PRACTICE PARTNER
One issue per visit strategy
could pose a safety risk
W
hen an Ontario mother took
her teenaged son to his doc-
tor appointment recently,
she noticed a new sign in the
waiting room that asked patients to limit their
visit to the discussion of one medical issue.
When she posted a photo of the sign on Twit-
ter, the conversation went viral.
Some of those who engaged in the debate
argued that limiting a patient to the discus-
sion of one issue was just smart time man-
agement – a way of allowing doctors to stay
reasonably on schedule for the benefit of all
patients. Others argued that it was not ac-
ceptable from a clinical practice perspective to
expect patients to be able to identify the one
problem most deserving of the doctor’s imme-
diate attention.
The College agrees that the one-issue per visit
strategy poses risk to the patient. Setting rigid
limits on the number of issues that patients can
voice in a single visit requires patients to triage
their own health issues – something many pa-
tients are not capable of doing. The issue most
important to the patient may not be the most
clinically significant issue.
Physicians have the requisite training and
clinical skills to know which issues need to be
addressed urgently and which can wait until
a later time. They also have the judgment to
avoid inappropriate prioritization that might
jeopardize a patient’s health.
While physicians are encouraged to give
patients an opportunity to express all of their
health concerns, they are not required to deal
with all of them immediately. Once the most
important issue is identified, along with any
other urgent issues, patients can be reassured
that their other concerns can be addressed
more fully in subsequent appointments.
ISSUE 2, 2019 DIALOGUE
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