Facility mission and policies
v1.0 (May 31, 2007)
- The facility and its physician(s) provide orthopaedic specialist assessment and consultation for conditions of the musculo-skeletal system. This process is normally initiated through a written request for consultation by a primary care physician. At all times, a patient is free to request referral to an alternate physician or facility; normally this referral will be initiated by the primary care physician.
- The facility and its physician(s) provide treatment for a subset of such conditions. Orthopaedic out-patient procedures and surgery can be performed within the facility, within the scope of practice approved by the College of Physicians and Surgeons of BC.
- The facility and its physician(s) arrange orthopaedic procedures and surgery in a hospital or non-hospital surgical facility when indicated. Examples include Peace Arch hospital, UBC hospital (hip and knee replacement only), Cambie Surgery Center or False Creek Surgery Center . Urgent assessment and/or treatment is provided in an Acute Care Clinic setting.
- The facility and its physician(s) provide referrals for orthopaedic and other care as indicated. Examples include referrals to neurology/neurosurgery, physiatry, rheumatology, vascular surgery, sub-specialty orthopaedic surgery, internal medicine, anaesthesia, physiotherapy, orthotist service. Note: ordinarily, referrals are not directed towards chiropractic, massage therapy, traditional chinese medicine, naturopathic medicine, or other complementary or alternative disciplines.
- The facility’s primary concern is the well-being of any and all patients under its care. Priorization of care is by physician judgement, this is not open to discussion. If concerns arise about priorization, this is to be discussed between the patient and the referring physician. The referring physician can contact the facility or its physician(s) for further discussion, at the referring physician’s discretion.
Patient appointments and communication are orderly arranged by appointment, to allow equitable access for all patients. Urgent concerns are communicated by telephone to facility staff, during assigned telephone hours. Arrangements are then made as needed, which may involve assessment by the facility physician(s), primary care physician, nurse, orthopaedic technician or other allied health professional, or the orthopaedic surgeon on call, depending on the nature of the concern and physician or other caregiver availability. Drop-in visits for immediate assessment or discussion are disruptive to other patients, as well as to other commitments of the facility and its physician(s), and are normally not acceptable.
- Common courtesy is expected, disrespectful interaction with staff or coarse language harms the patient-physician relationship. Staff safety can never be compromised. Appointments can be re-scheduled as needed. If less than 24 hour notice is given, a cancellation fee may be charged. If this is the case, the amount must be paid in full prior to any further appointment. Cell phone use is not permitted within the facility.
- Elective surgical treatment should only be performed after optimization of modifiable risk factors, to minimize risks to patients’ well-being. Common modifiable risk factors include:
- smoking (4 months of smoking cessation is required pre-operatively)
- obesity or being overweight. For most procedures, under most circumstances, the body mass index must be well below 35, preferably below 30. The facility physician(s) will discuss body mass index with the patient when indicated.
- triple prescription narcotics, illegal drugs, excessive alcohol intake.
- uncontrolled chronic conditions, amenable to optimization
When needed, strategies to deal with these issues will be discussed with the patient, a summary of this is normally sent to the referring physician.
- Developing a treatment plan requires decision making by patient and physician, based on the diagnosis and applicable treatment options, as outlined by the physician. Patient choices will normally be respected, as long as various risks and benefits are well understood. This not withstanding, both physician and patient have the right, sometimes duty, to not proceed with treatment. Physician refusal to proceed with treatment would follow from issues such as disruption of a normal physician-patient relationship, non-compliance with the treatment plan, patient expectations that cannot be met or a high risk of undesirable outcome, as judged by the physician.
- Prior to any surgery, informed consent for surgery, with an understanding of risks and benefits, needs to be provided by the patient (or substitute decision-maker). The patient needs to be satisfied that all concerns have been addressed well prior to surgery, even if this means that further discussion is required. It is better to postpone elective surgery to a later date, until all concerns have been addressed, than to proceed with surgery when the patient has unaddressed concerns. A patient can withdraw consent and refuse surgery, other treatment or assessment at any time, no reason needs to be given.
