Editor’s Note: The Current asked Dr. Jason Malinowski to share his thoughts on the impact of COVID-19 on health care in the Valley, and give us any good news that may have come out of this pandemic. Dr. Malinowski (above) is Chief of Staff at St. Francis Memorial Hospital (SFMH), as well as Clinical Lead Physician for the Madawaska Valley Family Health Team (MVFHT). He has provided the following review of the challenges and improvements to local health care through 2020.
Strains on healthcare workers
We faced a lot of challenges, knowing what was happening in China, Italy and New York with healthcare workers getting sick and dying while caring for their patients. Wearing my leadership hat, we had to make a lot of important decisions regarding patient flow, visitor policies, and personal protective equipment (PPE) – decisions made with insufficient, rapidly changing, and often conflicting information. The stress of not knowing how long this was going to last, and whether we would have enough PPE to safely care for patients was terrible. All the decisions at the tables I was at, were made with patient and staff safety as a prime consideration. As family physicians, we felt the stress (and still do) of not being able to care for our patients as we did before. We knew that some patients were going to forego care and possibly have bad outcomes related to waiting out the pandemic.
This past year has certainly driven a lot of innovation in health care. As family physicians, we realized that there is a certain proportion of patient encounters that do not require a physical visit to the clinic to be effective – that telephone or video visits would suffice in some cases. The government did recognize that and allowed us to be remunerated for phone visits, which they had not allowed previously. I hope they continue with that. Having said that, in some cases there is no substitute for seeing patients in person; for example, when I need to physically examine them or perform a procedure. So there’s a new wrinkle in the triaging of appointments. It is not only “How soon does this person need to be seen?” but also “Can I do this assessment remotely?” That extra triage step represented a learning curve for doctors and office staff alike. Interestingly, I find that in some cases access to specialist or tertiary care has actually improved, in that specialists are assessing patients more quickly. Many of the first assessments are done remotely – and the specialists are arranging tests or procedures in a much more deliberate and efficient way for follow-up visits.
The increase in virtual appointments has usually been found to be quite satisfactory for patients, as we know that transportation and family issues can be a significant barrier to care here in the Valley. Not having to arrange a ride, or child care, or respite care for an ill spouse for someone’s appointment has been a very welcome change for a lot of people. But some patients have struggled with not being able to “see” their doctor in as much of a timely way as they have been used to. We feel that frustration too, and I would ask that everyone be “patient” as we work out all these issues with flow and access, given the new reality.
We certainly can’t forget the implications that the pandemic has had on everyone’s mental health. We’re social animals, and being told to Socially Distance has made depression, loneliness, and other mental health issues worse, and more prevalent. We are working with patients on that front as well, and that will take a long time to address. We all just want to get together with family and friends, dance, and play sports, and have dinners. 2020 has been a social hell.
During this pandemic one of the big benefits is that we have been able to really strengthen our partnerships, and question our long-standing views and processes in health care. Now, we are meeting regularly with the Community Paramedic team. They have done an amazing job of being our mobile eyes, ears, and needles when patients have needed care that we were not able to deliver in person. In conjunction with them, the Renfrew County Virtual Triage and Assessment Centre (RCVTAC) program has been an excellent addition to the care options for patients who do not have access to a / their family doctor. As an example, when I look at the ER department data, visits solely for medication renewals have dropped off dramatically since the spring. New capacity at RCVTAC, increased access to the MVFHT, and the relaxation of pharmacists’ restrictions in extending prescriptions has played a big part in that.
Building the plane as you fly
Internally at SFMH, staff have been incredibly resilient and innovative in the face of rapid change and uncertainly. It really is like the expression “building the plane as you fly.” That phrase captures the “feelings of risk and uncertainty that accompany designing innovations and testing them in real time with actual participants, all while being responsible for keeping existing operations running.” There’s no how-to manual – and the rules are constantly changing! For instance, having to recreate a whole separate respiratory zone for screen-positive patients was an exercise in building a whole new ER from scratch. Every department contributed to its creation, weighing in with their suggestions and cautions.
Bridging gaps from one silo to another
We have been able to strengthen our ties to other partners as well, convening an initially weekly meeting with leaders from the hospital, hospice, MVFHT, home support, pharmacy, long-term care, paramedic and emergency services, and retirement home sectors. We have been able to streamline processes, break down some barriers to care, and share best practices and success stories. This part has been invaluable to me, as I have a hand in all those sectors in some way.
photo: Madawaska Valley Family Health Team