“The future’s so bright I gotta wear shades”

Sunglasses

The Canadian Medical Protective Association (@CMPAmembers) has an uncanny ability to nail it when it comes to providing a timely lecture or panel discussion in association with its August annual meeting.

This year was no exception as a keynote presentation followed by a panel discussion provided a good overview of where we stand currently with the dramatic increase in the use of virtual platforms to deliver care in the environment of the #COVID19 pandemic – where distanced interactions are de rigueur to protect both physicians and patients.

Seamus Blackmore, Atlantic Canada Health Consulting Leader at Deloitte gave the main address with an enthusiastic and almost totally positive perspective (worthy of a @ZaynaKhayat or @Philipe_Edgcumbe) on the transformative power of virtual care.

“The barriers preventing virtual care from going mainstream have been knocked down with a wrecking ball,” said Blackmore noting how provincial health care systems and physicians quickly adjusted fee schedules and office procedures to facilitate the delivery of virtual care.

“The entire world has changed for us,” acknowledged panelist Dr. Darren Larsen, chief medical officer for OntarioMD who provided the practitioner perspective at the session.

A number of webinars and panels on virtual care have been presented since May tracing these changes with evidence accumulating over the summer of how routine care has been transformed from in-person office visits to phone calls and in some instances virtual visits. And Blackmore is not alone. Having helped the Canadian Society of Physician Leaders produce several podcasts with physician leaders over the summer, I have found it noteworthy how many reference the growth of virtual care as one of the positive changes that they believe will be maintained after we are safely through the pandemic.

So far, so good.

But it should be no surprise that the CMPA meeting served as a reminder that the virtual care revolution is not occurring without raising many questions and that providing virtual care is still not without challenges.

Perhaps most importantly it showed that the legal/professional environment within which physicians must operate makes it impossible for them to safely embrace the approach of giving patients carte blanche to choose how and when they want to have a video visit, for example, with their doctor. Physicians can do more to find out how their patients would like to interact but ultimately they have an obligation to maintain a standard of practice or be at risk for professional consequences.

As Daniel Boivin, a general counsel for CMPA, said during question period, physicians have no obligation to take telephone calls or have or video visits with patients who are in public places or running errands because they need to be sure they are protecting that patient’s privacy and confidentiality.

Similarly, despite the constant drive for national licensure of physicians in Canada, Dr. Heidi Oetter, registrar of the College of Physicians and Surgeons of B.C. made it clear provinces still call the shots when it comes to licensure and physicians must be sure they are abiding by the rules if they provide care virtually to patients in other jurisdictions.

And despite the oft-repeated statement about how quickly systems adapted to paying physicians to provide virtual care, the simmering undercurrent of discontent among Ontario physicians suggests this is not all sweetness and light.

Dr. Oetter also raised the hugely important issue about the need to appropriately educate medical students about how to provide care in virtual environments in a safe and effective manner. The Virtual Care Task Force report released by @CMA_Docs, @Royal_College and @FamPhysCan has a large and under-appreciated section on just this topic.

Many other interesting facets of the virtual care situation and positive aspects were raised by Blackmore and the panel – far too many to reference here.

What comes most to mind to me when listening to the CMPA discussion is the perspective of Dr. Jeffrey Braithwaite (@Jbraithwaite1), director at the Australian Institute of Health Innovation and a global expert in quality care, who has noted just how hard it is implement changes into the health care system with the intent of improving the quality of care.

To quote a recent essay by Braithwaite: “Healthcare is a complex adaptive system … and cannot be completely understood by simply knowing about the individual components… When advocates for improvement seek to implement change (e.g. with virtual care) , health systems do not react predictably.”

Virtual care may be with us to stay now in all its manifestations from phone calls to video visits to remote home monitoring but it is far too early to predict the myriad ways this is likely to transform care in Canada.

The future for virtual care might be bright but whether that is the gleam of improved efficiency and well-being or glare from exploded expectations remains very much to be seen.

(Image courtesy of VSP Visioncare)

 

 

 

 

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