Update on Public Health Orders

CPSM received registrant feedback to our Public Health Orders Update from February 28. We want to offer further guidance to help you meet your professional obligations during this transitional phase of the pandemic.

As the provincial Public Health Orders and mask requirements are removed on March 15, it is prudent for medical practices to continue promoting mask use by staff, patients, and other visitors.

• Continue to use your medical practice’s mask and PPE policy. This includes wearing masks and appropriate PPE for physicians and clinic staff.
• Communicate your mask policy expectations to patients and visitors in advance (during booking, appointment reminders, and signage on the clinic door).

As physicians, you must ensure your patients receive quality medical care. Understandably, this requires some planning on your part to ensure the safety of your staff and other patients should a patient refuse to wear a mask. This can include:

• Have masks available for patients who arrive without one.
• Explaining why masks are required: for the protection of everyone in the clinic, including patients who may be at an increased risk for severe illness or death from COVID-19.
• Offering a virtual appointment if appropriate for their medical concern and falls in line with the Standard of Practice for Virtual Medicine.
• Offering appointments early or late in the day or during a quieter time slot to reduce contact with others.
• Asking patients to wait in the car and immediately rooming them upon arrival.

Physicians must apply their knowledge, skill and judgement to reduce the risk for everyone present at the clinic; however, patients cannot be denied in-person care. Following these steps allows you to treat patients with COVID-19 symptoms, with COVID-19, unvaccinated or those who do not comply with your clinic’s mask policy, under the same ethical obligations that apply to all patients.

This guidance is consistent with CMPA's direction. Read their FAQs on Face Masks for Patients. 

February 28 Update

The province downgraded the pandemic response level from Orange to Yellow on February 15, significantly removing Public Health Orders. Read the full list of updates here.

More Public Health Orders will be lifted in March. Proof of vaccination will be removed on March 1 and the use of masks is expected to be removed on March 15.

WHAT DOES THIS MEAN FOR YOUR PRACTICE IN A NON-INSTITUTIONAL SETTING?

While the Public Health Orders changing, the demands on the healthcare system are not completely over. CPSM encourages you to continue using the safety protocols you have come to rely on to protect yourselves, your patients, and your staff. However, the safety protocols must not restrict the access to care or the quality of care you provide.

• Continue screening protocols in your practice so you can accurately plan for in-person care. Screening must not restrict patients from receiving in-person care.

 E.g. A patient with a cough or sore throat must not be turned away. 

• Have a contingency plan for seeing patients in person with possible COVID-19 symptoms. Some practices set aside a window of time at the beginning or at the end of a day to see such patients.
• Patients must not be required to produce proof of a negative COVID-19 test to access in-person care. 
• Patients who are either unvaccinated, have COVID-19, or with possible COVID-19 symptoms must not be denied in-person medical care.

MASKS & PPE

Public Health recommends all persons continue to wear masks. You can ask and recommend staff and patients to continue wearing masks after the provincial requirements are lifted on March 15, however, patients who decline wearing a mask should not be denied in-person care. 

IF YOU PRACTICE IN AN INSTITUTIONAL SETTING

If you practise in an institutional setting, follow PPE guidance per Shared Health or institutional policy, which may vary depending on your practice and the clinical encounter.

VIRTUAL MEDICINE

The Standard of Practice for Virtual Medicine came into effect on November 1, 2021. Due to the rapid spread of the Omicron variant, CPSM relaxed the Standard temporarily, ending on February 15, 2022. CPSM members are required to resume in-person care. Virtual medicine should complement in-person care delivered.   

Review the Standard to ensure you are providing a blended model of care balancing in-person care with any virtual medicine provided. If you provide virtual medicine, you must have the ability to see a patient in-person, in a timely manner when required or if requested. The Standard’s intent is:

1. In-person care should be the routine medical care provided. Virtual medicine should be used to complement your in-person practice.

2. Timely in-person care is required when clinically necessary or if it is requested by the patient. 

3. It is not an acceptable standard of care to only practice virtual medicine. 

4. Practicing virtual medicine through online telemedicine companies does not likely meet the Standard of Practice requirements. Virtual Medicine through online telemedicine companies can only meet the requirements for good care if each CPSM member can provide timely in-person care – usually within 24 hours for family medicine/primary care– to a patient that is in their immediate geographic vicinity. This includes psychotherapy.

PRACTISING WHILE TRAVELLING

CPSM members who travel temporarily outside of Manitoba, must still adhere to the CPSM Standards in Manitoba.

Travel within Canada

If you are travelling within Canada, it may be possible to engage in virtual medicine with your patients in Manitoba only if you are able to provide an option for timely in-person care with a practice colleague when clinically indicated or if it is requested by the patient.

Travel outside of Canada

The same does not apply when travelling outside Canada.

There are privacy considerations and possible legal impediments to your patients’ personal health information being accessed anywhere outside of Canada (including the United States). The requirements of the Standard of Practice and providing good medical care cannot be met if there are privacy and legal impediments to accessing and creating your patients’ medical records and discussing personal health information outside Canada.

Furthermore, in many jurisdictions, this would also be considered as practicing medicine (in that jurisdiction) without a licence, which could create problems for you. Additionally, you may not have liability coverage.