Virtual care no substitute for on-site health provider

Virtual health services have been in operation in Manitoba for decades, providing patients in rural and remote communities access to professionals and specialists in larger urban centres like Winnipeg.

Platforms like Doc, Doc Inline and Maple allow residents with a valid Manitoba Health card to connect with local or Canadian-licensed doctors through secure video, phone or text for non-emergency medical concerns.

And through the provincially run MBTelehealth sites, patients can access secure videoconferencing for medical appointments, family visits and health services across nearly 200 dedicated Telehealth sites across Manitoba.

And there are still other specialized virtual clinics through the Rapid Access to Addictions Medicine Digital Front Door service, therapy and followup sessions for mental health and psychiatry, and other specialty care platforms.

In short, the model has been working well enough that it has become a stable part of rural Manitoba’s medical practice. While this form of virtual care has been in use for years, virtual medical practice has not been extended to faltering provincial emergency rooms. Until now.

In mid-October, the Winnipeg Regional Health Authority sent a memo to emergency department staff saying discussions were being had about virtual care models in emergency departments, but that these discussions were “informal and exploratory,” and that no commitments have been made.

The point of considering virtual care was to reduce wait times in city emergency rooms. While the memo stated, according to a CBC report, that any further approach toward implementation would be informed by “further engagement” with emergency department staff, it prompted more than 60 emergency care doctors to pen a letter to Health Minister Uzoma Asagwara calling on the province to pause on any such implementation.

The letter called for an urgent meeting with the minister, and for emergency care doctors and nurses to review the proposed model, identify concerns and develop alternatives before the idea went any further.

In spite of the health minister’s assurances that the province was still in the consultation phase and that no decisions had been made, it didn’t stop the province from setting up a virtual pilot program in Ste. Rose du Lac, which has been struggling with a chronic physician shortage and an increase in patients over the last several months.

According to the CBC, staff members have been under more pressure since the Dauphin hospital was forced to close down last summer, after the building flooded and area patients started driving to the Ste. Rose ER instead.

The facility needed a “more immediate … solution,” Asagwara said. “This is something that was actually brought forward by doctors themselves. They made clear to us that they needed more support.”

Under the program, a nurse would triage a patient in the emergency room, and a doctor would then join online afterward, with a health-care provider remaining in the room so patients aren’t alone.

The virtual physician would be able to order tests, review results and recommend treatment, according to the CBC article. The system would work best for patients who are not in serious condition, and who would be able to wait to be seen.

But the province’s efforts have taken significant criticism, particularly from the Society of Rural Physicians of Canada. Society president Dr. Sarah Giles said the province was looking to implement a different standard of care “based on people’s postal code.”

“It’s really hard to do life-saving manoeuvres when … you don’t have the skilled hands that can perform them,” she told CBC.

In medical emergencies, she said that some procedures can only be done by a doctor, and if there is no local doctor on call to perform these procedures, it can put the patient’s life at risk.

Giving doctors such an option could also undermine efforts by regional health authorities to bring physicians to rural communities in person.

And on Thursday, Manitoba pharmacists questioned why the province seems more likely to adopt virtual care for emergency departments than expanding their scope of practice to treat ailments like strep throat.

“It is perplexing that the health-care system is under so much strain that the government is considering virtual care in emergency rooms, yet hasn’t expanded the pharmacists’ scope of practice to allow them to help alleviate some of that pressure now,” Pharmacists Manitoba president Gayle Romanetz said in a press release Thursday.

The fact is that there is no substitute for on-the-ground, in-person medical care from an experienced physician when it comes to a true emergency. Virtual care cannot treat a broken arm or a deal with a patient with heart failure.

But it’s also true that successive governments — both NDP and Progressive Conservative — have been unable to solve the problem of chronic staff shortages of medical staff in rural and northern Manitoba, and there is a need for alternative methods of care.

The sad reality is that as the years drag on — and rural depopulation continues — Manitobans living outside urban centres like Winnipeg and even Brandon already have a lower level of care compared to their urban counterparts. And that’s based solely on how long it takes an ambulance to take them from their home to a still-operating rural ER.

All things considered, dismissing virtual emergency care outright is a luxury rural Manitoba simply cannot afford. When the choice is between seeing a doctor on a screen or driving an extra hour to the next town over, a virtual triage system has clear value for non-life-threatening cases.

Nevertheless, Giles and her colleagues are right to sound the alarm.

Virtual care must be treated as a pressure valve — alongside practical steps like expanding pharmacists’ scope of practice — and never as an excuse for the province to stop fighting for permanent, in-person doctors in rural communities.