Physicians Opting to Provide Care Online in the Wake of the COVID-19 Pandemic
To combat the wide-scale disruption that the COVID-19 pandemic has created, many industries and sectors have turned to virtual options. Health care is no exception.
As a way of keeping patients safe while still ensuring they have access to health care during the COVID-19 pandemic, many physicians have adopted ‘virtual care’ options like phone and video calls as a way of delivering care.
Dr. Ilana Halperin, an endocrinologist in Toronto at Sunnybrook Health Sciences Centre, is a firm believer in virtual care and was one of its early adopters when it was launched in Ontario.
In this Q&A, Halperin discusses the benefits of virtual care for both physicians and patients, what prompted her to integrate virtual care into her work and why she believes that the silver-lining of the pandemic may be that it creates new learnings about virtual care and the ways it can be applied within health care systems.
What is the focus of your clinical practice?
I am an endocrinologist, and my focus is on treating diabetes and other hormone disorders like thyroid conditions. I do a lot of work on woman’s health conditions like polycystic ovarian syndrome, and work with patients who are pregnant and have diabetes.
How have you have integrated virtual care into your practice as a physician?
I was one of the early adopters of the Ontario Ministry of Health’s Telemedicine Program back in 2018. The Ontario Telemedicine Program was originally launched to treat patients in remote areas who didn’t have adequate access to many physicians or specialists. The program has since been expanded for patients to access virtual care from their own homes, without any restrictions on distance to the health care provider. It is now called the Direct to Patient Video program.
I am a laboratory-based specialist, so for a lot of my patients, a physical, in-person exam adds very little to the clinical encounter. I found that a virtual form of communication was a more patient-centred way to provide care—especially for those patients that whose health care needs were ‘high-frequency, low-touch’, like frequent insulin and thyroid dose adjustments.
In these cases, we need a lot of follow ups to adjust medications based on lab results and it’s not always necessary to meet in person to do so. Patients really appreciate being able to call-in via phone or video to appointments because sometimes it’s only a five-minute interaction. This is one of the main reasons I offered virtual clinics prior to the pandemic.
What would you say are the benefits of virtual care?
I think it creates better access to care for my patients and makes it easier for me to keep in contact with them. There’s a perception that virtual care is impersonal –but I think it allows me to provide care with a personalized touch and efficiently.
In the past, patients would call my office with quick questions and depending on how complicated their questions were, my secretary would often have to book an in-person appointment for them so I could review their concern or question. But through adopting virtual clinics into my practice, I’ve been able to reserve spots for these types of quick calls with patients so that they don’t have to wait weeks or months to see me in-person.
Obviously one of the other big benefits of virtual care to patients is the time they save by not having to physically come into the hospital for an appointment, which can be expensive and disruptive to their routine.
Has the way you conduct your practise changed in relation to COVID-19?
I used to almost always meet patients in person for an initial consultation and then when appropriate follow-ups could be done virtually.
In the context of COVID-19, I’m taking a virtual first approach with all my appointments. I am trying to weigh the risks and benefits of having patients come in for in-person appointments and avoid face to face contact unless it is absolutely necessary and will change my management of the patient.
Are there any new learnings you have come across during the COVID-19 pandemic in relation to virtual care?
Even before the pandemic hit, something I noticed when I started offering virtual care is that it is as much of a change for administrative staff as it is for you as a physician. There’s lot of new programs to navigate through, so having staff that can help patients navigate any technical challenges they are facing is important.
The other thing I have learned, especially during the pandemic, is that you should try to prep patients in advance for their appointments. This means ensuring they have all the information ready that would be helpful for us as physicians, like their current medication list or medication bottles nearby. And if it's possible, I ask patients to get a read on their blood pressure and if they’re doing any monitoring of their blood glucose levels to have those results ready or to send them in advance of the appointment.
What have been the biggest challenges for you as a physician during this pandemic so far? Have there been any challenges or limitations you have experienced with virtual care?
Physicians are now able to have phone calls with patients, as opposed to just video calls. This was added to the Direct to Patient Video Program in response to the COVID-19 pandemic. This eliminates technology issues a patient may face with a video call, but it has limitations. There's a lot that can be gleaned from inspecting and actually seeing your patient’s face when you are meeting with them. So, I still prefer video over phone calls if it's technologically feasible.
With more physicians offering virtual care in the wake of COVID-19, do you think this will spur change to Canadian health care systems?
I think the COVID-19 pandemic may create new realizations about the practicalities of virtual care for both physicians and patients. This has been a trial period for physicians to use virtual care, so it might prompt some to continue offering it if they feel it provides patients with the amount of care they require.
And on the patient-side, some may decide they prefer virtual care after realizing how much care they can receive virtually.
The Government of Ontario and the Ministry of Health has really been pushing for virtual care, so it will be interesting to see if after the pandemic has passed if the telephone codes for billing will remain or if any changes will be made to the Virtual Care program.
Resources on Virtual Care for Physicians Featuring Dr. Ilana Halperin: