Once thought of as the potential future of medicine, virtual healthcare has quickly become the present reality during the pandemic. Telehealth is here to stay – as the major method of delivering medical care for family physicians and other specialists for the next year – and as an important part of care delivery in the future.
To reduce the risk of spreading infections, all physicians have been directed to suspend non-urgent nonessential procedures, investigations and in person consultations.
Virtual healthcare – or telehealth – is the provision of medical consultations or visits by phone or video.
A virtual visit with your doctor takes the place of an in person, face-to-face consultation in a medical office, clinic or hospital.
Both patients and physicians appreciate the convenience.
The patient doesn’t have to take extra time off to travel to the clinic, wait in a potentially crowded reception area and risk picking up infections from others. The physician doesn’t have to wait for each patient to be checked in, prepped and shown into an exam room. Missed appointments or late arrivals don't disrupt the schedule for other patients.
As with traditional doctor’s visits, patients describe their problems or symptoms and physicians will ask appropriate questions to determine the correct diagnosis and discuss how each condition could be managed.
Lab requisitions can emailed, investigations booked and prescriptions sent directly to pharmacies.
It sounds so easy and convenient for everyone. So why didn’t we do this before?
There are significant risks and pitfalls with telehealth.
Here’s what you can do to reduce your risks in the new world of virtual healthcare.
1. If your needs are emergent or potentially life-threatening, go to the nearest emergency department.
During the pandemic, emergency rooms across the province have become alarmingly quiet. It’s great that so many have heeded the advice of Dr. Bonnie Henry and Health Minister Adrian Dix to stay at home.
However, we are very concerned that those with potentially serious problems may be avoiding the urgent care they need.
Call 911 if you have symptoms suggesting a heart attack (such as chest pain or pressure, tightness in your throat or unexplained pain in either arm), stroke (such as the sudden loss of vision, speech, muscle strength or sensation in any part of the body) or uncontrolled bleeding.
2. Call your personal family physician first for any medical problems just as you would before the pandemic.
This includes both emotional and physical problems. You are not alone if you have felt overwhelmed with anxiety or deeply depressed while separated from your friends and loved ones. We are even more concerned with the disabled, elderly and those struggling to maintain mental health alone.
Many of my patients have chronic health conditions, such as diabetes and heart disease that require active monitoring and management. Without these regular checkups, their health will deteriorate.
There are a number of virtual health businesses that have seized the opportunity to take calls from anyone. Though qualified physicians may provide these services still paid for by the Medical Services Plan, they do not have your complete medical history and the long term mutually trusting relationship you share with your regular family physician.
A one-off virtual physician is no substitute for your real family physician who treats even an apparently simple problem in the context of your whole life and other medical conditions.
3. Recognize the importance of confidentiality and consent.
At the start of any video or phone visit, tell your physician who else is in the room with you. Do you want anything discussed kept confidential from others? When speaking with an unfamiliar physician working for a virtual health business, is any of your health information being shared with third parties for purposes other than your personal health?
4. Recognize the serious limitations of phone and video visits.
Though your description of symptoms provides vital information for your doctor to make a correct diagnosis, the examination is crucial for ruling out other serious conditions. Physicians require more than their eyes and ears to adequately examine each patient.
We feel for abnormal lumps, areas of tenderness and the texture of skin changes. We hear much more with our stethoscopes – not just for the lungs and heart, but also over the abdomen and large blood vessels. We see much more with our otoscopes and ophthalmoscopes than we can on a computer screen.
Without these crucial pieces of the puzzle, we may arrive at incorrect conclusions and propose the wrong treatment.
I fear that there is a growing number of serious missed conditions through virtual misdiagnosis.
When it is necessary to examine our patients in person, we have taken special precautions. We ask patients to wear face masks and let us know when they arrive in the building so that they can brought directly into a clean examination room without the risk of exposure to others. We are all wearing gloves, masks and eye protection with every patient.
Virtual health is here to stay, and your family doctor will continue to work with you to manage any health concerns and maintain your health over a lifetime.
Dr. Davidicus Wong is a family physician. He was the founding chair and lead physician of the Burnaby Division of Family Practice and continues to serve on the board. His Healthwise Column appears regularly in this paper. For more on achieving your positive potential in life, read his blog at davidicuswong.wordpress.com.