The Chronicle Herald (Provincial)
Doctor worries child abuse cases are being missed during pandemic
While a phone conversation with your doctor can be fine for diagnosing and treating many conditions, there are worries that some problems such as child abuse are falling through the cracks.
The province of Nova Scotia and its doctors reached an agreement early on in the COVID-19 pandemic that made it easier to bill for virtual health-care appointments such as the telephone and videoconferencing.
“That may be a barrier to picking up more subtle signs of child abuse that you might only pick up if you were doing a physical assessment,” said Dr. Amy Ornstein, a pediatrician with the IWK Health Centre's START team, which stands for Suspected Trauma and Abuse Response Team.
On top of that, emergency rooms and doctors' offices are eerily quiet these days as people stay away from public spaces for fear of contracting COVID-19.
“The volumes in our emergency departments are way down and so I think just overall there's a hesitancy to come into hospital for a concern that you may have,” said Ornstein, who also heads Dalhousie University's general pediatrics department.
“You may have just popped in the car three months ago and so I worry there may be some families out there that may have a worry about their child and or an incident say, for example, and they're not presenting to hospital.”
There hasn't been a noticeable drop in child abuse cases at the IWK but Ornstein said abuse reports to community services and police have plummeted up to 40 per cent in provinces such as Ontario.
Other departments at the IWK are reporting a drop in traffic during the pandemic. The endocrinology clinic, which usually handles six to eight Type 1 diabetes cases a month, hasn't seen one in six weeks.
Psychiatrists also say the move to virtual health has left them out of the loop because the pay code doesn't cover the time needed for appointments.
Ornstein said the START team handles about 250 cases a year, mainly involving sexual and physical abuse, and also children who are exposed to domestic violence.
A person talking on the telephone with their family doctor may fear raising those issues from home, Ornstein said.
“And then of course just thinking about the social distancing piece and the social isolation, we have a huge group of children right now that are not being seen and heard from people who they regularly interact with,” she said.
“So teachers, coaches, dance instructors, music instructors — all those folks that are really around and have eyes and ears on our kids — are not there anymore, at least for the time being, so that's a worry for me.”
When asked about the problem of people avoiding hospitals and doctors offices because of COVID-19 fears, Nova Scotia's chief medical officer of health said the message that the health-care system is open has been communicated to the public.
“We continue to have a health-care system in our communities, primary care is available,” said Dr. Robert Strang.
“Physicians' offices are open — much of that care is done virtually but it's still there and accessible. We've several times brought forward the message through these briefings that if people need — whether it's primary care or they need emergency care that's not COVID related — emergency rooms are open.
“If they're not sure, 811, the telehealth line, is still open. We're using it for Covid-related
(questions) but if people have questions about their health and they're not sure where to go, certainly calling 811 is there for the NONCOVID questions as well.”