Issue 4: December 2022
Message from the Registrar
Virtual Care Must Not Compromise the Standard of Care
The decision by a physician to provide virtual care requires an exercise of professional judgement considering the circumstances and condition of the patient. Virtual care must not compromise the standard of care.
Virtual care was ramped up quickly to provide access to care at the onset of the COVID-19 pandemic. Over the course of only a few years, it has now become a fixture in our province. While the availability of virtual care plays an important role in providing access to care, particularly for those on the Need a Family Practice Registry, there have been a number of unforeseen consequences.
There is public unrest. Complaints from patients regarding their virtual appointment bookings are on the rise. Most commonly, appointment times are missed by physicians, and no follow-up is undertaken to rebook the appointment. In some instances, virtual appointments experience technical difficulties, calls are dropped and then not reconnected. We also hear from patients who want to be seen in person but are offered a virtual appointment only or have been provided with a referral to a specialist located hundreds of miles away in the province.
Concerns are mounting from within the profession as well. Some common narratives are emerging. Emergency medicine physicians working in strained departments are exasperated at the number of patients referred to the emergency department as a result of a virtual consultation but with no urgent or emergent issue. Family doctors have raised alarm bells regarding no follow-up from virtual care consultations as well as no process in place to see patients in person when appropriate.
The decision by a physician to provide virtual care requires an exercise of professional judgement, which must appreciate the circumstances and condition of the patient. Virtual care must not compromise the standard of care.
In light of the growing tensions associated with virtual care, physicians are encouraged to review the provisions of the College’s Professional Standard Regarding Virtual Care.
Highlights from the College’s standard include:
When arranging their clinical schedules, physicians must:
- offer virtual care to patients only in conjunction with in-person care, not as an absolute alternative to in-person care;
- coordinate their clinical schedules so that patients have reasonable access to either in-person care or virtual care as required;
When offering or providing virtual care to patients, physicians must:
- apply professional judgment to determine if, when, and how to use virtual care;
- provide virtual care with the informed consent of the patient;
When virtual care identifies the need for an in-person assessment:
- if the physician determines that an in-person assessment is required, the physician must schedule an in-person assessment as soon as the patient’s presentation requires; and
- if the physician determines that the patient needs to be seen in-person by another physician or discipline, the physician must advise the patient, direct the patient accordingly and document their reasoning.