What A Toronto Doctor Wants You To Know About How To Really Support Healthcare Workers

We know that healthcare professionals are putting themselves at risk every day just by showing up to work. Walk-in clinic doctors have their own set of unique challenges during the novel coronavirus pandemic as people turn to them for non-urgent medical support. After all, people still get bladder infections, sprain their ankles, and need to reorder birth control. But how do you treat a population that probably doesn't want to set foot in a doctor's office? What should people do if they get hurt or are sick with a non-COVID-19-related illness? Is it even safe to see your doctor?

The answers aren’t black-and-white, so we called up a doctor at a walk-in clinic in downtown Toronto. When we spoke, she had been wearing the same surgical mask for three weeks as her clinic waits on more personal protective equipment (PPE); there have been shortages across the country. Aside from her own health, this doctor is concerned that, as more and more patients put off seeing their GPs during the pandemic, there will be a serious ripple effect on an-already strained healthcare system.

Here, she talks about what people should do if they are feeling sick, how clinic doctors have been impacted by the pandemic financially, and what she really thinks of people banging pots for healthcare workers.

We're mostly doing telemedicine and seeing some people physically, but the volume of patients is significantly reduced. Where we used to see maybe 40 people in six hours, we’re now talking to 25, and over a 12-hour day seeing four people [in person]. Initially, at the end of March, it was a lot of COVID-19 questions. Now, there are a lot more people coming in with anxiety and insomnia.

Patients are scared to come in. Our nursing staff is really scared, too. There are a lot of mixed feelings, even within my own clinic. Some staff don't want patients coming in, but it's a lot easier to diagnose accurately in person. Diagnosing over the phone is hard. People don't know how to describe their symptoms. I had a guy who was like, "I have back pain," and then we found an abscess on his butt. Or I had a girl say, "I pulled my groin," and then she had a Bartholin cyst. It’s harder to catch those things. We can do the video consults, but not everybody is set up for that. Some people send photos, but sometimes it's hard to see in a picture.

Sometimes people overuse the healthcare system — particularly walk-in clinics — for things that could wait a week or two, like a strained shoulder. Stay home in those cases. On the other hand, people should definitely still go in if something feels serious. A lot of procedures, like scopes and screenings, are being reduced, but we can still do blood work.

No. The walk-in clinics will not see you. We don't do the testing. The testing guidelines have changed, so I'm not sure if they're still the same as they were a week ago, but right now if you're in the general population or you have minor symptoms, you're not going to be tested. Unless you're in the hospital, you’re a healthcare worker, you live in a shelter or a prison, or are in long-term care, if you’re not in any of those high-risk groups, we just don’t have the supply of tests. For most people, if you’re feeling symptoms, self-isolate at home for two weeks. If it’s more serious, then go to the emergency room or call a doctor to assess.

There's a screening desk at the front of the clinic. Before patients even come close to staff, they're asked "Do you have a fever? Do you have a cough, cold, sore throat?” Any sort of COVID symptoms. A nurse wearing a face shield and a mask and a gown will do the screening, then, depending on what patient's issue is or if they need blood work or to get a shot, and they don't have any symptoms of COVID, then they can be seen physically. Doctors wear masks at the clinic, but supply is really limited, so you’re wearing the same mask day after day. 

It feels a bit weird, to be honest. Sure, I’m a frontline worker, but I still feel like I'm quite removed. I'm not in the intensive care unit. I'm not having to see patients FaceTime with loved ones to tell them goodbye. It feels uncomfortable on the phone when patients are like, "Thank you so much for all you do." And I’m like, "I'm just doing my job." I feel like a fraud. When they clap, I feel like a fraud.

Advocating for us with the government is the best way. The hardest part for some doctors right now is that we're not getting paid. There are different models of paying doctors; doctors like me are fee-for-service. I get paid for every patient that I see. If I'm not seeing people, nobody's paying me. Before the pandemic, we didn’t get paid for phone consults. Now, the Ontario provincial government has developed these new billing codes that we can use. The problem is there's no money actually allotted to those codes yet. And it looks like we won’t get paid until June or July. That's a significant reduction in income. It's stressful.

For me, because I'm a new grad, my cost of living is pretty low. I can live off of what I’m making now. But for people who have their own practices, who have to pay staff, who own their homes, that's a big reduction. If you're an owner of one of these clinics and you have to pay staff, but you're not seeing patients, these clinics can't sustain being open.

What about the Ontario government’s pledge to offer advance payments to cover 70% of a clinic’s average income? Does that help? 

Not really. We’re expected to repay that money [over a five-month period beginning in November]. The problem is that our volumes are currently down. Listen, I know people don't care about us because we make a good salary usually, but our incomes have been slashed. My actual income at the walk-in is 50% reduced and the government's not providing any support for that. We can't pay back a loan if we're not seeing the same number of patients. We’d have to catch up. I can't double the number of patients I see to 80 people in a day so I can pay back the loan in a few months. It’s not realistic.

This is going to last a long time. We're not close to a vaccine. We really don't know that much. All of that is still up in the air. Obviously, self-isolating is important, but this is not something where in two weeks we’re going to be able to reopen everything. It's going to be a slow process. Right now, our ICUs are really busy. If we were to all of a sudden open everything and then things explode, our healthcare system would crash. We would be overwhelmed. It's important to keep in mind.

The coronavirus pandemic, and resulting economic downturn, has disproportionately affected some professions — doctors, nurses, teachers, small business owners, cashiers, and food-industry workers are just some of the folks on the front lines. Checking In is an ongoing series where we pass the microphone to workers in industries most impacted, and ask them what they want us to know about their hopes, fears, and needs right now. Click here if you want to participate.