The doctor will see you now, just turn on your computer

virtual care

When the COVID-19 pandemic hit, Canadians were instructed to stay home and self-isolate. As a result, many businesses and services have changed the way they work to adapt to the new reality and health care visits with doctors are no exception.

Family doctors and other specialists have continued to see patients throughout the pandemic by using phone and digital technology. Although virtual care isn’t new, it’s definitely now in the limelight.

“When COVID hit, it became very clear that getting in your car, driving across the GTA and sitting in a waiting room in order to see a doctor was not the safest or easiest way to receive care,” says Dr. David Eisen, Chief of Family and Community Medicine at North York General Hospital (NYGH).

Dr. David Eisen
Dr. David Eisen

The benefits of virtual care are access and convenience. It’s safer during a pandemic for both patients and providers as they aren’t exposed to any viral transmission and can still be in contact.

“For many circumstances, virtual care will be as good as sitting with a person and you can certainly do a variety of therapies, counseling and information transfer without being in the same room,” says Dr. Eisen.

Virtual first

Virtual first is an approach which starts with speaking to a patient on the phone or over video and finding out what their exact concerns are then, based on risk and benefit, deciding what the next step should be. 

“In our Family Medicine Department, we determined very early on that a safer way to conduct a majority of medical visits was virtually in order to prevent exposure to patients, staff, learners and doctors,” says Dr. Eisen.

North York General’s family doctors we’re able to switch to virtual care within weeks of COVID hitting. “I’ve been here 30 years, and this is the fastest transformation of health care delivery I’ve ever seen in my career,” says Dr. Eisen. “We are a very nimble institution with outstanding leadership and when you have strong leaders with well-organized departments, converting to virtual first happened very efficiently.”

No one size fits all solution

Although a majority of patients can be seen virtually, there are many areas of primary and specialty care where face-to face contact is still needed.  

The Canadian Paediatric Society has advised family doctors and paediatricians that babies and children need to continue their vaccine schedule, otherwise they will be at risk for vaccine preventable illnesses such as measles, mumps and rubella. This means bringing babies and children ages 2 months to 4 years old in-person to offices to vaccinate them.

Another example is maternity care for mother and baby, as hands on examination of the abdomen and listening to the baby’s heartbeat are very important. “Some maternity visits can be done virtually but we’ve found safe ways to provide hands on care when we need to see our patients in person,” said Dr. Eisen.

When discussing virtual care, it is essential to consider there are vulnerable and marginalized populations for which this isn’t easier or more convenient. Having access is a privilege, one that not everyone has.

“We must think about the person who has no phone, the elderly person who can’t see or hear well, the person who can’t afford an internet connection, and those for whom English is a barrier, and ensure they receive the care they need,” explains Dr. Eisen.

Collaborating with community partners

The Ontario Health Teams (OHTs) are grounded in local partnerships and a commitment to the local community. North York Toronto Health Partners (NYTHP), in which the hospital is a partner, had begun working together with patients, caregivers, primary care leaders, and community partners before COVID, with a mission to transform health care in our community. 

“North York Toronto Health Partners is a fantastic collection of health partners who work together to provide, what I like to call, the patient’s medical neighborhood,” says Dr. Eisen. “And, when COVID hit, the partnerships already existed, so when we received the call that family doctors were needed to help test patients in the community and provide follow-up and virtual care, we were able to react very quickly.”

And now, in collaboration with NYTHP, NYGH is reimagining a whole new way to provide care to vulnerable settings, such as a shelter. The NYTHP, in partnership with CareFirst, can bring mobile care directly to any location and have a “doctor’s office on wheels”. 

Future of care

“There’s no going back from where we are now,” says Dr. Eisen. The health system has radically and dramatically changed overnight due to medical necessity and I think that gives us a real opportunity to let go of practices that don’t make sense and keep what truly works for patients in the 21st century.”

Based on a person’s personal medical status, goals of care and area of concern, patients and doctors can work together to decide what choice works best for them to receive care – whether that be an email exchange, a telephone or video call, an emergency room visit or an in-person appointment.

“We can work together to co-design the health system of the future, which is sleek, efficient, safe and ultimately works better for everyone,” says Dr. Eisen.

This article first appeared in the June 2020 issue of The Pulse.

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