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Healthcare in the Era of COVID-19: Transition from In-Person

Appointments to Telemedicine

Sarah Jane Bowser & Teah Clark

Durham College
COMM-1801-05
Communication Foundations
Amanda Clare
December 3, 2020
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Introduction

When 2020 began, the health and wellbeing of the world’s population was seen

in an optimistic sense. Since March 2020, the everyday life of the normal person has

changed drastically. From work, to shopping, to doctor appointments, everything has

changed. These changes are due to the effects that SARS-CoV-2 virus, better known

as COVID-19 has had on society. Having to put precautions in place, to keep the

general population safe from this virus, is the main objective of everyone in a seat of

power. Having to transition from in-person appointments to telemedicine, by ways of

telephone, video and e-mail, has been seen as a trial and error experience, to get all the

issues sorted out. The effects of telemedicine are different between the doctors, the

secretaries within the doctor offices, as well as the patients that are being seen.

Medical Personnel’s Experience with Telemedicine

Doctors

When people think about who is most affected by the pandemic, doctors seem to

be further down the list compared to the everyday family, and business owners.

Although doctors working in a hospital setting seemingly still see their patients in-

person, family doctors do not have this luxury.

Doctors use both speaking with the patient by discussing their symptoms as well

as using visual cues to fully diagnose the patient’s chief complaint [ CITATION DrC20 \l

4105 ]. A survey held in the summer of 2020, had a result that showed that 27.9% of

doctors were worried about missing a diagnosis [ CITATION Uzm20 \l 4105 ]. During a
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separate survey taken in June 2020, 75.9% of patients were assessed by telephone, a

means of telemedicine [ CITATION Ron20 \l 4105 ]. Many doctors prefer in-person

appointments, as technology cannot be trusted in the sense that calls can be dropped

or may not go through, depending on the weather or the area in which both callers are

using their phones [ CITATION DrJ20 \l 4105 ].

The arrival of COVID-19 has taken the concept of telemedicine, from a pipe

dream to a fixture across Ontario [ CITATION Mic20 \l 4105 ]. In the survey from June 2020,

23.9% of appointments were via video call, such as Telehealth [ CITATION Ron20 \l 4105 ].

Telemedicine appointments rose by 950% from before the pandemic to April 3, 2020

[ CITATION Jod20 \l 4105 ]. Video calls are not always feasible as a majority of Canada’s

population earn below the standard of living, being unable to afford a reliable computer,

with a webcam or a reliable phone [ CITATION DrC20 \l 4105 ]. Older patients may not be

able to use the software as they may not understand the technology. When taking

appointments via telemedicine, it is difficult to conduct tests that would be held in the

office. These types of tests include urinalysis or swabs for a suspected case of infection.

In terms of patients who are on narcotics, the doctor is recalling on the relationship that

is present with the patient, as to whether they can trust what the patient is telling them.

Many doctors go into medicine because they want to have an in-person

relationship with their patients, and see them grow and meet their goals, both

developmentally and personally [ CITATION DrK20 \l 4105 ]. Although approximately 0.2% of

appointments during this time are in person, these appointments put the doctors, as well

as the other staff in the office in danger, as the patient could potentially be a carrier of

the COVID-19 virus [ CITATION Ron20 \l 4105 ].

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Secretaries

During times such as these, everyone is focused on the doctors and the patients,

as medical secretaries are not high on the list of the people who are affected by the

pandemic.

Medical secretaries put in just as much time as the doctors do to establish a

relationship with the patients that are enrolled in their clinic [ CITATION Don20 \l 4105 ].

Although there are very few patients coming into the office, there are still phones to

answer, and emails to respond to. Doing all these things, when not seeing patients in-

person, can feel indifferent [ CITATION Sus20 \l 4105 ].

Even though there are still appointments taking place during business hours, the

doctors may complete their appointments off-site, such as their homes. This could lead

to the secretary alone in the office, creating a lonesome environment [CITATION Sha20 \l

4105 ]. Medical secretaries, nowadays, are expected to clean each room after the

patients have vacated the premises, adding to their already heavy workload [ CITATION

Sus20 \l 4105 ]. Due to the fact that telemedicine appointments are up 950% from January

to April 2020, it is on the secretaries to make sure the daily appointments move

smoothly [ CITATION Jod20 \l 4105 ]. This may mean that they will need to; returning phone

calls, screening patients prior to entering the clinic, receiving the information pertaining

to the chief complaints, charting the symptoms in the appointment block. If the chief

complaint includes lesions, bumps, or rashes, the secretary will then need to inform the

patient to email a photo to the email that the doctor’s office’s email address. All of these
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tasks will end up taking more time for the secretaries, instead of their regular duties

[ CITATION Don20 \l 4105 ].

Patient Response to Telemedicine

Patient Concerns

The shift to telemedicine and remote healthcare during the pandemic has raised

concerns among patients for their privacy and quality of care. There is a general distrust

among patients for digitalized healthcare, and in a survey by the Canadian Medical

Association, 75% of Canadians reported that telemedicine caused them anxiety over

their privacy (MacLeod, 2020). The pandemic has restricted contact between health

professionals and patients, and communication is largely taking place over email, which

some patients emphasize is vulnerable to cyber-crime (T.Clark, personal

communication, November 13, 2020). Furthermore, part of Canada’s emergency

response to the global pandemic is to expediate the launch of eHealth (Krausz et al.,

2020). EHealth is a web-based medical data collection platform used to facilitate patient

intake, triage, monitoring and referral (EHealth Ontario, n.d). The move to centralize

Canadian’s medical records on a digital platform, although for the benign purpose of

simplifying office-to-office communication, adds to patients’ worry over an information

breech. Patient concerns over telemedicine’s ability to maintain the sacred idea of

doctor-patient confidentiality poses a serious threat to Canadian’s trust in their health

care professionals.

