As Ontario reopens, why are vital doctor offices still being kept closed?
Ontario businesses are now substantially reopened with detailed and up-to-date public health guidance from the provincial government, but there is one glaring exception. Ontario’s family doctors are still working under rules imposed by the government back in November, well before the province’s successful vaccination campaign and the subsequent dramatic reduction in case numbers.
It’s a situation that isn’t attracting much political or media attention, but it’s significantly limiting Ontarians’ access to vital in-person medical care. The Ontario College of Family Physicians says only about 50 per cent of the work family doctors do is in person now, compared to 95 per cent before the pandemic. Total volume of care is down, too.
No wonder, when people might reasonably think the only service available is a phone call with a doctor. Tele-medicine got a lot of attention at the beginning of the pandemic as doctors scrambled to find ways to serve patients. In fact, doctors have never stopped seeing patients in person, but this has been little publicized. With all the attention paid to hospitals and long-term care, it’s as if the doctors most of us deal with have been forgotten.
The outdated provincial guidelines have made in-person medicine a challenge.
Doctors are expected to conduct exams while maintaining at least two-metres’ distance from the patient. Exam room surfaces must be disinfected between patients, even though, as the family physicians’ college notes, there is emerging evidence that surfaces are not “a significant route for transmission.” If there is any suspicion that a patient might have been exposed to COVID, full personal protective equipment is required.
Realizing that these special precautions are time consuming, the government’s guidance says, “Primary care providers could consider providing some care virtually even if an in-person visit is needed in order to minimize the in-person time required”.
It’s difficult to square this mid-pandemic caution with the current situation. In a province of 14.5 million people, we are seeing fewer than 200 COVID cases per day, over 80 per cent of Ontarians have been vaccinated, and nearly 66 per cent have received two doses. Ontarians are the safest they have been since the start of the pandemic, but their access to regular health care remains limited
Doctors’ offices need to operate safely, just like any other kind of business, but it’s time to return to a semblance of normality to make people confident in seeking the care they require. Virtual medicine can be convenient and will have a role to play in the future, but it’s no substitute for dealing directly with a doctor.
Just who would make the decision to loosen restrictions is rather unclear, like so many things in Ontario’s multiplayer health system. One might have thought that it would be up to the provincial government, the entity that brought in the practice-restricting “guidance” in the first place. A Ministry of Health spokesperson said, however, “The ministry does not direct patient care.”
Other contenders would include the province’s chief medical officer of health, Public Health Ontario or the local medical officers of health. None of them have stepped up.
The government suggests that the Ontario College of Physicians and Surgeons might be the one to do the job. The college has issued general guidance about striking a balance between virtual and in-person medicine, as has the Ontario College of Family Physicians. Neither of those documents in any way authorizes doctors to return practice to something like normal.
It is not as if family doctors have been sitting on their hands during the pandemic. Dr. Elizabeth Muggah, president of the Ontario College of Family Physicians, points out that family doctors have been helping with COVID in hospitals, working in long-term care and assisting with vaccinations.
These are all useful things, but they become less important by the day. As Muggah says, “We have to deal with a care deficit.” People’s reluctance to seek primary care during the pandemic has created a backup in diagnoses that is preventing Ontarians from getting timely care for serious conditions.
The situation is made more complicated by the still significant number of people who have not chosen to get vaccinated. They are not only a risk to themselves but, to a small degree, a risk to other patients they might contact in a doctor’s waiting room.
Returning to regular in-person medical care means government must weigh the slight risk of disease infection in a doctor’s office against the benefits of a fully functioning primary care system. It shouldn’t be that tough a call.