Family medicine teams defy COVID-19 by linking to patients via telehealth

When Antonio José Santiago (left) began exhibiting symptoms of a stroke at home, his wife, Eunice Gomes Santiago, used Zoom to connect to Dr. Mark Karanofsky, who confirmed what was happening and advised them what to do next
When Antonio José Santiago (left) began exhibiting symptoms of a stroke at home, his wife, Eunice Gomes Santiago, used Zoom to connect to Dr. Mark Karanofsky, who confirmed what was happening and advised them what to do next

All it took was a few moments for Dr. Mark Karanofsky to look at his patient and realize something was seriously wrong: Antonio José Santiago was clearly walking with a limp, and the right side of his face was drooping noticeably.

A stroke—no doubt about it!

Quickly, Dr. Karanofsky explained the nature of the emergency to Mr. Santiago and his wife, Eunice Gomes Santiago, who were able to get prompt medical help before his condition grew much worse.

It was an urgent situation, of course, but why single it out? Because Dr. Karanofsky made his diagnosis by looking at a computer screen during a video conference with the Santiagos.

In a sense, Mr. Santiago was lucky. When his stroke hit on April 17, he was already scheduled to connect by Zoom from home for a routine checkup with Dr. Karanofsky, who is Interim Director of the Goldman Herzl Family Practice Centre at the JGH.

That meant the doctor was on hand when Mrs. Santiago explained that her 78-year-old husband had not been feeling well since finishing some repairs around their Candiac house earlier in the day.

Even so, the video link proved to be essential. For Dr. Karanofsky, this was proof of telehealth’s value in circumstances like the COVID-19 lockdown.

“Before COVID-19, it wasn’t always clear, especially to patients, what telehealth was capable of,” says Dr. Karanofsky. “I think the situation is much different now.”

During the pandemic, Herzl appointments using telehealth (also known as telemedicine) became the norm, as the proportion of in‑person visits quickly plummeted to an average of about 12 per cent of all consultations.

Before COVID-19, telemedicine was relatively scarce, not just in the facilities of CIUSSS West-Central Montreal, but throughout Quebec. This was because the Ministry of Health and Social Services did not provide widespread reimbursement to physicians for most telehealth activities.

But this past February, just before COVID-19 struck the province, the Ministry realized that to prevent the spread of the virus, most patients (and many members of staff, including some clinicians) had to stay away from hospitals and certain other healthcare facilities.

So, moving quickly, the government approved reimbursement for most physician services that were delivered by video and telephone.

Herzl was also ahead of the game, because the CIUSSS’s Directorate of Information Technology had finished installing the Centre’s electronic medical record before the pandemic struck. Regardless of where members of Herzl staff happened to be, they now had easy access to their patients’ charts and other vital information.

Nevertheless, Dr. Karanofsky still shakes his head in amazement at the thought of what it took to push Herzl into telehealth. “On Friday, March 13, we got a directive that, as of Monday, 70 per cent of our activities had to be virtual.

“That was a mind-boggling moment because, on average, we had about 360 in-person visits a day before COVID-19, and to cut that to a little over 100 within 72 hours seemed impossible. But somehow we did it!”

Dr. Mylène Arsenault
Dr. Mylène Arsenault

Dr. Mylène Arsenault, a family physician at Herzl, also realized that since this was going be a new experience for many members of staff, she helped to develop a telemedicine teaching module for Herzl.

“We weren’t trained in telemedicine in medical school,” she says, “so we need the module to train our physicians and residents to do it safely.

“What we can’t do by telemedicine is anything that involves palpation or physical contact. But certainly, there’s a lot that can be done safely and properly by telemedicine, such as mental health-related counselling and follow-ups of chronic health conditions.”

In some respects, says Dr. Karanofsky, telemedicine can be superior to an office visit, since it allows a physician to take a look at a patient’s living environment.

“For example, if the patient is elderly and has what seems like too much furniture, you can get a sense of whether they’re at risk for falling. The key is that you still have to have the leeway—which we do—of bringing patients in for a face-to-face visit, if circumstances demand it.”

Since all of this is happening while patients are at home, they also tend to be more relaxed and comfortable, says Sabina Figueira, a clinical nurse at Herzl who specializes in diabetes and cardio-metabolic care.

“During the pandemic, they felt especially safe, since they weren’t in danger of being exposed to the coronavirus in the hospital,” she explains.

But what of the future? Might the pre-COVID-19 status quo creep back into Herzl, once the threat has passed? Dr. Karanofsky strongly doubts it.

He acknowledges that the level of telehealth visits is unlikely to remain in the range of 87 to 88 per cent. However, “in the medium term, we think that at least 60 per cent of all visits could be handled completely or in part by telemedicine.”

“It’s the way of the future,” agrees Dr. Arsenault, “and COVID-19 has just accelerated us into the telemedicine era. It’s definitely here to stay.”