Updated December 1, 2022
(* indicates a newly added/updated question)
Physicians are working hard to support each other and the public through this pandemic. Our goal is to provide clear information to help guide you as you exercise professional judgement to practice in this environment. If your question is not addressed here or if you need further support beyond the information provided below, please don't hesitate to contact us.
Are physicians able to practice outside of their usual scope of practice to help address the crisis being faced by paediatric hospitals?
Given the strain on paediatric hospitals physicians may be asked to practice outside their usual scope of practice to support responding to this crisis.
While CPSO’s Public Health Emergencies policy would normally only apply in a declared emergency, we recognize the need to apply this policy in these similar circumstances, enabling physicians to practice outside their usual scope of practice. CMPA has similarly issued a message of support, indicating the necessity of taking these steps at this time.
Can I restrict in-person care to those that do not have any flu symptoms or symptoms of COVID?
No. In-person care can be provided safely by taking appropriate precautions, including screening and isolating patients, and using necessary PPE. Patients cannot be denied access to necessary in-person care based solely on having symptoms of the flu or COVID-19. Similarly, it is not appropriate to directly refer patients to emergency departments when the initial assessment or ongoing care can be safely provided in an office setting.
*How can I help alleviate the pressures Ontario Paediatric Hospitals are facing?
It is critically important for physicians to prioritize seeing sick patients in-person whenever possible and to minimize direct patient referrals to the emergency room when the care can be safely provided in an office setting. To further support your practice, ensure the appropriate use of emergency resources, and help those caring for children experiencing respiratory symptoms, the Ontario College of Family Physicians has developed helpful tips on managing children’s respiratory illnesses at home and guidance on when to seek medical care.
The government has ended the mask mandates for most settings, what does this mean for my practice?
As of June 11th, all mask mandates have been lifted for indoor settings with the exception of long-term care and retirement homes.
Although mask mandates have been lifted, the Chief Medical Officer of Health continues to recommend that all physicians, staff, and visitors continue to wear masks in all health care settings. Physicians or health care facilities can continue to implement masking policies that ask all staff, patients, and other visitors to wear a mask when in the office.
What if a patient refuses to wear a mask?
If you have a policy that asks patients to wear masks, it’s important for patients to adhere to that policy. Some patients may have health conditions that make it difficult or inhibit their ability to wear a mask. In these cases, physicians are expected to offer appropriate options to ensure care can safely be provided.
If you encounter a situation where a patient not in need of an accommodation refuses to wear a mask, explain the expectation in your practice is that a mask be worn. When deciding how to proceed, consider that in most cases in-person care can be safely provided with appropriate precautions (e.g., donning appropriate PPE, isolating patients, providing care during set times), that physicians have a duty of care where care is urgently needed, that virtual care may be an appropriate alternative, and that redirecting patients to other parts of the system may exacerbate existing and significant resource challenges.
Physicians are not expected to tolerate verbal abuse or threats of physical violence and can take appropriate steps in these instances to defer or delay non-emergent care.
How do I balance providing in-person and virtual care to my patients?
Every practice is unique and finding the right balance will require judgment on the part of the physician to consider the merits of virtual vs. in-person visits and to determine which approach is in the patient’s best interest. Physicians should be continuing to utilize both in-person and virtual visits based on clinical need. It is critically important that the standard of care is always met, which means in many cases, care will need to be provided in-person.
Not all patients will be able to get the care they need virtually as there are limits to what can be done virtually. In-person care is essential for many conditions and some patients do not have adequate access to virtual care. For example, where patients have difficulty communicating virtually, where physical contact is necessary to provide care and services (e.g., newborn care, prenatal care, vaccine administration) and other diagnostic and therapeutic procedures (e.g., Pap smears and biopsies), or where physical assessments are necessary to make an appropriate diagnosis or treatment decision patients need to be seen in person.
As CPSO’s Virtual Care policy states, physicians must use their professional judgment to determine whether virtual care is appropriate and only provide virtual care if it is in the patient’s best interest to do so. This means only providing virtual care when the quality of care will not be compromised by the virtual modality or when the potential benefits of providing virtual care outweigh the risks to the patient. It is important to remember that the standard of care must always be met and that the same standards apply to in-person care as to virtual care. In addition to our policy, helpful resources regarding the limits and appropriateness of using virtual care have been developed by the Ontario College of Family Physicians, Canadian Medical Association, , OntarioMD, and the Quality Division of Ontario Health and Ontario Telemedicine Network.
How should I manage patients with symptoms of COVID-19 seeking care?
Some symptoms of COVID-19 are similar to many other conditions (e.g., flu, COPD, sinusitis). Consistent with previous guidance from public health officials, it is important that physicians not delay assessment and treatment of issues which have symptoms that overlap with those of COVID-19 but are clinically evident of a different diagnosis. Physicians will need to use their clinical judgement, taking into account local epidemiology and exposure history, to assess and treat these types of issues in a timely manner. While patients with these symptoms should be referred for testing and need to be told to self-isolate until a negative result is received, access to appropriate care should not be denied (including access to necessary in-person care, providing appropriate precautions can be taken), even if the patient has not yet been tested.
