Patients frustrated, concerned as some Ontario doctors slow to return to in-person appointments

Michelle Sadowski says she's fed up talking to her one-year-old son's pediatrician over the phone about his persistent cough and cold symptoms.

Because of COVID-19 restrictions at the clinic, they've not been allowed to see his doctor in-person for months aside from a routine wellness check, said Sadowski, a fully vaccinated Toronto resident who works from home. She's been told it's too risky if her son Avery has symptoms.

After half a dozen phone-call appointments, she ended up taking him to St. Joseph's Health Centre's kids clinic at the end of July.  After a two-hour wait there, doctors did a full examination and determined he had a double ear infection.

One side had become severely infected, she said, something that could've been avoided had his doctor seen him weeks earlier.

"As a first time mom, it's absolutely terrifying to know that if my kid is sick, he can't go and see his own doctor," said Sadowski.

"And its very frustrating because now everyone is being funnelled to St. Joe's and lined up down the stairs and out the door of the hospital." 

Most recently, Avery was misdiagnosed with croup cough — when a doctor at the clinic happened to hear him cough through a nearby baby monitor over the phone, she said. That led to another trip to St. Joe's for a physical examination and the doctor there said that wasn't the case, but wasn't sure what was causing his symptoms.

The clinic at St. Joe's has been busy lately and is back to pre-pandemic levels, said Unity Health spokesperson Jennifer Stranges. One reason is because doctors there see children with fevers, runny noses and coughs in person.

"We encourage patients to contact their child's primary care provider to see if the issue can be addressed in-person or virtually by the health-care provider who knows them best," Stranges said. 

Even after antibiotics for the ear infection, taking a puffer and allergy medication,sleeping with a humidifier and testing negative for COVID-19, Avery is still "non-stop sick" and has yet to be seen in-person by his doctor to find out if something else is going on, said Sadowski.

"Now it's an ongoing problem that, for me, feels like it's never going to end," she said.

Regulators receiving complaints

Ontario's Patient Ombudsman and College of Physicians and Surgeons both said they've recently received complaints from patients in similar situations. 

The college says while some physicians are striking the right balance, "unfortunately, we're increasingly hearing about physicians' offices that are not providing in-person care." 

It's resulted in emergency departments seeing a "significant increase" in the number of patients who could receive care elsewhere, the college says. And specialists are getting referrals for patients who haven't first had a physical examination to determine if they actually need to see one.

Many seniors are also still struggling to see their doctor in person, said lawyer Jane Meadus with the Advocacy Centre for the Elderly. The legal clinic in Toronto is hearing from them and their family members. 

"People are concerned things are being missed because they're not having that one-on-one," she said. "For certain, they're unhappy they haven't seen a doctor for a year and a half."

Throughout most of the pandemic, the province had recommended family doctors do appointments virtually, said Dr. Elizabeth Muggah, a family doctor in Ottawa and president of the Ontario College of Family Physicians. This summer, the guidance changed to encourage doctors to move back to office appointments if patients prefer them and to meet their clinical needs.

Doctors, who may be balancing small clinics where it's difficult to physically distance with the safety of staff and patients, are making the switch, she said. Research suggests about 50 per cent of visits are now in-person. 

"The overwhelming majority of family doctors are fully open to both types of care," she said. 

'Patients choose wisely'

For the last month, Dr. Tara Kiran with St. Michael's Hospital Academic Family Health Team has practised a "patient-led" approach at her clinic, leaving it up to patients to decide if they want to come in to see her or speak to her over the phone.

She encourages her colleagues to do the same, but has noticed some are still in a "virtual-first mentality." She said many factors are probably at play, including the size of a doctor's clinic and their personal preference. 

"For the most part, I found that patients choose wisely," Kiran said. 

Some patients who are nervous about COVID or have busy schedules stick with virtual, Kiran said. But those who experience language barriers, are consistently in poor health or want to talk about mental health conditions are eager to meet face-to-face.

And patients who are experiencing a new or worsening condition, like a possible ear infection, need to be physically examined by a doctor, she said. There's also a backlog of patients waiting for routine screening like Pap tests or who need to have their blood pressure monitored.

"Many patients are very comfortable to come in and they usually have a long list of things that we need to catch up on," she said, "so I do find my in-person clinics are busy."