Scarce resources: Caring for patients during COVID-19

CMPA Podcast

COVID-19: Reasonable care (15 min)

Issues

• Resource constraints have long been a reality for Canadian physicians. In the context of COVID-19, these resource shortages are likely to be more pronounced.
• There have been acute resource shortages in some regions during the COVID-19 pandemic. The scarcity of resources may continue once COVID-19 subsides.
• There is no perfect solution to address resource dilemmas. However, steps can be taken to manage shortages in order to reduce patient harm and minimize medical-legal risk.

The bottom line

• Even when faced with resource constraints, do your best for patients and act reasonably under the circumstances. Courts and regulatory authorities (Colleges) may take into consideration any resource constraints when adjudicating civil actions and complaints related to care provided. Contact the CMPA for context-specific medical-legal advice regarding the delivery of care to patients in these challenging circumstances.
• Consider alternative ways to deliver care and assess which non-essential medical services can be deferred.
• Remember, all physicians have a role to play in health advocacy as important voices in an environment of limited resources.

Need to know

Reduce non-essential or elective care

• To minimize the spread of COVID-19, many provincial medical officers of health ordered that all non-essential and elective services be reduced to minimal levels, subject to certain exceptions. Most Colleges supported the decision to scale back non-essential services if made in a fair and principled manner. These measures were designed to assist with the allocation of resources to the highest-need patients and preserved the use of personal protective equipment (PPE).
• Use and document the clinical judgment you used to determine what constitutes a non-essential medical service and which services can be resumed pursuant to updated guidance from your institution, health authority, provincial medical officer of health, and College.
• Once non-essential and elective services fully resume, this is likely to create even more pressure on an already strained system. It will be important to continue to apply protocols and appropriately manage scarce resources and wait lists during this period.

Find alternative ways to deliver care

• Adapt and develop creative solutions to provide care where resources are limited, including where there is a shortage of PPE. Among other things, consider:
• implementing COVID-19 screening measures before seeing patients in person (e.g. screening patients by phone, posting signage requesting patients to call ahead, etc.)
• re-directing patients to public health or hospitals, or both, as appropriate, where they meet the criteria for potential COVID-19 infection
• relying on virtual care (which includes phone and video consultations) where possible to keep in contact with patients suspected of having COVID-19 and who are being monitored, as well as other patients with chronic diseases, acute illnesses and those who may not require an examination in person
• supporting patients as much as possible to access care if you are no longer legitimately able to practice safely

Duty to act reasonably, not perfectly

• Courts and Colleges are likely to consider the circumstances when assessing whether a physician met the standard of care, including the resources available at the time. Physician care is judged not on a standard of perfection, but rather on the standard of care that might reasonably be applied by a colleague in similar circumstances.
• Regularly communicate with colleagues regarding best practices and ways to manage limited resources.
• To the extent possible, place the best interests of patients first while using resources judiciously. In the event triage protocols are implemented to allocate resources, the best interests of the public must be weighed against the interests of individual patients.
• Follow any applicable emergency directives and triage protocols established by government and public health authorities regarding the use of resources. This can help minimize medical-legal risk by demonstrating that you met the standard of care in the exceptional circumstances of COVID-19.
• Document any steps taken to attempt to resolve resource issues.

Engage in appropriate health advocacy

• You may feel compelled to advocate on behalf of patients and yourself. Any advocacy should be done in a professional manner [PDF] and one that maintains public trust.
• If you practise within an institution, be especially mindful of any applicable bylaws, protocols, and policies regarding appropriate advocacy by medical staff, allocation of resources, and PPE use.

Looking ahead

• Suspending elective and non-essential services during COVID-19 will inevitably result in extensive wait times once these services resume. Resources that are depleted during COVID-19 will likely continue to be in short supply when non-essential medical care recommences.
• The lessons learned through the COVID-19 pandemic may also be useful in allocating resources when non-essential medical services resume.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.