Family doctors across Ontario are rapidly transitioning to a “virtual-first” care model as a way to halt the spread of COVID-19 in their offices and waiting rooms.

Starting this week, most doctors will talk to patients on the phone, by video conference or through email as a first-step to determine who needs to come to the office for an in-person appointment.

Patients who require face-to-face care, including pregnant women, babies requiring scheduled vaccines and some seniors with chronic health conditions, will have in-person appointments. But many patients will receive virtual advice on how to care for their condition at home.

As well, some patients will be told upcoming, non-urgent appointments will be postponed for weeks or months. For example, Cancer Care Ontario on Monday advised physicians to postpone cervical cancer screening for low-risk women.

For the most part, these province-wide measures are in place to protect family doctors, nurse practitioners, office staff and patients from getting infected with COVID-19.

“We don’t want to bring healthy patients into an office where they could be potentially exposed to COVID-19 by mistake,” said Dr. David Kaplan, a family physician at North York General Hospital. “It’s part of social distancing. If you want to keep people out of communal spaces, it’s the same for keeping people out of waiting rooms. This is just another way that family doctors can help.”

Last week, the province’s Ministry of Health, after discussions with the Ontario Medical Association, announced new billing codes to allow family physicians and nurse practitioners to move to virtual care.

Pushing more routine appointments to virtual visits will help family physicians more effectively deal with the surge in patients needing treatment or advice on COVID-19. And seeing more patients virtually will help preserve face masks, disposable gowns and other protective equipment which could be in short supply as the COVID-19 pandemic progresses.

“It’s a real flip on how we offer care,” said Kaplan, an associate professor of family and community medicine at the University of Toronto. “Instead of everybody coming in physically, everybody is coming in virtually — and then you decide who really needs to come in to the office.”

Dr. Thuy-Nga (Tia) Pham, physician lead for the South East Toronto Family Health Team, said her patients are welcoming virtual care, especially with so many having questions about COVID-19. They know it keeps them safe from busy waiting rooms and they want advice from a trusted doctor who knows their history and background, she said.

Virtual care especially helps those patients who need in-person visits, often those who are vulnerable with underlying health conditions, because they will have less risk of getting COVID-19, said Pham, adding she expects to see about two-thirds of her patients virtually.

“For example, newborn babies for their well-baby visits, they will still need to be seen, to monitor their weight, for breastfeeding issues, for their regular vaccines to protect them from everything else,” said Pham, an associate professor in the University of Toronto’s Department of Family and Community Medicine. “The more we minimize traffic in times of social distancing, the better.”

Most physicians who video conference will use the secure platform approved by the Ministry of Health, which only requires a patient to have an email address and a digital device with a camera, Pham said. There’s also a secure way for doctors to email or text with patients. And for those patients without internet access or a smart phone or computer, “the good old fashioned telephone works as well,” she said.

Dr. Sohail Gandhi, a family physician in the town of Stayner, southeast of Collingwood, and president of the Ontario Medical Association, said family doctors are using a mix of tactics to deliver both virtual visits and in-person care to patients. And it’s up to individual doctors to decide which patients they see, and when and how they see them, he said.

Some will screen patients for symptoms of an upper respiratory infection or flu-like symptoms before asking them to come to the office, he said, while others are using email to communicate directly with patients about health concerns. Physicians are also asking otherwise healthy patients to postpone some already scheduled appointments, such as routine physical checkups, he said, adding patients shouldn’t be surprised if their doctor delays a visit.

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And though virtual appointments will help ease the increasing burden family doctors face as more and more patients want advice and screening on COVID-19, Gandhi wants people to know that — for now — the majority of people with flu-like symptoms will likely have Influenza B.

“That’s the virus that is going around; COVID-19 is still only affecting a very small number of people,” Gandhi said, adding people with mild symptoms should check in with their family physician or Telehealth Ontario.

“You don’t have to run to doctor’s office or the hospital right away. It’s OK to call first and get advice from your physician.”