Vituperation in Edmonton
========================

* Andrew Stewart

I was interested in your recent description of the misadventures of Renier Van Aardt at his Nova Scotia walk-in clinic.1

Pediatricians at the Royal Alexandra Hospital in Edmonton established a pedicentre as an after-hours walk-in centre for our patients. As with Van Aardt's clinic, it grew beyond reasonable limits and soon extended to family practice and non-Royal Alexandra patients, and to referrals from ERs that felt their waiting times were too long. I personally saw 36 patients in a single evening.

We closed the pedicentre after some 5 years because patients' parents were physically fighting for their place in line and were verbally abusive to the receptionist and physician on duty, especially about waiting times. The vituperation heaped on us after we closed the centre was something to behold, as were the demands for continuing care.

We compiled some fascinating facts about patient visits. When the clinic opened at 5:30 pm there would be a few patients waiting who had been picked up at day care and were ill. There would then be a hiatus until 7 pm, by which time fathers had finished their supper and another group of patients would arrive. I enjoyed being in the clinic during the Stanley Cup playoffs, Grey Cup and Super Bowl because it would be really quiet during these times.

Another interesting feature of the clinic concerned the remarkably few prescriptions written. I am not a therapeutic nihilist, but the night I saw the 36 patients I wrote 1 prescription. The rest of the time I offered advice.

Finally, we found that visits to our pedicentre began to replace patients' visits to their own physicians simply because it was more convenient for their parents to bring them to us. Many of the children had more than 25 visits to our clinic without being seen by their own doctors.

What is the message? Our pedicentre, like Van Aardt's clinic, was set up to respond to a perceived need in the community, and it was abused. Do we have to change patients' expectations of the system, or should the delivery of medical care change for the convenience of the patient?

**Andrew Stewart** Pediatrician Edmonton, Alta.

## Reference

1.  1. Moulton D. Solution turns sour as patients demand physician's services. CMAJ 2001;165(9): 1244.
    
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