In the face of COVID-19, shouldn’t we loosen our health-care rules?

In normal times, rules are there for a reason, and they should certainly be followed. But these are not normal times
By Steve Paikin - Published on Mar 23, 2020
There are strict rules in place in Ontario that prohibit doctors from emailing their patients without prior written consent. (iStock/Iuliia Zavalishina)

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Ontario’s health-care system has all sorts of rules in place for all sorts of reasons. Some of those rules are really useful and smart. Some are about ensuring accountability. Some are more about optics. And all of them make a certain amount of sense in normal times.

Folks, these are not normal times.

So should we really be slavishly following the normal rules?

Here’s an example. The health-care system cares a tremendous amount about your privacy. In fact, there are strict rules in place that say doctors are prohibited from emailing their patients without prior written consent. It’s also illegal to Skype with patients. Such things are forbidden out of an abundance of concern for patients’ privacy.

In fact, many players in the health-care system are obliged to be so cautious about revealing personal information that their telephone numbers are blocked by call display. The thinking is, no one else in your home should know that a hospital may be trying to get in touch with you, in case you don’t want that information to go beyond you and your doctor.

Yes, that means a hospital could be trying to call you with your COVID-19 test results, but when you look at the window on your phone, the number is blocked.

How many of you routinely don’t answer your phone when you can’t tell who’s calling?

Are doctors still following these protocols in the midst of the worst global pandemic in a century? This weekend, a physician in one of the academic hospitals affiliated with the University of Toronto told me: “The last email I got from my hospital was that I still have to follow all the rules and regulations of the hospital.”

And, yes, the doctor thought that was nuts.

The province’s Telehealth service and family doctors are now routinely telling patients not to go to a doctor’s office or hospital if they suspect they have COVID-19. Talk on the phone first.

“We’re trying to transfer to virtual clinics, and yet we’re not allowed to email or Skype,” the doctor said, suggesting that the current situation almost requires doctors to break the law if they’re going to provide the fastest, best care possible in the midst of a global pandemic.

Another doctor I was in contact with this weekend, Michael Wansbrough, a chronic-pain and emergency physician, emailed me this: “The government has loosened the rules around which platforms we can use to communicate with patients, however the details are still unnecessarily complicated for both docs and patients.” Again, worshipping at the altar of hyper-privacy is the issue.

Another former senior policy adviser in the Ontario health ministry tells me that there’s a huge divide between the decision-makers who understand it’s not business as usual and the bureaucrats who are supposed to implement new ideas.

“The decision-makers send those ideas down to lower levels in the bureaucracy for implementation, but those people are still bound by all the standing rules and regulations. They’re waiting for permission to think outside the box. So that’s the first thing that needs breaking down.”

Want some examples?

Why should people who test positive for COVID-19 be going only to hospitals, where their infections could spread to other patients?

“If we do our best for everyone in need, we overwhelm our health-care system, and we have trouble providing ongoing care with other emergencies,” said Howard Ovens, the chief medical-strategy officer and an emergency physician in Toronto’s Sinai Health System, on an in-house conference call to hospital staff.

In fact, health-care decision-makers seem only to be concerned with hospital capacity. For most people who contract the virus, staying home for 14 days and waiting it out will be the best and easiest option because the effects won’t be that dramatic.

But there will be those who need more intensive medical attention: Why not turn school gymnasiums (they’re empty, after all) or the Scotiabank Arena or the Rogers Centre (both of which have no games happening) into instant COVID-19 patient-care centres? The Sudbury Community Arena is now being used to feed homeless people who previously would have gone to soup kitchens or shelters. All meals are bagged.

In Philadelphia, the Major League Baseball Phillies have allowed their ballpark to be used as a testing site for COVID-19. It’s accessible by public transit, and there’s plenty of parking.

“Loosen up the rules that don’t make sense,” the former adviser says. “We’re stuck in an ideological model of Medicare that has demonized the private sector. But right now? The private sector may save the day if we partner with them properly.”

What about hospital foundations? They’re sitting on hundreds of millions of dollars that the law says must go only toward research and capital projects. But, at a time when we need more money for protective masks, gloves, and respirators, does it make sense to so rigidly follow the old rules?

What about health human resources? Telehealth is required to be staffed exclusively with registered nurses. At a time like this, do we have the luxury of that arrangement? Shouldn’t we allow practical nurses the right to staff Telehealth so that those more highly trained registered nurses could be put to better use in hospitals or other settings?

The Ontario government seems to be somewhat awakening to these incongruities. This past weekend, Premier Doug Ford urged manufacturers to retool their processes to aid the cause. With a new website calling for proposals, the premier insists he’ll spare no expense to help businesses transition to making more important items: Hand sanitizer instead of spirits. Surgical gowns instead of winter parkas.

The Ontario government is getting early kudos for the way it’s handling many aspects of the coronavirus situation. But if it truly is a crisis we’re trying to solve, shouldn’t we dispense with some of the rules that seem to make little sense at a time like this?

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