For many patients, the fear of miscommunication of symptoms and misdiagnosis

taints their trust in telemedicine. Elderly patients who struggle to use digital platforms

like e-mail or video-calls, are at a disadvantage when trying to communicate with their
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doctors (MacLeod, 2020). Communication hurdles patients face when using digital

platforms like the lack of proper equipment at home to check vitals, limited vocabulary

when describing symptoms, and difficulty in accurately photographing ailments. In the

same survey by the Canadian Medical Association mentioned previously, 77% of

Canadian’s worry about losing what Mary MacLeod of the CBC calls “the human

connection of healthcare” (MacLeod, 2020). Patients expressed to MacLeod concern

over “fragmented care”, “misdiagnosis”, and “impersonal transactions” (MacLeod,

2020). Both the anxiety over a loss of privacy and diminished empathy in virtual

healthcare makes it a hard transition for patients, and potentially weakens their faith in

receiving quality care by Canadian medical institutions.

Patient Benefits

Despite a majority of patients’ reluctance to embrace virtual healthcare, there are

indisputable benefits to employing digital platforms for remote care during the

pandemic, and even after a vaccine. As intended, telemedicine during the COVID-19

outbreak has minimized risk of exposure to the virus for patients and health

professionals. Telemedicine has also ensured that patients continue to have access to

medical professionals even during strict lockdown orders. When physical distancing

measures were first put in place in the spring of 2020, some clinics saw 45% of

appointments cancelled in the three weeks following the new protocols; however, once

healthcare transitioned to virtual platforms like phone and video, only 6.3% of

appointments were cancelled or missed in those same clinics (Krausz et al., 2020). For

patients with long-term care needs during the pandemic, like cancer treatment,
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confidence in the quality of care received by virtual methods has increased from 39% to

59% as patients and doctors improve communication strategies (Gill et al., 2020). For

patients living in rural areas or remote locations, like First Nation communities,

telemedicine has improved their access to doctors and specialists (MacLeod, 2020).

The potential opportunities for better medical care among vulnerable Canadian

populations has grown as patients and doctors adapt to telemedicine and has cemented

digital communication platforms as valuable medical tools.

Conclusion

In 2020, the global pandemic has radically changed healthcare delivery almost

overnight. Telemedicine has had to rapidly evolve from the development phase to being

the standard of healthcare during a state of national emergency. The use of phone,

email and video conference technology has replaced in-person appointments to

guarantee the safety of doctors, patients, and staff from the virus. Doctors, secretaries,

and patients share similar concerns about the transition to telemedicine breaking down

meaningful communication and accurate diagnosis, that emphasizes how integral

human connection is to medicine and the healthcare industry. It is uncertain how

COVID-19 will continue to influence society, however the healthcare’s adaptation to

digital platforms with growing success indicates that telemedicine will be a major

component in the future of healthcare.

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References

Charnow, J. A. (2020). Practicing in a Pandemic: Doctors Adapt, Improvise. Renal & Urology,

16-18.

Chung, D. J. (2020, November 6). (T. Clark, Interviewer)

Clark, S. (2020, November 6). (T. Clark, Interviewer)

EHealth Ontario. (n.d.) What We Do. Retrieved from https://ehealthontario.on.ca/en/about-us

Gill, S., Colwell, B., Hirte, H., Welch, S., Campbell, A., Hao, D. (September 2020) Evaluating the
Impact of COVID-19 on Medical Oncology Workforce and Cancer Care in Canada: A
Serial Survey Study . DOI: 10.1158/1557-3265. Retrieved from
https://clincancerres.aacrjournals.org/content/26/18_Supplement/PO-016

Harper, D. K. (2020, November 20). (T. Clark, Interviewer)

Hawridge, S. H. (2020, November 12). (T. Clark, Interviewer)

Krausz, M., Wesentberg, J.N., Vigo, D., Trafford-Spence, R., Ramsey, D. (15 May 2020)
Emergency Response to COVID-19 in Canada: Platform Development and
Implementation for eHealth in Crisis Management. JMIR Public Health Surveill, 6 (2).
DOI: 10.2196/18995 . Retrieved from https://publichealth.jmir.org/2020/2/e18995/

MacLeod, M. (14 May 2020) Virtual Health Care is ‘Not the Answer for Everything,’ Critics Warn.
Retrieved from https://www.ctvnews.ca/health/coronavirus/virtual-health-care-is-not-the-
answer-for-everything-critics-warn-1.4939283

McLean, D. C. (2020, November 13). (T. Clark, Interviewer)

McQuigge, M. (2020). Doctors, patient advocates say telemedicine in Canada spurred by

pandamic is here to stay. The Star.

Urooj, U., Ansari, A., Siraj, A., Khan, S., & Tariq, H. (2020). Expectations, Fears and

Perceptions of Doctors during COVID-19 Pandemic. Pakistan Journal of Medical

Sciences.

Wlson, D. (2020, November 17). (T. Clark, Interviewer)

Zhu, R., Kim, H., Jeimy, S. (17 July 2020) Appointment Characteristics During COVID-19: A
Canadian Allergy/Immunology Centre Perspective. The Journal of Allergy and Clinical
Immunology: In Practice. 8(8). DOI: https://doi.org/10.1016/j.jaip.2020.06.062