What safety precautions do I need to take when providing in-person care?
The Ministry of Health continues to provide guidance on how to safely provide care during each stage of the pandemic. The most up to date information can be found on the Ministry of Health's website, where guidance is provided for different sectors within the health care system.
It’s important that you follow guidance provided by the province or public health officials in order to implement safety precautions that are designed to protect everyone. You can also inform patients about the safety precautions you’ve put in place to ensure compliance with these measures.
Pandemic-Related Practice Issues
Patients are asking me to write notes supporting a medical exemption from COVID-19 vaccines — what do I need to know?
Patients may ask you to write notes or complete forms exempting them from getting vaccinated. If you are asked by your patient to provide information supporting a medical exemption from receiving a COVID-19 vaccine, your patient must have a legitimate medical condition that would warrant an exemption.
The National Advisory Committee on Immunization (NACI), the Ministry of Health, and some public health units have provided guidance regarding contraindications for COVID-19 vaccines. The Ministry of Health has also provided guidance about medical exemptions in the Medical Exemptions to COVID-19 Vaccination document, and guidance for specific allergy populations in the COVID-19 Vaccination: Allergy Form document.
Generally speaking, there are very few acceptable medical exemptions to the COVID-19 vaccination (examples include an allergist/immunologist-confirmed severe allergy or anaphylactic reaction to a previous dose of a COVID-19 vaccine or to any of its components that cannot be mitigated, or a diagnosed episode of myocarditis/pericarditis after receipt of an mRNA vaccine).
Given the rarity of these exceptions, and in light of the fact that vaccines have been proven to be both safe and effective, any notes written for patients who qualify for a medical exemption need to clearly specify:
- the reason they cannot be vaccinated against COVID-19 (i.e., document clear medical information that supports the exemption); and
- the effective time period for the medical reason (i.e., permanent or time-limited).
While physicians are generally required to complete third party medical reports for patients when requested, the circumstances of the pandemic support physicians declining to write notes or complete forms when the patient making the request does not have a medical condition that warrants an exemption. If you find yourself in this situation, clearly and sensitively explain to your patient that you cannot provide them with a note or form, along with the reasons why.
It is also important that physicians work with their patients to manage anxieties related to the vaccine and not enable avoidance behaviour. For example, for extreme fear of needles (trypanophobia) or other cases of serious concern, responsible use of prescription medications and/or referral to psychotherapy may be available options. Overall, physicians have a responsibility to allow their patients to be properly informed about vaccines and not have those anxieties empowered by an exemption.
What do I do if a patient has an expired health card or a red and white health card?
Due to COVID-19, the Ministry of Health has extended expired health cards and red and white health cards so that they remain valid. The Ministry has requested that health care providers continue to accept these health cards from Ontario residents until further notice, provided the card belongs to the person presenting it and the card passes Health Card Validation. If a patient does not have a valid Ontario health card, you should not turn them away. You can use the billing codes identified by the Ministry of Health for those without OHIP or another provincial health plan.
Why should physicians get vaccinated?
Having a fully vaccinated health-care profession is critical to minimizing the risk of COVID-19 transmission and/or outbreaks in offices, clinics and hospitals. Even if you do not feel sick, asymptomatic infection and subsequent transmission is possible. The COVID-19 vaccine reduces your chance of becoming infected and is one of the best ways to control the spread of the virus, and so getting vaccinated is an essential step to protecting your own health, the health of your patients, and the community at large.
This pandemic offers physicians an opportunity to lead by example. By getting vaccinated, physicians can help relieve the strain on our health-care system and support the health, safety, and well-being of the people of Ontario.
While the College recognizes that some physicians cannot get vaccinated due to medical contraindications, those physicians can still provide strong leadership on COVID-19 prevention and continue to advocate for full vaccination of all those eligible.
I’ve read about some drugs that might prove beneficial in treating COVID-19: Should I be prescribing these drugs as a precautionary measure? Can I prescribe them for myself or family?
No. Many of these drugs have an intended use and prescribing them as a precautionary measure has or may contribute to drug shortages, compromising care for others. Should these or other drugs prove useful in combating COVID-19, their use will need to be carefully managed to support those who need them the most.
At a time where resources may be scarce, actions like those mentioned above dramatically depart from the core values of medical professionalism, undermine the public trust in the profession at a time where the public is most vulnerable, and may contravene the College’s Physician Treatment of Self, Family Members, or Others Close to Them policy.
Professionalism and Complaints
What should I be thinking about as I engage on social media about issues relating to the pandemic?
Physicians are reminded to be aware of how their actions on social media or other forms of communication could be viewed by others, especially during a pandemic. Your comments or actions can lead to patient/public harm if you are providing an opinion that does not align with information coming from public health or government. It is essential that the public receive a clear and consistent message.
The College’s Social Media policy sets expectations for physicians to conduct themselves in a professional manner while using social media and to consider the potential impact of their conduct in the online environment on the reputation of the profession and the public trust. The policy also includes expectations for physicians sharing health-related information online. Additional guidance and resources can be found in the Advice to the Profession: Social Media document.