When should family physicians and psychiatrists resume face-to-face visits?

Posted on June 6, 2020 by Madalon Burnett

Summary

There are no specific guidelines on when it is safe to perform a given procedure in an asymptomatic patient during the pandemic. Most boards that provide guidelines for physicians recommend that virtual care be used if possible, and that risks and benefits for the patient be considered individually for each in-person visit. 

I.   Guidelines

  • Doctors of BC has provided a document outlining the steps that should be taken as clinics reopen to usual services (1)
    • When to provide different services depends on “your own health, risk factors and personal circumstances;  your patient’s state of readiness for virtual visits ; your supply of PPE”
  • The Canadian Medical Association (CMA) has produced a document to guide physicians in opening their practice. Whether to conduct the visit in person or to have a virtual visit is an individual decision for each patient based on (2): 
    • “Is the patient visit urgent/crucial to the patient’s health?
    • Could further delay in provision of the care result in a worse outcome for the patient? 
    • Will offering care in a community setting lessen the burden on hospital facilities, or prevent the need to access acute care in the future?
    • Are there other services developed to address medical needs that patients can be referred to? (e.g., municipal or regional child immunization clinics, COVID care clinics)”
  • College of Physicians and Surgeons Alberta also has a document to guide physicians in reopening their practice and recommends that each visit be considered on an individual basis (3)
  • College of Physicians and Surgeons Ontario has a set of guidelines on how to safely reopen services. They recommend that physicians rely on virtual care as much as possible – online care is the default if it is possible to provide safely and appropriately (4)

II.   Pap Smears

  • BC Cancer recommends against routing Pap smears at this time with the following explanation for patients (5): 
    • “A Pap test is a non-urgent, non-emergent screening test. By not visiting your health care provider, you are supporting physical distancing which will assist in efforts to minimize COVID-19 transmission in healthy people.
    • If you receive an abnormal Pap result, your follow-up procedure might be delayed. Health authorities are triaging procedures at colposcopy clinics based on the capacity of their health care facilities.”
  • If the patient has symptoms, BC Cancer recommends: “Patients with significant symptoms including post coital bleeding, persistent intermenstrual bleeding and/or a persistent vaginal discharge that cannot be explained by benign causes such as infection should have a speculum examination by someone with experience in cervical disease. Referral to a colposcopist is appropriate and may be expedited if the clinical suspicion is high. A Pap test is not required for referral.”
  • Cancer Care Ontario recommends that all routine screening tests be deferred during the pandemic (6)

III.   Psychiatric Patients

  • The Ontario Ministry of Health recommends that: “All mental health and addictions service providers in community settings are encouraged to implement a system for virtual and/or telephone delivery of services (including individual and group sessions) to replace in-person encounters, when and where possible.” (7)

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. The Doctor is In Recommendations for expanding in-person care in community-based physician practices [Internet]. 2020 [cited 2020 Jun 8]. Available from: https://www.doctorsofbc.ca/sites/default/files/recommendations_for_expanding_in-person_care_in_community_practice.pdf
  2. Re-opening your practice during COVID-19 [Internet]. Canadian Medical Association. 2020 [cited 2020 Jun 8]. Available from: https://www.cma.ca/re-opening-your-practice-during-covid-19-0#jump-2
  3. COVID-19: Reopening Practice [Internet]. 2020. Available from: http://www.cpsa.ca/wp-content/uploads/2020/05/AP_COVID-19-Reopening-Practice-V-03.pdf
  4. CPSO – COVID-19 FAQs for Physicians [Internet]. Cpso.on.ca. 2020 [cited 2020 Jun 9]. Available from: https://www.cpso.on.ca/Physicians/Your-Practice/Physician-Advisory-Services/COVID-19-FAQs-for-Physicians
  5. COVID-19 and Cancer Screening [Internet]. Bccancer.bc.ca. 2019 [cited 2020 Jun 10]. Available from: http://www.bccancer.bc.ca/screening/health-professionals/covid-19-and-cancer-screening#Cervix
  6. ‌Cancer Screening During COVID-19 [Internet]. Cancer Care Ontario. 2020 [cited 2020 Jun 8]. Available from: https://www.cancercareontario.ca/en/get-checked-cancer/screening-during-covid-19
  7. COVID-19 Guidance: Mental Health and Addictions Service Providers in Community Settings [Internet]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_MHAS_Community_guidance.pdf?fbclid=IwAR2EZ7FNIKjm4Su739GElUHRCMNUU0eLF2I-VmkL_8zoF6GXbRcdTRj-hFE

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.