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Virtual reality: one patient’s story of her virtual care experience

When Margie Catlin visited her local walk-in clinic in January 2020, she was not expecting her visit to be an introduction to virtual care. A nagging, chronic earache had prompted the visit, yet when she was brought into the exam room, there was no physician.

Instead she met a nurse practitioner, who talked through her symptoms, took her vitals and suggested an online assessment. Using a small scope equipped with a camera, the nurse took footage of the inside of Catlin’s ear, then connected virtually with a physician in another part of the province, sharing details of her symptoms and the footage she’d taken. Although earaches are not always suited to a virtual assessment, this walk-in clinic was properly equipped.

Within a half hour of the exam, Catlin was on the phone with the doctor who had studied the images. After asking a few follow-up questions, he shared the diagnosis, provided a prescription and even phoned it into a pharmacy, where it was ready to be picked up that same day.

Living in the small community of Portland Ontario, halfway between Kingston and Ottawa, Catlin says access to physicians, particularly specialists, can be a challenge and this experience opened her eyes to the benefits of virtual care. “It can save time, and take some of the burden off family practices,” she explains, adding she would use virtual care regularly if she had the option.

Catlin’s experience with virtual care is not unique. Yet after only ever seeing physicians in person, many Canadians remain unfamiliar with how virtual care works.  

To help make the transition easier, the Canadian Medical Association(CMA) recently published a virtual care guide for patients, in collaboration with the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada. By explaining the basic technology requirements, how to prepare and what to expect from a virtual visit, the guide is one way to help make patients more comfortable with virtual care options.

Although virtual care has always been useful in connecting rural patients with physicians outside their immediate area, the COVID-19 pandemic has now made it clear that virtual care is also a safer option when there is a need for social distancing. Many physicians are now using texts, emails, telephone calls and video visits as ways to connect with patients and provide treatment in situations where the use of these technologies does not compromise their care.  

What can be safely assessed and treated virtually? *

Physicians follow a basic principle for virtual visits — a physician must not compromise the standard of care. If a patient seen virtually provides a history that requires an in-person examination, the physician must redirect the patient for one.

Conditions amenable to virtual care:
  • mental health issues
  • skin problems
  • urinary and sinus infections
  • sexual health care
  • conditions monitored with home devices and/or lab tests
  • conditions that don’t require palpation (using hands to check the body) or auscultation (using a stethoscope or other tool to listen to sounds from the heart, lungs or other organ)
Conditions not amenable to virtual care:
  • Chest pain
  • Shortness of breath
  • Loss of neurologic function
  • Ear pain
  • Cough
  • Abdominal symptoms
  • Musculoskeletal injuries
  • Congestive heart failure

Note: Physical examinations can be waived if they do not serve the patient’s best interests, such as during contagious disease outbreaks.

*As outlined in The Virtual Care Playbook

This shift to virtual care, brought on by the pandemic, has also highlighted the need for better connectivity across Canada, particularly in rural communities where Internet service is slow or unavailable. As part of its pre-budget submission to the federal government, the CMA is calling on the federal government to boost broadband access across the country, to ensure virtual care is accessible to everyone.  

For Margie Catlin, that first introduction to virtual care smoothed the way for further virtual encounters, which have all been positive.

“If you give it a shot,” says Catlin, “you may find that the outcome is positive.”

The success of virtual care doesn’t just happen; there needs to be plan for how to access and deliver it effectively. The CMA is also calling on the government to make virtual care a common feature in our national healthcare system and is outlining the steps needed to ensure its success. Digi-health teaching tools, for example, are pivotal to building virtual care literacy — to help understand what Canadians know, and what they need to learn.