Resuming non-essential care

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A return to pre-COVID-19 medical services will require careful planning and prioritization to ensure the best possible care for all patients.

FAQ

Non-essential medical services are now resuming. Should I ask patients to execute consent forms and/or sign waivers for providing care in-person?

Physicians should continue to exercise their clinical judgment regarding the appropriateness of providing in-person care. In determining whether care should be provided in-person, physicians should follow direction from public health officials and their College at the relevant time, including consideration of:

  • the risk to the patient of delaying care even longer;
  • the ability to provide a safe environment, including PPE, for patients, physicians and staff;
  • the capacity to implement proper screening measures and infection prevention and control practices; and
  • the impact on scarce resources.

Physicians should document thoroughly the informed consent discussion with the patient regarding the material risks and benefits of the proposed in-person treatment, including the risks of contracting COVID-19 and the option of postponing care. While consent forms are helpful as written confirmation that explanations were given and the patient agreed to what was proposed, a written consent form does not, in and of itself, fulfil the requirement for obtaining informed consent. The key for obtaining informed consent is a good discussion between the physician and patient. The physician must also answer any specific questions posed by the patient regarding the purpose and risks of the treatment. The patient must always be given the opportunity to ask these questions.

A physician’s obligations with respect to treatment and informed consent remain the same whether or not a waiver is signed by a patient. A court or College is unlikely to rely upon a waiver in determining a physician’s liability for an adverse patient outcome related to exposure to COVID-19 while providing care in-person. Some Colleges might also be critical of any attempt to obtain such a waiver.



How do I determine which medical services are reasonable to resume and manage my medical-legal risks as the restrictions on non-essential care are lifted?

It is expected that there will be only gradual movement to return to pre-COVID-19 medical services and the backlog of postponed care will be difficult to manage. Physicians will need to determine which medical services should be reintroduced and how care should be prioritized in their practices.

In determining which medical services can be resumed, physicians will want to follow direction from Ministries of Health, Chief Medical Officers of Health and Colleges. These directions may provide guidance with respect to particular services that can be provided, bearing in mind broader public health policy considerations. Application of these directives will also require physicians to use their clinical judgment to prioritize care as restrictions are lifted. The guidance to date suggests that physicians consider a number of factors when deciding whether care should be provided in person, such as:

  • the risk to the patient of delaying care even longer;
  • the ability to provide a safe environment, including PPE, for patients, physicians and staff;
  • the capacity to implement proper screening measures and infection prevention and control practices; and
  • the impact on scarce resources.

Physicians should also continue to monitor and assess what medical services can be effectively provided using virtual care and document in the patient record their rationale for providing care in person or virtually.

Physicians will also want to continue working with other health care providers and administrators to appropriately manage scarce resources and wait lists during this period to ensure patient safety and reduce medical-legal risk. Regular communication with colleagues regarding ways to deal with prioritization of care, appropriately advocating for your patients, and consideration of best practices for handling scarce resources can assist in demonstrating physicians acted reasonably in the circumstances.


 

Need more medical-legal information amid COVID-19? Visit the CMPA COVID-19 Hub