Risk-benefit analysis can help physicians determine if standard of care can be met in a virtual encounter
As restrictions on in-person interactions ease, and patients and physicians try to find new footing in a post-pandemic world, a new draft policy specifically providing guidance on virtual care is ready for consultation.
During a time of extreme uncertainty, virtual care played an important role in maintaining a connection between patients and their doctor, and improving access to care. But not all conditions can be treated virtually and not everyone has equal access to or is comfortable using technology, states the Virtual Care draft policy which is now out for consultation.
“Generally, virtual care is not meant to replace, but to complement in-person care as there are limits to what can be done virtually and there are some patients that cannot be appropriately treated virtually,” said Dr. Sarah Reid, an Ottawa pediatric emergency physician who sees some patients virtually.
Depending on the nature of the practice, meeting the standard of care will likely require physicians to practise in a manner that includes a mix of both in-person and virtual care or having coverage arrangements that allow patients to have timely access to in-person care, when necessary.
“Any physician who wished to have a fully virtual practice would likely be very limited in scope regarding the type of care that can be provided,” said Dr. Reid, who is on the Policy Working Group of the College.
While the draft does not specify the circumstances where virtual care would or would not be appropriate, it does make clear the standard of care must be maintained and sets out a number of factors to assist in making that decision.
The standard of care is always context-specific with a number of factors determining what the standard is in each instance and whether it can be met with a virtual encounter. Considerations for virtual care include the patient’s presenting complaint and health care needs, their specific circumstances (e.g., access to in-person care), the technology used to facilitate the encounter, the ability to obtain the information needed to appropriately diagnose and treat the patient, and the risks associated with in-person care.
A risk-benefit analysis can help physicians determine whether the standard of care can be met with a virtual encounter.
Dr. Reid says that she will arrange in-person care if a test is required in order to make a diagnosis, if an in-person physical examination is needed in order to assess the patient’s condition or if a full assessment needs to be done prior to making a specialist referral.
The pandemic has created significant access to virtual care and many patients have enjoyed that access and the convenience it affords. But the draft policy is clear that patient preferences are just one part of the analysis physicians need to undertake. Physicians are ultimately responsible for determining the appropriateness of providing virtual care in the circumstances and ensure that providing care this way is in the patient’s best interest.
The bottom line, says Dr. Reid, is that regardless of whether care is provided in-person or virtually, the standard of care must always be met. Physicians must continue to provide a comprehensive assessment, diagnosis, and treatment plan in virtual care as would be required in those instances they are seeing patients in person.
4 things to know about the draft policy
- Physicians must be mindful of the limitations of virtual care and take appropriate action if, during the course of a virtual encounter, it is determined a patient requires in-person care.
- Physicians must only provide virtual care if it is in the patient’s best interest to do so (i.e., where quality of care is not compromised or the potential benefits outweigh the risks).
- When providing virtual care, physicians must continue to meet the standard of care, and the existing legal and professional obligations that apply to care that is provided in person, including those pertaining to prescribing drugs, medical recording-keeping, protecting personal health information, consent to treatment and continuity of care.
- Physicians must use technology that fits the purpose and can facilitate a quality encounter.