By Darren Lum
Many doctors in Ontario are seeing lower volume of patients in their offices as concerns over contracting the COVID-19 virus grow.
To address this issue and to expand access to medical expertise the website Dial-a-Doc was formed which provides consultations over the phone.
The website is the brainchild of Toronto-based doctors Dr. Mark Auspitz and Dr. Thomas Debssou of the Watson Medical Clinic.
“We get a list of patients and we disperse them among some other clinics so that they can stay in service because a lot of everyone’s [patient] volume [has gone] down a lot now” Auspitz said.
Dial-a-Doc has connected with more than 7000 people since the website was created on March 18.
Patients are from communities all over Ontario including rural communities such as Sioux Lookout Kenora Thunder Bay Sault Ste Marie and Wellington.
Dial-a-Doc helps people stay in their homes and avoid using the emergency departments.
Originally the service began as a way to benefit Auspitz’s patients and staff who he didn’t want to lay-off due to the approximately 50 per cent reduction in patient hour care.
“We started this service to [provide] an alternative for people to come to the clinic and also our volume decreased a lot because a lot of people didn’t want face-to-face care. We started mainly to support our clinic” he said.
Dial-a-Doc is free and covered by OHIP. No registration is required. Patients are not asked for personal health information from Dial-a-Doc. All a person has to do is provide a phone number.
Once a patient submits a request they can expect a call from a doctor within 24 hours.
Dr. Norm Bottum of the Haliburton Highlands Family Health Team said phone consultations are not a new concept and are already provided by him and his colleagues.
During phone calls with patients Bottum said either a nurse or a doctor will determine a course of action based on if a phone consult is enough or if an in-person meeting is required.
Like other doctors Bottum said he has seen fewer patients in-person and fewer overall.
His phone calls with patients are about double that of his in-person consultations on an average day in the office.
Bottum said his patients appreciated phone consultations even before the pandemic.
“Patients like it. They don’t have to leave their home and a lot liked it before this COVID-19 thing because in general a lot of patients don’t like to take the time out to go see a doctor. They just want to deal with it by phone” he said.
Unlike some doctors in other places who are compensated per patient visit he said his compensation is based on the payment system known as capitation. Bottum gets paid a fixed fee per person per year regardless of how often that person comes in.
Phone appointments are an important source of revenue for doctors who are compensated per patient.
“Some of them are looking for different revenue streams and one of those revenue streams could be phone appointments” he said.
For doctors like him there is a financial incentive to provide additional care to the patients by offering other medical services such as house calls hospital work and after hour services.
Bottum noted there are new COVID-19 safety measures at his office.
“We’re not using our waiting room anymore. So patients that come for an appointment they’ll come and get screened at the door and they may be asked to go back and wait in their car until we have a room available to them and a nurse will actually text them on their phone or call them” he said.
The message he has for the public is to not ignore any health issues because of fears of contracting COVID-19.
“I had a patient who decided to stay at home with chest pains. Well we found out about it and got her down to Peterborough to see a cardiologist. Another fellow had jaundice – when your skin turns yellow. It’s usually a sign of liver disease and he’d been home for a week but he didn’t want to risk COVID. We don’t want people to risk other significant health problems trying to avoid COVID. We’re trying to do everything we can to protect people if they come to our office the Minden office the Haliburton emerg the Minden emerg. We’re trying to do everything we can to minimize the risk to people to get health services” he said.
Bottum said the Dial-a-Doc service can be helpful for people in the Highlands under certain circumstances.
“If you don’t have a family physician this may be an option for you. It’s not ideal but it’s better than nothing and it may avoid a trip to the emergency department” he said.
Auspitz said his service is best for those who don’t already have a family doctor or who cannot reach that doctor.
“Really if the family doctor is available that should always be the first place they call” he said. “Having said that most of the people who call us they either don’t have a family doctor so they don’t have anyone who manages them and a lot of people for whatever reason can’t reach their family doctor clinic at this time.”
Among the challenges facing Auspitz and clinics like his he said is not just the loss of revenue from fewer patient visits but the competition posed by private clinics which represent a movement to a two-tier system.
He said he doesn’t have a problem with people who knowingly choose a company that connects people with doctors over the phone for a fee. His concern is for those who don’t know what they’re paying for once the government stops covering it.
Since March 14 the Ontario government has been covering medical phone consultations.
Auspitz said once the health crisis is over provincial coverage will end and if people want to continue with a private company they may be surprised when they receive the bill.
Auspitz said his website isn’t about profits and he expects to shut it down when the health crisis is over.
“I don’t think we’re unique by any means. I think everyone is trying to do what they can right now” he said. “Unfortunately with the economy and everything that is going wrong and people getting laid off it’s [about feeling] like you’re able to provide some value. We get a lot of pride from that.”
Anyone interested in accessing the website can visit www.dialadoc.ca.