More than 100,000 medical visits lost in one year

Family doctors have complained for years: patients do not show up for their medical appointments and do not bother to cancel them. The phenomenon is now quantifiable: nearly 110,000 no show have been reported by general practitioners to the Régie de l’assurance maladie du Québec (RAMQ) since April 2021.

The figure strikes the imagination, but underestimates the problem, according to the Federation of General Practitioners of Quebec (FMOQ). “We now know that there are at least 100,000 lost visits,” says its director of communications and public affairs, Jean-Pierre Dion. But it is estimated that there are certainly several hundred thousand. »

“Blocked” appointments

Family physicians can voluntarily declare their patients’ absences without notice to the RAMQ. A new unpaid billing code was created in September 2021 (with retroactive application to April 2021) to measure the proportion of patients not honoring their appointments.

According to the RAMQ, 3,652 family physicians — out of some 7,500 practicing on the front line — have used the code. They reported 109,532 absences from 95,010 different patients. Repeat offenders are therefore among absentee patients.

The D^D Élyse Allard, who practices in Havre-Saint-Pierre on the North Shore, has been using the RAMQ code for a few months. “On a day when I can see 12 patients, it can happen to me that a quarter is absent. It blocks appointments for other people who could have had them, ”laments the family doctor.

According to her, the phenomenon has worsened since the pandemic of COVID-19. Patients seem less embarrassed to miss a telephone consultation than an in-person office appointment.

The D^r François Vachon, who practices at the GMF MédiCentre Chomedey in Laval, notes on the contrary that his registered patients are less likely to let him down since the health crisis. “The pandemic created a lot of delays, a lot of patients were falling between two chairs,” he said. It seems that when patients have an appointment with me, they consider themselves lucky and tend to miss their appointments less and less than before. »

However, rabbit setters remain frequent walk-ins, according to D^r Vachon. He estimates that of the 100 to 120 beaches offered each day, 5 to 6 are lost. “People make an appointment online on RVSQ [Rendez-vous santé Québec]they try two or three parallel approaches and often, they end up being seen, but they don’t even cancel, ”laments the doctor who has stopped reporting these absences to the RAMQ.

The D^r Vachon believes that patients have little reason to do so. The RVSQ platform sends notifications to confirm appointments and offers the possibility to cancel.

Also among specialists

Many medical specialists deplore the phenomenon. However, no RAMQ code allows them to measure the extent of this.

At the Sainte-Justine University Hospital Center (CHU), the 12 doctors of the pediatric gastroenterology outpatient clinic have recorded 523 absences since 1^er January, reports gastroenterologist Valérie Marchand. A little more than a hundred were new patients, most often having a priority “D” (consultation offered within three months after the request), she specifies.

“We have waiting lists, and people don’t understand that, if they don’t come, they will take a second place later and will also take the place of a new patient, who could have been seen and who , he would have come, ”explains the D^D Merchant. These no show harm the efficiency of the health system, she points out. “There seems to be a disempowerment of the patient in relation to this social responsibility,” she says.

The Federation of Medical Specialists of Quebec (FMSQ) is well aware of the problem. She points out that “several types of interventions” diagnostic or surgical “can generate anxiety and fears in patients”. Anxious patients leave without telling their specialist.

According to the FMSQ, doctors “take the time” to fully explain the procedures to patients in order to reassure them and avoid this type of situation.

The doctors’ union believes that the population must also be made aware of the importance of canceling an appointment and the consequences of not doing so. “Patients who miss their two appointments can also be called to an outpatient meeting to discuss the procedure, the need to perform it, and reassure them if necessary, in order to limit anxiety and the fears that can lead to a no show “, adds the FMSQ in an email.

The D^D Alexandra Dépeault, surgeon at La Malbaie Hospital in the Charlevoix region, implores patients to call their clinic to cancel their appointment. “It’s okay to cancel,” she said. Things can happen in life. People may be afraid of the exam. Their spouse may be sick, it does not happen. We’re just going to reschedule their date. »

Jean-Pierre Dion, of the FMOQ, also believes that we must focus on “educating patients”. However, appointment cancellation systems need to be efficient and fast, he stresses. It’s hard to blame a patient for giving up after 45 minutes of waiting on the phone.

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