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Published on: April 16, 2020
by Dr. Vivien Brown for CJN:
Last September, I wrote to you about virtual care and how telemedicine was becoming more and more important to the Canadian public as there was, and is, a shortage of family doctors. The article was about the value of seeing a health-care professional online, without travel time. The research on the quality of care and communication has been seen to be positive for both the doctor and the patient. While not purely theoretical at that time, there was no sense of urgency for most of us. Rather, virtual care was thought to be convenient and a good alternative for the Canadian public.
That landscape has been altered irrevocably by the emergence and devastation of COVID-19. With the clear public health directives of staying home, maintaining a social distance and the need to practise various degrees of isolation, virtual care or telemedicine is no longer elective. Rather than being a reasonable option, it is suddenly the absolute norm, the necessity, the first step in accessing medical care.
Family doctors are often thought of as the gatekeepers in our system of health care. With the patient as a partner, we evaluate a given condition or concern, decide if a specialty consult is needed, which laboratory tests or imaging are required and, finally, whether the condition needs treatment and what form that may take. A prescription? Physiotherapy? Surgical intervention? What is the next step for the patient?
In the last few weeks, as we try to have patients visit either by phone or on a secure website for a face-to-face experience, we are all learning the incredible value of virtual care. I have talked with patients privately by phone and online. We have discussed issues from elevated levels of cholesterol and their impact on cardiac risk to an evaluation of acne, with clear pictures and dialogue. We have managed anxiety, urinary infections, early pregnancy questions and upper respiratory issues. Medication monitoring, including renewals, questions, changes of dose, duration and intervals have all been managed virtually.
More than 80 per cent of patient visits have been successfully negotiated online. I believe both the patients and the health-care professional feel gratified with the interaction, satisfied that public health directives are being followed and that, overall, there is a significant sense of safety in maintaining a social distance with decreased exposure. Yes, we are still the gatekeepers, but part of that “gate” now includes deciding whether an in-office visit is necessary.
Things that cannot be done online include some areas of examination that involve gynecology, such as a Pap test or prenatal examinations, or an ear exam. Infants need to be seen to have their routine immunization on time and as required, so that they are protected personally and so that we, society, do not risk a measles outbreak or infant deaths from pertussis. Other preventive measures, such as screening for colon cancer, can be delayed, as recommended by public health officials, but eventually will require in-office visits. Immunization to prevent various cancers related to HPV and immunization to prevent shingles are being delayed for the moment, but will require more than virtual visits in the near future.
In this new world we now face, there are many tools and many options that we need to consider to help maintain our best health. While public health organizations are helping us with day-to-day directives, it is time for all of us to be creative, thoughtful and open to new opportunities in the health-care environment. Virtual care is an efficacious tool, one of the options to help protect patients and their families, doctors and their staff, and the health-care system itself as we work diligently to ease the incredible burdens on our system.
So what does this all mean for you? Well, it is really time to become more comfortable with your computer, your email and your phone. There is a good chance your next appointment with your doctor will be online, so let’s get ready, Canada. This is how we will stay connected. This is how we stay well. This is how we protect our families and ourselves.
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