Patient dropped by Dartmouth family doctor after not visiting for two years

Not all primary care physicians follow guidelines on reducing practice

George LeRoy still doesn’t understand how he ended up on a waiting list for a family doctor when he had one two years ago.

LeRoy was a patient with Dr. Emad Malak at the Montebello clinic in Dartmouth. However, he said he did not visit for two years, and was dropped.

“He’s not my doctor anymore. Not by my choice but by his,” LeRoy said.

LeRoy said he didn’t have a reason to visit the doctor during those two years.

“I’m the type of person that doesn’t go in to see a doctor unless I really need one. I would rather see more people that need one go in to see the doctor than me,” he said.

LeRoy said he was diagnosed with a bleeding ulcer, almost ending his life in March 2021. He was hospitalized for three days, and when released, he said he was told to get a follow-up blood test with his family doctor.

He said he learned he was no longer a patient when he called the clinic to book an appointment.

“The receptionist came in and said, ‘Oh, you haven’t been here in two years, go to a walk-in clinic,’ ” LeRoy said.

LeRoy is still trying to find another family doctor. He said he tried getting back with Dr. Malak, but couldn’t.

According to a November report by the Nova Scotia Health Authority, there are 120,409 Nova Scotians actively looking for a family doctor, and now LeRoy is part of that waiting list.

The Signal tried multiple times to reach Dr. Malak for an interview.

‘A balancing act’

Dr. Gus Grant, registrar and CEO of the College of Physicians and Surgeons of Nova Scotia, said that while patients have the right to not be abandoned, physicians also “have a degree of professional autonomy and have the ability to control the size of their practice and control the amount they work.”

Family doctors can choose whether they want to drop patients, but Grant said they should follow the guidelines while doing it, and give notice in advance.

In the guidelines, patients can be dropped if there is a safety risk, fraud, abuse, or disrespect from the patient; or if the doctor is leaving the practice due to health issues. There is no mention of dropping patients because they don’t visit for certain periods of time.

LeRoy did not meet any of those criteria.

Grant said there has to be “a balancing act” between the patients’ rights and the rights of the physicians.

“One of the things that we encourage physicians to do when reducing the size of the practice is to do it in a consistent, transparent and non-discriminatory way,” he said.

Grant said that some physicians “failed to meet” these obligations, but the only thing he can do is encourage them to follow the guidelines.

There are no consequences for physicians who don’t adhere to the guidelines.

Grant says the main issue for patients after being dropped is not being able to find another doctor. Patients who are terminated just “go on a list with the other patients, the other many thousand patients in Nova Scotia,” he said.

The college did not receive any formal complaints about this issue, but it did receive inquiries, said a spokesperson in an email.

Complaints received

Alexandra Rose is the social co-ordinator of the Nova Scotia Health Coalition, which advocates for public health care and acts as a forum for health-care discussions.

She said the coalition has received complaints from patients being dropped by family doctors, but she doesn’t have specific numbers. All were dropped after not accessing their doctor for two years.

Rose said physicians should tell patients that if they fail to visit regularly, they will be dropped.

“Only if they decline this advice, only then, it’s understandable for doctors to discontinue that relationship,” she said.

Rose said she understands doctors sometimes wish to downsize their practice, but in the cases she looked at, physicians are dropping patients to pick up new patients from the waiting list.

She said that because accessing family doctors is already a widespread issue, there should be a change in the guidelines regarding terminating patients who don’t visit for a while.

“Family doctors are primary care. Primary care keeps people out of acute care, but only if they are utilizing it. And we hope that they do,” Rose said.

Sondos Elshafei

Sondos is a fourth year BJH student at the University of King's College. She published articles in the Dalhousie Gazette and in magazines. Sondos also worked as an editor for an American magazine, AM Woman.

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