Doctors worry Canadians skipping appointments, creating backlog amid COVID-19

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Doctors are worried many Canadians are missing necessary medical appointments amid the novel coronavirus pandemic, which could be creating a large backlog.

Dr. Ritika Goel, a family physician in Toronto, said she expects to see the number of people accessing medical care increase as the country reopens.

I think there’s a lot of medical issues that people have decided to put off temporarily just to see what happens with the pandemic,” she said. “And because actual appointments and procedures have been put on hold, I think we’re we’re absolutely going to see a backlog of services to be provided and patients coming in.

Dr. Michelle Cohen, a family physician and assistant professor in the department of family medicine at Queen’s University, echoed Goel’s remarks, saying she has seen a “big drop” in the number of appointments amid the pandemic — especially during the first few weeks of the lockdown.

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She too said she is “quite concerned” about the potential backlog this has created.

I think we’re going to be dealing with backlog and backlog-related issues for a long time,” she said.  “We’ve suspended a lot of preventative screening programs, so that may cause some potential problems down the road.”

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Goel and Cohen’s remarks were reflected in a poll released Wednesday by Angus Reid, which found 38 per cent of the 1,777 Canadians surveyed have faced barriers accessing medical appointments, treatments or scheduled procedures during the pandemic.

The poll, conducted online between May 18 and 19, found that of those affected, 23 per cent said they were unable to make a needed visit to their family doctor.

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Eighteen per cent of those surveyed said they had to miss an appointment with a medical specialist and 13 per cent said they were not able to have a diagnostic test like an MRI or a CT scan.

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Seventy-six per cent of the respondents who were affected said it has had an adverse impact on their overall health.

“Disproportionate impact” on marginalized communities

And even though many clinics and physicians have tried to make adjustments amid COVID-19, Goel said the pandemic has created new barriers for those who are accessing primary care.

She said these barriers “disproportionately” affect marginalized communities.

“I think particularly for people experiencing homelessness that have had challenges accessing their regular supports or for people who use drugs, [or] people with language barriers that may have difficulty navigating the system,” she said.
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And, she said not everyone has access to or can use technology.

Goel said as Canada implements new online models of care amid the pandemic, we need to “be mindful about different populations and differing abilities.”

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COVID-19 fear

Goel said the survey’s results also likely reflect, in part, patients’ fears of accessing medical care during the pandemic.

“I’ve certainly had conversations with patients where I’ve wanted them to come in and see me in person, even though we’ve had a phone-based appointment,” she said. “And despite feeling medically that they should be assessed in person, they were concerned enough about the virus that they didn’t want to come in to be seen by [me] or go into the emergency room.

Cohen said this fear is making people wait and see if their symptoms will go away over time, instead of accessing appropriate care.

“A lot of us are worried about what’s going to happen when people who have been kind of waiting to present their problems or come in and discuss their issues do finally show up,” she said. Is that going to mean that their issues are worse or that something could have been done sooner, [but] wasn’t done sooner because they didn’t come in when they otherwise would?”

She said that is “quite concerning” because it is unclear how they will manage an influx of patients.

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“All of that is still on the horizon,” she said.

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Asked if there is anything we could be doing now to avoid a massive backlog, Cohen said it’s difficult to say because the pandemic is an “unprecedented event.”

“It’s a bit of a black box right now and we’re trying to just make our decisions based on the best available evidence that we have,” she said. “Yet there’s a lot to be concerned about because there’s just so much we don’t know in terms of what’s ahead of us.”

Goel said she is most concerned about procedures, surgeries and specialist appointments, many of which have been delayed or cancelled due to the pandemic.

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“I think that’s going to be a bigger challenge for the system to handle and I suspect [it] might lead to longer wait times unless there’s a way for us to increase capacity,” she said.

Ultimately, Cohen said it’s about striking the right balance between offering necessary care, while also managing the risk.

“You can’t have people suddenly pouring back into the office or into a hospital,” she said. “But you also can’t keep those services restricted forever, so trying to find that balance, that kind of happy medium that balances those opposing risks is very tricky and really historically we have no guidance.”

The Angus Reid Institute poll was conducted from May 18-19, 2020 by a representative randomized sample of 1,777 Canadian adults who are members of Angus Reid Forum. A probability sample of this size would carry a margin of error of +/- 2.3 percentage points, 19 times out of 20.

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