess conditions outside my scope. Many of them have disabilities and are unable to wait for hours at a walk-in clinic. There is a lack of resources to treat poverty, mental health, and addictions. The money should go there. 

The paperwork and number of patient visits related to an injury is overwhelming. The bulk of these patients have soft-tissue injuries that are not quantifiable. A huge number of unnecessary imaging and consults are ordered to prove the diagnosis. I am an experienced physiatrist who teaches and lectures at home and abroad, but have absolutely no idea how to answer the generic questions found on those forms. Most doctors fill out what the patient tells them or face conflict, strains to the treating relationship, and letters of complaint. When I do a legal review it is alarming to see the number of times some patients see their family physician—three to four times per month, then twice per month, then monthly for years, with essentially no change. Serial visits to family doctors do not improve outcomes in litigation or open claims.[1] Visits should be every 2 to 3 months for a chronic condition.[2] “My lawyer/insurer says I must,” is not a medical necessity.

We need strict limits on visits for injury. After the initial assessments, insurers should be responsible. Even for significant pathology, there is no need to be assessed at frequent intervals. ICBC, WorkSafeBC, and insurers should stop feeding off the public trough and treat their own patients. We should just write that “The patient has limitations with their right arm. Please modify their job to accommodate or find them another position; if not, get a vocational and functional assessment and follow that plan.”
—Paul Winston, MD, FRCPC
Medical Director Rehabilitation and Transitions, Island Health
President, Canadian Association of Physical Medicine and Rehabilitation

References

1.    Felhaber T. The risks of worklessness. Accessed 6 August 2019. https://thischangedmypractice.com/the-risks-of-worklessness.

2.    Verhulst L. Am I overservicing my patients? BCMJ 2017;59:402. 

Paul Winston, MD, FRCPC. Reducing disability paperwork and family practice visits. BCMJ, Vol. 61, No. 7, September, 2019, Page(s) 277 - Letters.


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