Winnipeg Free Press - PRINT EDITION
Use cancellation fees with care, MDs warned
Service denied over missed appointment
WAYNE GLOWACKI / WINNIPEG FREE PRESS ARCHIVES Enlarge Image
Suzanne Macduff: mom turned away
No Manitoban should be denied medical care because of one missed appointment, says the regulator of the province's physicians.
Manitoba's College of Physicians and Surgeons deputy registrar Dr. Terry Babick said doctors can charge patients a fee for missing appointments, but are expected to consider why the patient was unable to attend and "act reasonably." Babick said there is a difference between a no-show and a cancellation, and physicians must carefully review and consider the patient's ability to pay before they issue a penalty fee.
The Free Press reported Thursday that staff at Lakewood Medical Centre refused to let Suzanne Macduff's elderly mother see a physician due to an unpaid $120 fee from a previously cancelled appointment. Macduff phoned to cancel her mother's appointment with a specialist last week because her mother, who is in her nineties and suffering from dementia, was too ill to attend. She said she wasn't told of the hefty fee when she first booked the appointment and thought the clinic would waive it due to her mother's condition.
She was shocked when clinic staff refused to let mother see her family doctor this week until the fee was paid.
Macduff said she has lodged a formal complaint with the college.
The college will not comment on the case or confirm if they are investigating the complaint, due to privacy.
"Illness, I think, is different than 'I just forgot' and 'I just forgot once' is different than 'I forgot for the fifth time,' which is different from 'It's not convenient for me so I'm not coming,'" Babick said. "At the end of the day, we expect physicians to look at each circumstance and react reasonably.
"The college would expect that a patient would not be denied care because of an isolated missed appointment."
Macduff's case has ignited a debate about the ethics of billing patients who don't show up or cancel medical appointments. Fees are not regulated, and physicians must use discretion and advise patients in advance of any penalties for missed appointments and how much notice they need to give to avoid a charge.
Babick called the issue a "dilemma," saying there are patients who frequently miss appointments and fees are meant to compensate for a physician's lost time. However, he said doctors should understand when unexpected illnesses or emergencies surface.
"We would expect a physician who deals with sick people all the time to understand that a patient couldn't make it that day because they were ill," Babick said.
University of Manitoba medical ethicist Arthur Schafer said patients shouldn't be slapped with a fee for missing appointments.
"The whole policy is going to hit people who are poor or have modest means much more than people who live in Tuxedo, where the doctors live," said Schafer. "That's a lot of money for many people and contradicts the philosophy and spirit of medicare which is free access."
Schafer said the college should scrap its policy and the clinic should apologize to Macduff's mother and her family.
Lakewood Medical director Dr. Taras Gwozdecki previously said the fees collected are donated to charity and missed appointments increase wait times, and "rob other needy patients" of physician time.
Two former clinic employees contacted the Free Press to allege the fees collected did not go to charity. Gwozdecki has not responded to clarify which charity the money went toward and how much the clinic collects annually in missed appointment fees.
Republished from the Winnipeg Free Press print edition August 27, 2010 B3
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