Quebec’s indulgence towards patients is less and less great. Under a new directive aiming at a more “active” management of waiting lists to see a general practitioner, nearly 4,200 patients were ejected from the Access to a Family Physician (GAMF) after two phone calls went unanswered. answer, learned The duty.
At least this is what data obtained by the Régie de l’assurance maladie du Québec (RAMQ) reveals the number of registered patients who failed during the first appointment with a doctor assigned by the GAMF, as well as patients who failed to respond to two or three telephone contact attempts.
The new directive, which entered into force in March 2021, introduces stricter measures to ensure “sound management” of waiting lists, in particular that for accessing a family doctor.
A compilation made by the RAMQ at the request of the To have to shows that 4,188 patients were taken off the waiting list between March 2 and November 13, after failing to answer phone calls from clinics. In the midst of the pandemic, in 2020, more than 6,500 patients were removed from the list after being considered “unreachable” by telephone, and nearly 4,800 in 2019.
After two unanswered calls, made by a clinic or a group of family physicians (GMF), the directive provides for the patient’s suspension from the waiting list. In the case of calls coming from an “establishment”, it is after three unreturned calls that the patient is suspended. In both cases, a postal letter is then sent to the patient to advise him of his withdrawal.
But according to user advocates, this directive, like that aimed at reducing waiting lists for surgery, once again blames the delays on patients, rather than on the inefficiencies of the GAMF management system. .
“I have a quarter of my members who are mostly seniors, who can only be reached by mail or email. They are not always on the end of a cell phone. Most don’t even have one! »Says Me Paul G. Brunet, President and CEO of the Council for the Protection of the Sick.
If the latter says he agrees with the basic objective of the government, namely to improve waiting times to access a family doctor, he wonders about the means chosen to achieve it. “It’s always easier to lay the blame on the patients. The target should be the inefficiency of the system itself, ”he adds.
Some family physicians, overloaded with consultation requests, do not, however, share this vision of reality.
According to the Dr Michel Breton, family doctor in Laval, it is true that some patients are very difficult to reach and that missed appointments, colloquially called ” no show », Continue to weigh heavily in the daily management of private clinics and FMGs.
“It is up to the clinic to reach the orphan patient assigned to us by the GAMF. Sometimes it’s a real problem to contact people by phone, ”he explains.
According to the RAMQ, however, there are very few patients recommended by the Guichet d’access à la clientele orpheline (GACO) and who fail to come to a medical clinic or GMF for a first appointment with a family doctor.
In 2021, 538 of these patients registered with the GAMF did not show up for the appointment set for a first meeting with the family doctor who had been assigned to them. There were 500 in 2020. In 2019, it was 1079 patients registered at this counter who had missed their first appointment with the general practitioner to take care of them.
Adapt to reality
The Dr Breton, who has already administered the access window to family doctors for the Laval region, still wonders about the range of means retained by Quebec to reach orphan patients. “When we think of the new generation, we reach people more easily by text, by [l’application] Messenger or email. They’re not all good on the phone, ”he says.
For the Dr Sylvain Dufresne, head of the GAMF for the Vaudreuil-Soulanges region and general practitioner at the GMF des Trois Lacs, the rule of suspension after two or three calls is far from being applied to the letter. “We don’t stop here, even after three attempts. Because often these are people who work during the day, who are very busy. It is also up to us to adapt to the reality of our patients, ”he argues.
From experience, he finds that “orphan” patients who fail to call back or miss their first appointment are often younger and assigned to new doctors who are starting their work. “If they’re 30 years old, and have no health problems, they don’t have the same urgency to see a doctor. Vulnerable people are seen quickly, ”he said.
To reach “orphan” patients, clinics do not obtain information from GAMF other than the civic address and telephone number. Contrary to widespread use in several private clinics, contacts and confirmations by text or email are not used by GAMF.
According to the Dr Dufresne, the number of absences for the first appointments (no show) with a family doctor has declined significantly over the past year, now that these can be done by telemedicine. “There are fewer and fewer of these patients who fail us. “
Faced with the explosion in the number of patients registered with the GAMF (865,000), for an average of a year and a half, the Minister of Health, Christian Dubé, promised in mid-November the forthcoming creation of the “GAP” in March 2022, a front-line access point, which should reduce waiting times by giving patients access to medical care, but also to nurses and other health professionals.