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Issue 4: December, 2021

Managing Unvaccinated Patients – A Message from Doctors Nova Scotia

Yesterday, the CBC published a news story about a family physician in Ontario who is choosing to leave practice after allegations that she denied care to unvaccinated patients made her the centre of a storm of social media abuse.

The physician denied the allegations and provided examples of how she has been accommodating unvaccinated patients; the College of Physicians and Surgeons of Ontario declined to open an investigation into her practice. However, the experience has caused the physician to decide to close her practice.

The COVID-19 pandemic has created an environment where people are feeling strongly about their right to choose whether they are vaccinated or not. There is a great deal of mistrust and misinformation in this digital age, and emotions are running high.

I recognize that family physicians and pediatricians in this province are grappling with a set of patients who may be challenging to manage. Physicians in different areas of the province have called me looking for guidance on a variety of vaccination-related processes, guidelines and information. I’ve rounded up some information that I hope will be helpful to you.

Develop Messaging for Administrative Staff
Everyone is doing the best they can, but there is so lots of information to convey. Providing staff with a script to manage conversations with unvaccinated patients will be helpful to ensure your staff members are conveying appropriate information.

Screening
Ask your patients COVID-19 screening questions, such as:

  • are they experiencing COVID-19 symptoms
  • are they awaiting test results
  • have they recently travelled outside of Nova Scotia
  • have they been in contact with someone known to have COVID-19

Screening patients in advance will help your practice determine how to provide care for an unvaccinated patient and how to receive them when they arrive for their appointment.

Schedule with Care
If a virtual care appointment is not appropriate for an unvaccinated patient, consider scheduling them at the end of the day, when they are less likely to meet other patients. Consider home visits for immunocompromised patients. If you have a large volume of unvaccinated patients, consider booking them together in a block. If you are concerned that the patient may have COVID-19, follow Infection Prevention and Control Protocols and use PPE.

Virtual Care
Virtual care can be offered to complement in-person primary care services.

Personal Protective Equipment

Ensure you and your office staff have access to personal protective equipment (PPE) to protect yourselves from possible exposure. The government’s offer of free PPE for community-based physicians has been extended until March 31, 2022. Log in to your Shopify account to ensure your practice profile is up to date. Keeping this information accurate is critical for the appropriate allocation of PPE. Community physicians can click here to submit a request to the Department of Health and Wellness for additional PPE supplies; either update a previous request or make a new one. Your organization will be notified by email of the approved supply and instructions for online ordering. For more information, email PPErequest@novascotia.ca.

COVID-19 Testing
If you decide COVID-19 testing should be conducted, refer the patient to do an online self-assessment and/or book a COVID-19 test. Patients can also contact 811 to book a COVID-19 test. Physicians may still see patients who are awaiting a COVID-19 test appointment or test result; follow Infection Prevention and Control Protocols and use PPE.

COVID-19 Vaccination: Children aged Five to 11
Nova Scotians five years of age and older may now be booked for COVID-19 vaccine appointments. Pfizer is approved for children five to 11. The National Advisory Committee on Immunization recommends eight weeks between first and second doses of the COVID-19 vaccine.

Children who receive both doses before they are 12 will receive two doses of COVID-19 vaccine for children 5 to 11. Children who receive their first dose before they are 12 and their second dose when they are 12 will receive one dose of COVID-19 vaccine for children five to 11 and one dose of COVID-19 vaccine for children 12 or older.

Children aged five to 11 cannot get other vaccinations at the same time as their first or second dose of the COVID-19 vaccine. They need to get other vaccines at least 14 days before or after the COVID-19 vaccine.

All COVID-19 vaccination appointments (for children five to 11 years old and for those eligible for an additional dose or booster dose) must be made online or by phone at 1-833-797-7772.

Template Letter: Medical Exemptions for Nova Scotia’s Proof of Vaccine Policy
As communicated on Sept. 2, Dr. Robert Strang, Chief Medical Officer of Health, provided information on valid medical exemptions for Nova Scotia’s Proof of Vaccine Policy. A letter template has been provided for physicians to use when they need to certify that a patient meets the criteria for a medical exemption from COVID-19 vaccination. Individuals claiming a medical exemption to COVID-19 vaccination will be required to have a copy of this letter template completed with their details.

Read Dr. Strang’s memo

Guidelines Regarding Medical Exemptions
The College of Physicians and Surgeons of Nova Scotia has prepared Guidance to Physicians Regarding Medical Exemptions for COVID-19 Vaccinations for all physicians. Physicians must only support requests for a medical exemption from COVID-19 vaccination for patients with a legitimate medical condition that would warrant an exemption; only a handful of conditions qualify. This guidance was developed in conjunction with the Chief Medical Officer of Health.

Adverse Events Following Immunization Reporting
Following immunization, all healthcare providers are required by law to report adverse events by completing and sending the Adverse Events Following Immunization (AEFI) form to Public Health. To determine if an AFEI form is required, consult your local Public Health office.

Learn more

Resources

DNS is here to help
If you need more information or would like support, please contact your Physician Advisor:

Jennifer Girard
Physician advisor (Zones 1-Western and 4-Central)
902-481-4912
1-800-563-3427 ext. 4912
jennifer.girard@doctorsns.com

Ryan Brown
Physician advisor (Zones 2-Northern and 3-Eastern)
902-481-7016
ryan.brown@doctorsns.com

Kim Oakley
Senior physician advisor and compensation manager
902-481-4924
1-800-563-3427 ext. 4924
kim.oakley@doctorsns.com

Thank you for all your efforts throughout the pandemic. These have been incredibly trying times and I am so proud of the way physicians have stepped up to care for their patients and their communities.

Sincerely,

Heather Johnson, MD, CCFP
President, Doctors Nova Scotia

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