Quebec doctors demand more flexibility when it comes to telemedicine

MONTREAL -

Another point of tension has arisen between the Legault government and the Fédération des médecins omnipraticiens du Québec (FMOQ), this time over the number of telemedicine appointment.

The government says it now wants to cap the number of teleconsultations at 30-40 per cent, while family physicians are opposed and are calling for greater flexibility.

"We don't want to set a maximum number of teleconsultations... because it depends on the type of clientele, on the circumstances," explained FMOQ President Dr. Louis Godin.

According to him, patients and physicians have become fond of telemedicine since it was deployed under the state of emergency related to the COVID-19 pandemic.

"We don't want to put some kind of quota on it, to say, 'You can't do more than 30 per cent or 40 per cent of teleconsultations.' That's inappropriate," said Godin. "We're not comfortable with that. We certainly need to discuss how to frame it, because we don't always agree on that."

He gives the example of a doctor whose patient "works, has had an experience with telemedicine and likes it," but come December, his doctor has reached his "quota" of teleconsultations for the year.

"The doctor is going to have to say, 'No, no, I can't see you via teleconsultation, I've reached my quota.' I mean, we don't have the same approach as the government," he said.

In recent months, the Department of Health says it has felt the need to issue guidance, calling on physicians to be extra careful and return to face-to-face practice.

It states that while telemedicine can be useful, it does not work in many cases, especially if a physical or neurological examination is required.

"A rate of more than 90 per cent of activities... in telehealth is considered unacceptable," the ministry notes in a document entitled 'Use of telehealth under the health emergency decree.'

"Discussions are underway... to determine the parameters of application... including what happens in the event of non-compliance," said ministry spokesperson Robert Maranda.

The FMOQ agrees that it is unacceptable for a doctor to only provide teleconsultation.

"A patient who wants to be seen, must be seen. You are a doctor... you organize yourself to see him, or your colleagues. You don't want that patient to be sent to the emergency room to see a doctor," said Godin. "But at the same time, we don't want to put a number on it. We don't want to say, 'The norm is 40-45 per cent,' we don't want that to be it."

When asked about the issue, the Federation of Medical Specialists of Quebec (FMSQ) told The Canadian Press that it has not decided on the implementation of a telemedicine ceiling, which "can have a perverse effect."

"The federation believes that a physician must use his or her clinical judgment, taking into account a patient's history, as well as his or her health problem, to determine the best mode of consultation," it said.

The College of Physicians noted it does not comment on "specific numbers," referring instead to a statement by the College's president, Mauril Gaudreault, issued last February, which is "still relevant and represents the position of the College."

"Is telemedicine always an option? No. Some situations will always require a face-to-face assessment. It is a matter of prudence and discernment," he wrote.

-- This report by The Canadian Press was first published in French on Nov. 9, 2021.