Glass houses

I practised over 20 years along conventional lines with primary obstetrics care, hospital care including serving orphaned patients on rota for what was then called “doctor of the day,” and so forth. I now serve my patients out of a reputable walk-in organization and see more intimately what happens here. Front-line medicine is clearly going through much upheaval despite the attempts of the usual organizations trying to revive primary family practice, with government incentives and multilevel calls for action. This fragmenting is not only here but across the globe, and disparaging an evolving segment, walk-in medicine, only reveals to me true ignorance.

I have now brought my patients and practice to merge into an established walk-in clinic. New graduates are so much disinclined to consider the onerous responsibilities of a full conventional practice with all the management responsibilities, overhead, etc. My previous attempts to “hire” new graduates speak to this difficulty. Teaching first-year medical students revealed that most of them readily brought up the notion of lifestyle in contemplating selection of practice venues when looking to the future. From my present vantage, I do not begrudge them such thoughts. Where I am now, I focus more of my energy in good clinical practice, and pay a little more to have the nonclinical aspects of practice governed by the corporation of the clinic. I am much involved in the walk-in component aspect as well, a blended system that more primary care physicians are developing, evolving, and accepting. Indeed, they are being forced to do so due to the sheer number of orphaned patients. These numbers will continue to balloon unless we get a healthier balance to our own practices to limit burnout. 

I am astounded at the numbers of patients who show up who have good primary clinicians in the community! This has to do with the convenience of longer operating hours at our clinic and the advantage of seeing a physician quicker, despite the wait in hours here vs the wait of a week or two to see their regular practitioners. Much of what I do now is like a subacute emergency department; we must be helping decrease the numbers showing up in the local hospital emergency. We triage cases that may require more urgent assistance. I admit my earlier wrong (and naive) assumption that walk-in clinics only had the “easy” cream of money-making problems, such as simple prescription renewals. No, there truly is a spectrum of acute conditions (including H1N1 influenza A). My colleagues here are excellent clinicians making good decisions, and we work in a system with good follow-up.

Be careful when throwing stones! Walk-in clinics are here to stay, like so many other initiatives that add to the complex and varied styles of practices and opportunities that are clearly healthy for a viable society.

—John de Couto, MD
New Westminster