OPINION: In healthcare, it's not about virtual or in-person. It's about the relationship

The secret to quality in healthcare is continuity of care with a trusted doctor, working closely with an interconnected team and the right tools and technologies.

Dr. Dominik Nowak 5 minute read December 2, 2021
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A blend of virtual and in-person care makes sure that people receive care at the right time and by the right professional. GETTY

As a family doctor, my ability to follow a person through their life course is crucial. For my patients, it is a major determinant of their experience with healthcare.

When a person and their doctor build a relationship over time, they foster understanding and trust. We call this concept “continuity of care.” Continuity results in decreased emergency room visits, reduced hospitalization, more preventive care such as vaccines and cancer screening, and an overall higher quality of care. There are several studies that even show people with continuity not only feel greater confidence and safety in their care, but also live longer.

But along came the COVID-19 pandemic, and with it, disruption to our healthcare system.

A main disruptor was the sudden jolt away from in-person care, toward virtual care. By June 2020, most non-hospital healthcare visits in Canada were virtual. Amid this shift, many have commented on the benefits and drawbacks of virtual care as opposed to in-person care.

But it is not one or the other. It is both, depending on the person’s preferences, health concern, barriers to getting to an in-person visit, and more.

For family doctors like myself, blending virtual and in-person visits allows for continuity with the people in my practice. Looking at a recent morning, it is easy to see why:

The first person I cared for had a life-changing diagnosis, and had just finished their hospital stay. Given their health and mobility, we booked a virtual appointment. I have known them for years, but in this visit, we reviewed their new medications, and they invited their partner to discuss the implications of this diagnosis on their life and loved ones.

In the next room, I saw a person who wanted to discuss vaccines. In this case, the in-person visit let us build confidence in the relevant shots, but also update their immunizations on the spot.

The next person was from a colleague’s practice. Their doctor wasn’t available, but they wanted to flag a new health concern. A virtual visit allowed them to seek care without taking time off work and parenting responsibilities. As we use a shared health record, I was able to build on their previous care, despite not being their usual doctor. Here, continuity of care meant a relationship with an interconnected team.

This blend of virtual and in-person care makes sure that people receive care at the right time and by the right professional. It removes significant barriers, such as travel time, distance, scheduling, or mobility, and in doing so promotes continuity of care with a dedicated health professional or team.

In many places, virtual care also fills health system gaps. This includes support for families who live in remote or rural areas, helping family doctors and specialists reach people who could not access care in their local communities.

And yet, we have work to do.

Currently, millions of Canadians are without access to a family doctor. Being dedicated to continuity of care means making sure no one is left behind. It means ensuring everyone has a trusted doctor and is supported by a team of health professionals that understands their values, context, and history.

It also means supporting family doctors with interconnected teams of professionals who can work together to care for people in a community. Now that more Canadians are vaccinated against COVID-19, however, we have seen a recent false dichotomy between virtual and in-person visits. Pushing for more in-person appointments may bring back the same barriers that prevented people from seeing their doctors in the first place.

Good care is too complex to take a one-size-fits-all approach.

Instead, a collaborative approach is the answer. Collaboration between healthcare professionals, administrators, patients, and caregivers can ensure Canadians have positive and successful experiences managing their health.

We can get there, thanks to technologies, such as electronic medical records, that assist healthcare teams in easily accessing a patient’s record, or apps such as TELUS Health Virtual Care that seamlessly connect healthcare professionals and patients for virtual consultations.

As we think about our vision for Canadian healthcare, the debate between in-person and virtual care must go.

Both have barriers, and both have benefits. Our focus must instead be on how to promote the secret to quality in healthcare, which is continuity of care with a trusted doctor, working closely with an interconnected team and the right tools and technologies.

Dr. Dominik Nowak is a family doctor and faculty member in the Dalla Lana School of Public Health and the Department of Family and Community Medicine at the University of Toronto. Outside of his clinical work, Dr. Nowak is a recognized leader in primary care and health systems strategy. As Chair of the TELUS Medical Advisory Council, he is a trusted adviser to TELUS and other Canadian organizations in supporting health policy that is based in science and compassion. 

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