Health team doctor explains working through COVID

During the uncertainty of the pandemic, patients of the local family health team may have wondered what to expect if they wanted to see their physician.

Dr. Steve Durocher says physicians have been working full-time all through the pandemic and available to their patients, although they have limited office visits to those requiring urgent care.

With an office in the Niagara Medical Centre, Durocher is a doctor with the Niagara North Family Health Team, which includes many Niagara-on-the-Lake residents in its roster.

Initially, Durocher says, physicians tried to avoid physical exams unless urgent. Some were working from home, some physical distancing in the office, and were offering telephone or video appointments.

“That was in early March, when there was a fear of the unknown,” he said.

From the start of the pandemic, the local health team has been following the guidelines of Niagara Public Health and the Ontario Medical Association, he said.

Although physicians continue to offer virtual appointments, as they became more comfortable with the safety precautions being taken, “we have lowered our threshold for office appointments,” he said, although physicians within the health team use their 

own discretion when deciding whether to see a patient.

There is always a physician present for urgent needs at the clinic during office hours, he says, and after-hour clinics are still operating.

There might be slight differences between the Virgil clinic and the one in the former hospital on Wellington Street, and between doctors themselves, depending on their comfort level, “but our policies are very similar.”

Initially, the number of calls to the clinic was down drastically, says Durocher.

“People might not have known their doctors were still working, or might have been afraid to seek medical advice.”

That changed to a large influx of calls, which have levelled out now, he says.

If a patient calls to make an appointment, they reach  voicemail, and are asked to leave a message. “That might leave the impression the office is closed,” he says, “but a secretary working from home will call back shortly.”

Patients are then screened over the phone, and if an office visit is arranged, when they arrive, the office door is locked, and they are asked to call a number, and are screened again before they enter.

“It’s important to let patients know we’re screening them so we know where to direct them, and so we can be prepared with the correct protective equipment.”

Patients are also asked to bring a mask with them, but if they arrive without, they are handed one and escorted to an office, says Durocher.

Appointments are spaced out so the need for waiting is reduced, and if there is a wait, patients might be asked to wait in their cars, he says.

“Appointments are organized to minimize traffic as much as possible.”

There are also waiting areas set up inside, if needed, that allow for physical distancing, he says.

With testing for COVID-19 now readily available, “there is a very low threshold for a physician to recommend testing,” which is generally accompanied by a referral to one of the assessment clinics.”

The Virgil clinic has some resources, but “definitely a low percentage” of testing is done at the clinic — most are at the assessment clinics, where local doctors also help. 

The recent months have seen an evolving process at the clinics, he says, “definitely with a high degree of uncertainty initially, but we’ve been adapting to the situation as time progresses, up to the patients’ level of comfort.”

Durocher describes the current situation as “less clinical gestalt” and more patient-centred medicine.

Advising patients by phone or video presents some limitations, he says. “There are the things we could potentially miss,” and in some cases, physical exams are offered to reassure patients and provide a level of comfort for them.

If a patient is “significantly unstable, a doctor will see them at their discretion, or send to an emergency room where they are screened, triaged, and sent to separate areas to keep everybody safe.”

Durocher says it’s important for patients to know if they have any medical issue “they should have zero hesitation to call the office, and although we are working remotely, they should leave a message. Even though our door is locked it doesn’t mean we’re not here. It’s just for safety precaution.”

Durocher says for him personally, he’s now at the point where he has the same number of “clinical encounters” as during pre-COVID times.

He’s working more hours to get less work done, he says. Screening, leaving extra time between appointments, putting on PPE and taking it off, all take a significant amount of time. 

Could some of the pandemic measures become the new norm? 

“I don’t know if they’re temporary or long term,” says Durocher. “It’s up to the Ministry of Health as to how we provide patient care.”

In the early stages of the pandemic, physicians were getting new information all the time, sometimes changing information throughout the day.

For instance, he says, he has travelled at the end of February, and when he returned, he was told medical practitioners “should consider isolating for 14 days.”

He was going to work from home, but the next day, the message was that health care practitioners should go to work and monitor their health. Shortly after that, the message changed to “you definitely need to quarantine.”

The information about COVID-19 was rapidly evolving, he says, and physicians were trying to make decisions with the best information available, but there was still much that what was unknown.

“Physicians are accustomed to having a certain comfort level with uncertainty,” he says. “Nothing is ever black or white. But there definitely was a level of fear with this that hasn’t been completely eliminated. There is still some fear, although now I’d say we are working with vigilance and diligence, as opposed to fear.”

He’s getting a lot of questions about antibodies, about testing, about how people can know if they have COVID, he says.

“There is still a lot of uncertainty, and part of being a doctor is working with uncertainty. This isn’t new, but it is more significant. We have to remain patient as new information comes forward.”

Durocher says in addition to the uncertainty, “talking into a telephone” to diagnose patients is not ideal.

“I became a doctor because I love human interaction,” he says.

“Not having that interaction can be frustrating.”

But like everyone else, “I’m adapting to the situation, making the most of it, and trying to be as readily available as possible for patients, even if virtually. I just want to be sure they are receiving the appropriate health care. And if this is the future, I’ll adapt to it.”

While the concern for frontline workers has crossed his mind, especially because of his parents, he says he thinks health care workers may actually be safer than the general public. They take extra care about distancing themselves, and he has never been without PPE or had to fear it would run out.

“I’m more concerned for the grocery store employees not having it. I think it’s more society as a whole that’s at risk. Even though I work at the clinic, I feel protected,” says Durocher.

“But when I think of the frontline workers where there wasn’t enough PPE, when I think of having to work without enough PPE, it scares the bejesus out of me. That was never the case for me personally.”

He sees a bit of relaxing now in attitudes toward the pandemic as the number of cases has decreased dramatically, and a lessening of fear. It’s helped him to “take a step back” from watching the news as much as he was, which was too much, and which became fear-provoking and overwhelming at times.

But while there may be some relaxing now, less living in fear, he says, “it’s still important to remain vigilant.”