Improve primary care access? Let’s start with transparency of office hours

I have yet to meet a family physician who does not believe, through a delusion or not, that they are providing tremendous access to their patients.

Certainly the recent results from the Health Quality Ontario report on quality indicators in primary care were controversial, including 44% of patients reporting they can get an appointment the same or next day, and only 78% could get a same-day response to a phone call.

The responses you heard from physicians were along the lines of “I always have appointments available, my patients just go straight to walk-in clinics”.

So we have a disconnect. Some patients believe they can’t see their physician, or even get a phone call response. Some physicians say that’s not true, the patients just aren’t trying hard enough to get a hold of them. I think that it’s possible that they’re both right. Many physicians are indeed available, and many patients just don’t know that they’re available. (I am going to casually sidestep the issue of physicians who don’t actually provide good access).

Let’s start with a painfully simple solution. Let’s provide accurate hours of operation to our patients on a weekly basis, available online on our practice websites.

There really is no rationale for why this shouldn’t be easily available for our patients. If they are ill, they should know exactly how and when they can get a hold of us. The available schedule should include hours where you see patients, hours where your phones are answered, and who patients should call after your hours of operation. Updated on Sunday evenings, ready for patients to see what their physician’s schedule looks like for the week. Away at a conference? Taking the afternoon off for a family event? This should be accounted for on a weekly schedule, where patients can quickly reference. Nearly every other service industry provides detailed hours of availability, and there is no reasonable explanation for why we can’t provide transparency.

For this article, I did a quick perusal of some practice websites of physicians who I know are providing great access, but their hours listed and contact information on the websites are still not clear. We must approach this from the perspective of a patient who is looking for care and wants to know where to turn. Make it crystal clear for them to know who to call when, either during hours or after hours, when messages are appropriate, and the locations and addresses of the clinics involved. If messages are returned on weekends to book patients for Saturday or Sunday morning clinics, this should be clearly outlined. If you’re on holiday, the contact information for your coverage should be clear, with expectations for what type of conditions will be seen urgently, and what can wait, and when you will respond to requests. Highlight clearly if you offer same-day appointments, in BIG BOLD LETTERS. And maybe a quick explanation about what THAS is and when/how they should call THAS.

Some physicians already do this. Some do it sporadically, then forget about their website for months at a time. But if we make it a systemic, formalized approach, we can gradually train all of our patients to collectively know where they should turn for their first point of care.

And let’s reward physicians for complying. A monthly component of the existing capitation fee tied to successfully keeping updated online hours, subject to a collectively bargained process for auditing compliance.

For seniors or others who don’t have access to the Internet, the Telehealth staff (or even ER staff or other health care workers) would also be able to access the physician’s hours online, and guide the patient to the appropriate available resource.

Apart from improving patient knowledge of our availability, my hope is that this type of transparency with hours would lead physicians who are underperforming in their provided access to improve their availability, or at least work towards a mechanism for their patients to access other members of their team.

Such a simple, almost trivial issue. But perhaps a solution that can begin the path towards improved patient perception of access to primary care.

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