What Dr. L. Fourie Smith remembers most is how apologetic his patient was when he finally arrived at Dakota Medical Centre earlier this week.
The man, a lifelong smoker, was complaining of chest pains and shortness of breath. He said he hadn’t gone to the clinic earlier because he was quite sure he didn’t have COVID-19 and everyone had warned him to stay at home unless he had symptoms related to that specific virus.
However, a closer examination and chest X-ray revealed the man was suffering from a fairly serious pneumonia. Fortunately, they caught it in time — but only just.
"That patient, a couple of days from now, is likely in hospital, probably in an intensive care unit," said Smith, president of Doctors Manitoba. "The worst-case scenario is that he loses his life. The best-case scenario is that he survives but we’ve used up all these resources we’ll need for the pandemic that is headed our way."
Smith said provincewide, doctors are reporting a drastic reduction in the number of patients visiting family physicians and walk-in clinics. Doctors Manitoba has confirmed some physicians are laying off staff at their clinics because so few people are keeping their regular appointments.
And that has caused a new concern: that patients with chronic health problems are forgoing normal medical attention to avoid any contact with COVID-19.
"We’ve all been told to avoid each other as much as possible and to keep your social distancing, which is all quite appropriate," Smith said. "But what we maybe haven’t done is remind Manitobans that most clinics remain open and they should not stop getting treatment for their medical conditions. Doctors are not running for cover right now. We are still here for you."
A number of factors could be convincing patients to stay at home even when they are having trouble with new or chronic medical conditions. In some instances, it could be a fear that they are more likely to come into contact with someone infected with COVID-19 if they visit their doctor’s office. Or, that doctors are so busy with COVID-19 cases that they do not have time to care for patients with chronic health problems.
It’s not hard to see how those assumptions could be made. The talk-track from the province, reinforced by all public education materials and the daily COVID-19 briefing from public health officials, is to refrain from needless or baseless visits to doctors and hospitals. An early concern when the virus first hit was that panic could lead to hospitals in particular being overrun by people who did not display any of the symptoms associated with COVID-19.
There are still daily warnings against seeking a COVID-19 screening test without displaying relevant symptoms. And cautions to health-care providers not to administer a screening test without meeting provincial clinical standards. For the most part, it appears those messages are getting through to Manitobans; early reports are that people are not overrunning the health-care system with baseless concerns. However, it appears pretty obvious that there has been an unintended consequence from all that public education: a drop in visits to family physicians and walk-in clinics, even by those people who have appointments.
In a stroke of luck, innovations the province has introduced recently to provide virtual medial consultations may help keep people with chronic conditions in touch with their physicians.
The province recently approved virtual consults — either by telephone or video conference — as an insured service. This was done primarily to create some distance between potentially infected patients and their regular health-care providers so they could be diverted to specific screening locations with less overall risk. However, Smith said the virtual consults also allow people with chronic conditions to determine whether they need to make a visit to their doctor’s office.
"It’s another way you can contact your doctor’s office and ask them, ‘Do you really need to see me?’" Smith said. If a particular physician or clinic is not set up to perform a virtual consult, Smith said it still makes sense to call the physician and ask for an opinion about whether a scheduled appointment needs to be kept or whether it can be pushed back.
Smith said more needs to be done to ease the reluctance that some Manitobans have for seeking regular medical attention. Although no one can say with certainty that there aren’t any confirmed cases of coronavirus in a walk-in clinic, for the most part patients who demonstrate COVID-19 symptoms who have had exposure to other confirmed cases or travelled outside of Canada are diverted to a designated screening centre. For those who are very ill, hospital admission would take place pretty quickly.
"The same demons and dragons we’re fighting as it pertains to people’s health pre-pandemic have not gone away. My patients with diabetes are still there. My patients with chronic obstructive pulmonary disease are still there. All of my most vulnerable patients are there. The question remains — if I’m not seeing them, where are they?"
Born and raised in and around Toronto, Dan Lett came to Winnipeg in 1986, less than a year out of journalism school with a lifelong dream to be a newspaper reporter.
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Updated on Monday, March 23, 2020 at 7:44 AM CDT: Clarifies wording regarding people to be tested for COVID-19