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There is no perfect solution to address resource dilemmas, but you can take steps to reduce patient harm and minimize medico-legal risk.
During this pandemic, resources are scarce. How do I balance my patients’ needs with the scarcity of resources?
The few legal cases touching on these issues signal that the courts are willing to consider the resources available to physicians when assessing whether the standard of care was met. A court in Ontario, for example, has indicated that "…a doctor cannot reasonably be expected to provide care which is unavailable or impracticable due to the scarcity of resources.”
A physician is expected, within resource constraints, to do the best he or she can for patients, and to act reasonably in such circumstances. It is also critical for health sector stakeholders to engage on these issues in order to help alleviate and prepare for resource shortages. In this regard, physicians have a role to play in health advocacy and are an important voice in an environment of scarce resources. Physicians should document any steps taken to address resource issues.
Emergency directives from government and public health authorities may also be issued regarding the systematic use of resources.
Do I have a duty to provide usual medical care (e.g. routine screening, elective surgeries) during the COVID-19 crisis?
It is generally considered reasonable to postpone elective and non-essential medical services and in some jurisdictions this is being mandated. Most Colleges understand and support the decision to scale back on the usual services physicians provide to patients if made in a fair and principled manner. Physicians will want to work with colleagues and their hospitals (with guidance from public health and medical specialty organizations) to determine what is considered a non-essential medical service. Physicians will also want to consider whether some of the normal services they provide to patients could reasonably be provided through virtual care.
Physicians may face criticism for shutting down their practices entirely, unless there are legitimate reasons to do so (e.g. the physician is ill or must self-isolate). Where physicians must temporarily close their practices, College policies generally suggest that physicians should attempt to make alternate arrangements for care of their patients. Physicians are encouraged to coordinate with colleagues to provide coverage in care where needed and develop creative solutions to provide care to patients during these trying times.
The level of care consultants can reasonably provide may also be affected in the context of COVID-19. This does not generally mean consultants should avoid providing advice to other physicians or participate in the care of patients. Some Colleges have indicated that consultants should at least provide direction to the referring physician, regardless of whether the consultant is able to see the patient directly. As with community physicians, consultants will want to consider whether they can provide care to patients using virtual care.
Need more medico-legal information amid COVID-19? Visit the CMPA COVID-19 Hub