After pandemic, we should keep option of seeing doctor by phone

Several people have noted how much easier it is to get medical advice now that doctors are doing consults by phone. The cause, of course, is the COVID-19 outbreak, which has made traditional office visits more hazardous for patients, physicians and clinic staff.

Not every ailment can be dealt with in this manner. Some require a physical check-up.

And there is the risk that patients might call their GP with symptoms that appear straightforward, but which mask a more serious underlying condition that only a face-to-face meeting would reveal. High blood pressure is one such disorder.

Nevertheless there are good reasons for hoping this policy becomes more than a short-term response to a (hopefully) temporary crisis.

Though estimates vary, it is generally accepted that at least 500,000 British Columbians do not have a family physician. And these numbers are unlikely to improve in the immediate future. Due to aging and burn-out, almost as many GPs are retiring as new recruits are entering the system.

Yet family doctors are the first line of defence in our health-care system. That so many of us cannot find one is unacceptable.

The previous alternative was spending hours dialling walk-in clinics looking for an opening, then waiting, possibly for days, to see someone. Now this can be done in a 10- or 15-minute phone call.

Moreover, if blood or urine tests are needed, the physician can decide that during the phone call, and you pick up your results online.

If a follow-up appointment is needed, the physician will schedule it.

Where a prescription is required, your doctor can order one, again without the need for an office visit. You simply go to the pharmacy and pick it up.

There is one administrative obstacle that fortunately is being dealt with. For the first several months of the COVID outbreak, the fee doctors could charge for a phone consultation was lower than the fee for an office visit.

There might have been two reasons. First, the Health Ministry might have feared physicians taking advantage of a much less timeconsuming procedure to ramp up their billings.

Second, the office visit fee contained a component meant to reimburse physicians for the costs of maintaining an office. But if many doctors are working at home, doesn’t it make sense to reduce the overhead portion?

The first of these objections might hold up if we had a sufficient supply of family physicians such that every patient who wished could have one. Since that isn’t the case, the likelihood of over-doctoring is near zero.

If anything, we have serious under-doctoring.

The second objection might have merit. Even so, while physicians may be working from home, most must retain an office, and pay staff to answer phone calls, send orders to laboratories, and meet patients who need face-to-face consults. Telephone medicine is not overhead-free.

The B.C. Medical Services Commission recognized these points, and as of June 1, fees for office visits and telephone consults are equal.

In one sense “telemedicine” is not new. Specialists have been able for some time to read diagnostic scans and lab results at a distance.

But what we are seeing here is genuinely new. For the first time, patients can interact with a family physician by phone and receive an entire course of treatment, including follow-ups. Office visits are still scheduled if complications arise.

This appears to be a significant improvement, which hopefully will be retained once the outbreak passes.

If this procedure is adopted, a monitoring process will be needed to see if telephone appointments achieve the same results office visits?

All of this said, we do not live in an ideal world. So long as the shortage of physicians remains, telephone medicine may well be the next best solution.