Province urges doctors to return to in-person patient care

The province is urging doctors to go back to their offices and invite patients to see them in person given the protections now in place against COVID-19.

B.C. health officials want to avoid crowding emergency rooms with people who are unable to see their family doctors face to face.

In a letter dated Sept. 3, top provincial health officials urged physicians to restart in-person visits where appropriate, noting masks and broad-based vaccinations make it safe to move forward.

The letter also warns the pay system for virtual visits is under review.

While many doctors' offices have already made the switch, some physicians are hesitant because they fear seating patients in their ill-equipped waiting rooms could spread the virus.

The letter — signed by Provincial Health Officer Dr. Bonnie Henry, Assistant Deputy Health Minister Ted Patterson, and the CEO of the College of Physicians and Surgeons of B.C. Heidi Oetter — makes the provincial stance clear.

The letter acknowledges that virtual care was important over the past 17 months, but says that COVID-19 management is at a new stage.

The novel coronavirus is now considered a vaccine-preventable virus that Canadians will be living with into the future.

The letter says: "Given broad vaccination coverage, COVID-19 should no longer pose a barrier to in-person practice …[such as] assessments and preventative health measures, such as Pap tests and childhood immunizations.

"We expect all practitioners to resume routine in-person visits" given "there is strong evidence of ... protection from COVID-19, including against all variants currently circulating in B.C."

Dr. Matthew Chow, president of Doctors of B.C., says the vast majority of physicians have returned to in-person care or a hybrid of in-person care and virtual care.

It's only a small minority of doctors who have not returned to any physical care whatsoever — and who are the primary target of the letter.

"This guideline, this directive, is directed primarily at them. It is a reminder to medical doctors that  ... a very important part of our toolbox is face-to-face care, providing physical examinations, physical treatments, physical preventative measures and this needs to continue," Chow said. 

Chow says the ability to provide in-person care has improved considerably from the start of the pandemic when little was known about how the virus spread. 

"Over time, the pandemic situation has changed. We have a better understanding of how COVID-19 works. We have protective measures in place and, in fact, 97 per cent of doctors are fully vaccinated," Chow said. 

"It's safe to do [in-person care] with proper infection control guidelines and precautions in place."

Virtual care a useful tool

Despite this, family doctor Dr. Manya Sadouski says virtual care, such as phone calls and online video chats, remain a useful part of health care and shouldn't be abandoned.

"We're seeing cases and hospitalizations surging. Not to mention that an incredibly important part of our population cannot be vaccinated yet," said Sadouski, who practices on Salt Spring Island. "It's dangerous."

Sadouski says doctors need the tools to properly triage patients and revamp offices so they are safer, allowing more space between people. She says the current safety plan the province advocates ignores how easily the delta variant can spread.

"What am I as a physician supposed to do in a context where I understand I am supposed to act in the best interests of my patients to keep them safe while they're getting medical care? Shrug my shoulders and just let it burn through my waiting room?"

Sadouski believes this push for a return to in-person visits puts children who cannot be vaccinated at particular risk.

While the provincial directive letter congratulates doctors for embracing virtual care when there was no choice, it says the pandemic reinforced the importance of in-person care, especially for remote and Indigenous communities. 

The letter also says that the temporary adjustments to the pay schedule approved during the pandemic for virtual visits is now under review by the ministry to determine what's appropriate for virtual care.