Family doctors put on notice: it’s time for them to see symptomatic patients in person again

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MONTREAL — Quebec’s health ministry has informed the province’s network of family medicine groups (FMG) it’s time for them “to move towards a new normal now,” and start seeing more and more patients in person who have a variety of symptoms, including COVID-19 symptoms.

The goal is to relieve pressure on overburdened hospital emergency rooms by restoring front-line care to the way it was pre-pandemic.

"We've asked generalists to take on more patients, even those who have certain COVID-19 symptoms," said Health Minister Christian Dube in a news conference Friday.

Some specific examples of symptoms a patient can present with were provided in a letter sent to clinic directors, and include a runny nose, earache, nausea or vomiting.

In the document obtained by CTV News and dated July 13, assistant deputy minister Dr. Lucie Opatrny wrote in French, “several sites [emergency rooms] have a rupture in services or are on the brink,” and “the contribution of the FMG are essential,” to respond to the needs of the population.

She said Quebecers require more health services now than they usually do during the summer months, due to the pandemic.

Health Ministry spokesperson Marie-Louise Harvey told CTV News, as the letter also explained, that “it’s safe to resume front-line activities,” because vaccination rates among health care workers and the population have progressed, and because the circulation of the virus is low.

Doctors working the FMG will be expected to reduce the number of teleconsultations they have, while maintaining a risk-management strategy.

If, following an evaluation, a person has obvious COVID-19 symptoms they can still be referred in the short-term to a designated evaluation clinic (CDE), a ‘hot’ clinic.

However the government has already started shutting down those evaluation clinics and plans to close them all by Sept. 6, which means that FMG will need to be fully operational by then and ready to see patients no matter what their complaint.

DOCTORS REACT

After more than a year working in a very different way, getting back to normal doesn’t feel very normal, said Dr. Barry Slapcoff, an assistant professor in the department of family medicine at McGill University who works at two west-end FMG.

“The truth is we all have this ambivalence now, we're all struggling with it.” But, he quickly adds that he doesn’t see it as a bad decision. “There's no doubt that having more time available in the urgent care clinics will lessen the load somewhat for the emergency rooms. We're all part of the same system, we all have to play our roles."

Slapcoff said there’s no doubt that urgent care family doctors want to fulfill their responsibilities. “They just want to do it safely,” he said.

As long as the health ministry remains flexible and responds to any uptick in COVID-19 cases in the fall, for example --even reverses course if needed, then, the GP said, he's comfortable with the plan moving forward.

“It's really about the patients, the administrative staff, and the nurses who have less power as employees of these places. They’re the ones who are just as frontline as we are...and they need to be protected," he said.

Dr. Mark Roper, head of the Queen Elizabeth FMG, said they plan to keep the telemedicine system functioning since it makes sense in some cases “but a minority of cases. In the majority we still need to examine the patients,” he explained.

He agrees with the health ministry’s rationale that now that “people are doubly vaccinated, patients and doctors and staff, the risk of bringing in patients is much less,” he said.

They will still use proper protective equipment in the clinics like gloves and masks, and patients will still enter and exit in a controlled and distanced manner, “because some people aren’t vaccinated yet and some may carry the virus,” said Roper.

He points out that while vaccines are highly effective, they’re not foolproof, and they want to prevent even the mildest of cases from being spread in their healthcare setting.

CLINIC HOURS

Opatrny’s letter to the family medicine groups made it clear they will now also have to go back and maintain the established hours of operation.

Some of the FMG did restructure their hours of operation and saw fewer patients in person during the pandemic because “we weren’t seeing people with fever,” Slapcoff said, “and people had to be physically distant.”

He noted people were also afraid to go sit in a waiting room at an urgent-care clinic, “so there wasn’t a need to have as many urgent care hours available.”

Roper, who is also Chief of the Division of Primary care at the MUHC said he hears the ministry's message loud and clear: “now you have to see more patients because they’re clogging up the emerg."

Given the dramatic improvements all along the COVID-19 spectrum, Roper concluded that seeing more symptomatic patients now is "a logical progression.”

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