Letter to the Editor: A Modernized Approach to Rural Medicine in Uncertain Times

Being a physician in a rural community means I care for people at every stage of life and in every type of social demographic. I provide pediatric, adolescent, adult and geriatric care. I serve populations including LGBTQ+, Indigenous, those with precarious housing and victims of abuse. I do hospital inpatient work and house calls. I work in senior’s facilities. I also provide palliative care for patients at the end of their lives. In short, I’m a “country doc.” Every day is different — and that’s the way I like it.

It’s why I moved to a rural practice in Eastern Ontario in the first place. Working as a family physician in a bigger city like Ottawa, I found I was spending my time playing traffic cop — referring patients to one specialist or another — and I wanted to use the skills and training I had worked hard to develop while collaborating with patients and other providers, including medical specialists, physical therapists, mental health workers and pharmacists.

Even though more than six million Canadians live in rural communities, there aren’t enough health care professionals who want to live in the country. Specialists are frequently clustered in city centres and team care is often unevenly distributed. There just isn’t the same level of access to medical care and services outside of urban centres. This has become even more apparent as the COVID-19 pandemic has spread, and the resulting need for physical distancing has made in-person visits with health care professionals more challenging.

One way we are closing the gap is through innovative digital technologies. Where once there was no other option than to drive 100+ kilometres to see the doctor, now some chronic conditions can be monitored through Bluetooth devices and consultations can happen through a secure telehealth platform. This has also opened the door to virtual visits with specialists to determine if in-person care is needed, saving patients time, travel and the associated costs.

At our practice, we use a secure online platform to share test results with patients. In addition to the convenience this can offer, patients also tend to feel more empowered and engaged with their health care planning.

Additionally, our clinic has begun using e-prescribing. With PrescribeIT, a secure, online prescription service from Canada Health Infoway, prescriptions are transmitted digitally from the clinic to the pharmacy.

PrescribeIT reduces the need for in-person physician or nurse practitioner visits and enables vulnerable populations to limit their time outside, thereby reducing their risk of infection at a time when we’re all being encouraged to stay home. Following the virtual consultations with my patients, I send prescriptions electronically to the patient’s pharmacy of choice and, often the prescription is ready to be picked up when they arrive at the pharmacy. Pharmacies can also request prescription renewals electronically, so there is no need for another visit with a physician and there is no delay as there is with fax.

Even as urban centres continuously grow and densify, there is no indication that rural communities are getting any smaller. What digital health can do is bring us closer together, reduce our distances through virtual options, and improve the way we work together. This team approach in patient safety and care is especially critical during times of crisis like we’re currently facing with COVID-19.

These modernized approaches help bring our community of health care professionals together, communicating and collaborating with our different experiences and perspectives, but always with the goal of providing the best care for patients.

Dr. Marilyn Crabtree is a family physician in Morrisburg and Ingleside, Ontario. She holds leadership roles at the St. Lawrence Medical Clinic, Winchester District Memorial Hospital and previously at the Champlain Local Health Integration Network. She is a member of Ontario’s Provincial Council for Maternal and Child Health, and a vocal advocate for digital health and patient access to care in rural communities.