- After surgery, a handout will be provided with instructions, a prescription for pain medication and a follow-up appointment, usually approximately 2 weeks from the date of surgery. For most orthopaedic procedures, triple-prescription narcotics are not required.
- Services such as physiotherapy, occupational therapy, hand therapy, splints or braces may not be insured by the government health plan, and payment to the applicable health care provider may be required. This may be covered to some extent by extended health insurance. It falls to the patient and the applicable healthcare provider to deal with such financial transactions. Some services may be available on a limited basis at no direct cost, through the hospital system. This applies mainly to rehabilitation after total joint replacements or major long bone and hip fractures.
- The patient has access to the contents of the medical file. Storage of such information is not a service insured by the government health plan. Release of information at a date after the creation of the file entry necessitates additional administrative measures to secure integrity of the medical file and patient privacy. Any request for release of medical information must be made in writing.
- To contain costs and to minimize administrative measures, patient information can be made available to the patient at the time of chart entry. A nominal administrative fee will apply. This allows patient control and storage of personal medical information. The patient registration process includes the choice to accept or forego this option.
- Any delayed request for release of information directly to the patient will be subject to an administrative fee, as outlined above, applicable to each entry, with an additional fee related to the length of storage, counting from the date of the earliest entry requested.
- Any request for release of information to a third party must be accompanied by a written authorization of clear unambiguous intent. A facsimile of good quality is acceptable. An additional office and secretarial fee will apply.
Any of these fees may be pre-paid. If this option is not chosen, payment is due in exact cash at the time of release of information.
Of note, information such as imaging, laboratory and hospital reports are available to the patient directly from the provider of such a service. This may be an alternative or complementary means of obtaining desired medical information.
- Provision of medical notes, letters, forms and various reports is not a service insured by the government health plan. Any request for such documentation must be made in writing. A charge will apply, at the discretion of the facility or its physician(s). This fee may be pre-paid. If this option is not chosen, payment is due in cash upon delivery of the requested documentation. The facility and its physicians have the right to refuse provision of certain types of documentation. This would be a rare occurrence, and reasons for this would be provided as deemed appropriate by the facility or its physician(s). If release to a third party is requested, a written authorization of clear unambiguous intent must be provided.
- The facility or its physician(s) do not ordinarily offer medico-legal services or Court appearance to assist in personal injury legal proceedings. On a case per case basis, a decision will be made as to the degree of involvement acceptable to the facility and its physician(s). A fee may be required to respond to such requests, as well as to additional services such as interview, assessment, review and preparation of documents, meetings, Court appearance etc.. The facility and its physicians have the right to refuse provision of medico-legal services and Court appearance to assist in personal injury legal proceedings. Rationale for such a decision may or may not be provided, at the discretion of the facility and its physician(s).
- The facility and its physician(s) strive to pursue and deliver excellence in the provision of orthopaedic care, within the framework of our existing medical system. Patient feedback is critical to allow identification of improvement opportunities. The patient may receive an evaluation form. It is important that time is taken to complete this. Patient perception and experience is important. The facility, its physician(s) and staff, face serious capacity issues, as does every other medical facility in BC, related to a shortage of medical manpower and lack of resources. A balance is sought to provide maximum access to care, while maintaining a high standard of personalized care.
The facility would be pleased to answer any questions or concerns, preferably provided in writing. Additional resources for information or complaint are the College of Physicians and Surgeons of BC (tel: 604-733-7758), the BC Medical Association (tel: 604-736-5551 or 1-800-665-2262) ), the BC Orthopaedic Association (BCOA@telus.net, no direct telephone access), the Canadian Medical Association (1-613-731-8610), the Canadian Orthopaedic Association (1-514-874-9003), the applicable MLA and MP, the Ministry of Health or the applicable Health Authority.