In response to an inquiry regarding the proposed establishment of an outpatient clinic staffed by a particular specialty, the College has developed the following Guideline on responsibility for continuity of care in such situations. This Guideline has application to all outpatient specialty consultations and not just those which may occur in the context of an established outpatient specialty clinic.
The College recognizes that outpatient specialty clinics can be a practical response to long wait times to be seen by certain specialties, and a worthwhile initiative to improve access to certain specialist services in the community. Having said this however, the College must always consider its responsibility to address, in accordance with the Medical Act, 2005, allegations of conduct deserving of sanction which may be filed against a physician.
The College frequently receives allegations from patients (or their families) that a treating physician has not arranged for appropriate follow-up treatment. While the facts and circumstances of these allegations vary widely, a previous inquiry received from a health authority on an analogous question on responsibility for continuity of care for discharged inpatients did lead the College to develop a guideline on Responsibility for Continuity of Care – Patients without a Family Physician. (link below)
While the situation of an outpatient specialty consultation may differ in some respects from the fact situations dealt with in theResponsibility for Continuity of Care – Patients without a Family Physician guideline, in the view of the College there is a similarity in terms of the potential negative impact on outpatients requiring follow-up care after outpatient consultation with a specialist. In some circumstances, the patient may not have an established relationship with another physician who is able to provide the appropriate follow-up care.
The College is of the view that the principles previously set out in the Responsibility for Continuity of Care – Patients without a Family Physician guideline have application to the circumstances of outpatient specialty consultation, whether such consultation occurs in the context of an established outpatient specialty clinic or on some other basis. In the view of the College, a specialist who provides outpatient consultation to a patient and who deems that patient to require follow up care which cannot be reasonably expected to be provided by the referring physician or by another physician does have a responsibility to seek to arrange other appropriate follow-up care.
If the College were to receive an allegation from a patient who had been seen by a specialist as an outpatient that no or insufficient arrangements were made for follow-up care, then the College would look to this Guideline and to the principles set out in the related Responsibility for Continuity of Care – Patients without a Family Physician guideline. As indicated by theResponsibility for Continuity of Care – Patients without a Family Physician guideline, a verbal or written advisory to the patient to the effect that the specialist would have no responsibility to provide, or arrange for, follow-up care would not necessarily meet the expectation of reasonable notice to terminate the doctor-patient relationship. In the view of the College, there is a responsibility to arrange follow-up care regardless of whether the doctor-patient relationship arises from inpatient care or outpatient consultation.
Approved by Council - May 8, 2010