The sign says, one issue only per visit. But is that OK?

A member of the public recently contacted the College asking whether it was acceptable for physicians to have a practice policy limiting patients to one issue only per appointment. Following is the College’s response.

Physicians have a professional, ethical and legal obligation to provide appropriate medical care to each and every patient irrespective of the setting in which they work, and regardless of the amount of time that may take. Patients are not medically trained. It is not realistic or acceptable from a clinical practice perspective to expect patients to be able to identify the one problem deserving of priority management. Eliciting a list of presenting complaints and triaging accordingly is foundational to all of medicine. It is how all patient encounters must begin. 

It is a reality that patients with long problem lists who make recurrent requests for discussions of multiple and seemingly unrelated health issues can make patient scheduling in a busy practice difficult. The College is sympathetic in these circumstances to patients, to physicians and to medical office assistants who are responsible for running an efficient practice. Rather than posting a sign outlining a practice rule of “one issue only,” the College always recommends that physicians have open discussions with their patients to understand the scope of their concerns, to make clinical judgements about related or unrelated health issues, and to manage patient expectations. In some situations it would not be unreasonable for a physician to decide which problems need to be addressed immediately, and which problems can be addressed at a subsequent appointment. The College encourages physicians to advise patients when more time is required to “do justice” to a more complex concern. 

While the College has limited authority to direct how physicians manage their office practices, including time management, it would not accept a “one issue only” policy as a defence in the event of a complaint alleging deficient care.