Dialogue Volume 15, Issue 2 2019 - Page 41

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 41