STATEMENT No. 190 PRACTICE COVERAGE AFTER HOURS AND VACATION

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1 STATEMENT No. 190 PRACTICE COVERAGE AFTER HOURS AND VACATION BACKGROUND: The Code of Conduct of the College of Physicians and Surgeons of Manitoba states that a physician must: Having accepted professional responsibility for a patient, continue to provide services until they are no longer required or wanted; until another suitable physician has assumed responsibility for the patient; or until the patient has been given adequate notice that you intend to terminate the relationship. The College supports the concept that continuity of care is the best medical practice for patients. It is therefore in the best interests of the patient that he/she have access to medical care for urgent medical issues that arise after regular office hours, on week-ends, or during the physician s vacation periods. The College recognizes that there are different types of physician-patient relationships, including continuous care physician-patient relationships and episodic care relationships. The College does not regard the practice setting as determinative of the nature of the relationship. SCOPE: This Statement applies to all physician-patient relationships. REQUIREMENTS: It is the position of the College that: a. The provision of ongoing medical care is not only the responsibility of the family physician, but also of specialists and other focused-practice physicians who are involved in the treatment of patients. Statement #: First Print 00/00

responsibility for a patient, continue to provide services until they are no longer required or wanted; until another suitable physician has assumed responsibility for the patient; or until the

2 Practice Coverage After Hours and Vacation Page 2 b. This Statement also applies to physicians who are providing medical service in locations such as urgent care centres and walk-in clinics. c. Each physician must ensure that medical care is continuously available to the patient in his or her medical practice. d. Each physician must make a specific arrangement with another physician or physicians or call group for the care of his or her current patients when the physician is unavailable to provide that care. e. Each physician must ensure that the other physicians or call groups who are available for after hours or vacation care for his or her patients is aware of and have agreed to the arrangements for the periods that the coverage is required. f. Each physician must ensure that his or her patients are aware of the coverage arrangements the physician has made. g. It is not acceptable for a physician s answering service to direct patients to attend an emergency room or other episodic care facility unless the physician has a formal arrangement with the specific facility or with a physician working in that facility. h. As part of the specific arrangement, there must be an expressed willingness on the part of the receiving party (e.g. an on-call physician or an emergency department) to accept responsibility for all patient care that is required. i. Physicians who provide episodic care to patients should determine at the outset of the visit whether the patient has a primary care physician. If so, the physician providing episodic care is responsible to promptly communicate significant findings of the examination and plan for treatment to the primary care physician. j. When a physician providing episodic care is attending a patient with an acute condition, the physician has the right to limit the care provided to that current episode of acute care, subject to the requirement that a physician who provides care for a particular medical episode assumes responsibility for the patient until that medical episode is complete or until care is transferred to another physician. However, the physician who wishes to limit the care in this way must explicitly communicate his/her intention to the patient. An exception exists for physicians attending a patient in an emergency room, where the limited nature of the relationship is self-evident.

Each physician must make a specific arrangement with another physician or physicians or call group for the care of his or her current patients when the physician is unavailable to provide that care.

Page ARTICLE I Statement of Purpose 1. ARTICLE II Authority 1. ARTICLE III Responsibilities of the Emergency Department 1

EMERGENCY DEPARTMENT RULES AND REGULATIONS TABLE OF CONTENTS Page ARTICLE I Statement of Purpose 1 ARTICLE II Authority 1 ARTICLE III Responsibilities of the Emergency Department 1 ARTICLE IV Responsibilities