3 minute read
Doc in a box
Dr. James Purnell is addressing the physician shortage in Wollaston Lake head on through remote presence technology
By Maria Ryhorski
Adequate physician coverage is an ongoing struggle in many remote communities in northern Saskatchewan. Through a partnership with Northern Medical Services, Dr. James Purnell is helping change that for the residents of Wollaston Lake using remote presence technology, less formally known as “doc in a box.”
Wollaston Lake is located 550 kilometres northeast of Prince Albert and is only accessible by air or winter roads. Previously, physician coverage was sporadic, with as many as two thirds of planned physician clinics cancelled due to weather and other factors that rendered landing a plane impossible.
“What made me try this is that, when Northern Medical Services approached me, Wollaston had been without physician services for two months prior,” says Dr. Purnell. “There is an acute physician shortage.”
While he admits that a remote presence is not ideal, it is a great deal better than nothing. Using “doc in a box”, a solution similar to telehealth, Dr. Purnell is able to hold a weekly clinic in Wollaston Lake. Dr. Purnell can access the system from anywhere with a cellphone connection, and patients see him and interact with him on a screen. On the ground in Wollaston, clinic staff act as his hands as he examines the patient using a variety of peripheral attachments.
“I have access to a Bluetooth stethoscope, so whatever the nurse hears in the exam, I can hear,” he says. “I have the audoscope, the ophthalmoscope and a dermatocope that plug in digitally so I can do your nose, throat, eye and dermatological exams. So I run it as a full clinic, providing a full day of clinic time to one dedicated community.”
To date, this technology has primarily been used in acute care. Dr. Purnell’s application of it – to provide a regularly scheduled primary care clinic to a community that would not otherwise have physician coverage – appears to be the first of its kind in Canada and possibly even the world. He also flies to Wollaston Lake once a month to provide care in person and to build relationships with the clinic staff – something he considers critical to the success of this program.
In his experience, if an interaction between local staff and the physician is negative, the staff will be reluctant to use the technology again. In addition, the lack of face-to-face contact has the tendency to amplify the potential for a negative interaction. “So you have got to be able to answer the phone at two in the morning with a smile on your face,” advises Dr. Purnell.
If this program is expanded to provide care in other remote corners of the province, he suggests that the personalities of the physicians who will be involved should be a primary consideration. “You have to be really selective about who those early adopters are and what their personalities are like, because they have to come across as both collegial and helpful when working with nursing staff and the rest of the team.”
Payment is one of the barriers to using this technology to alleviate physician shortages in northern communities.
“There is still no billing code for the work that I do,” says Dr. Purnell who, as a salaried physician, is able to continue virtually “seeing” his patients in Wollaston Lake. However, fee-for-service colleagues have limited billing codes for reimbursement of this type of service. Currently, in order to be reimbursed for providing virtual care, doctors and patients must both be located in a government-approved telemedicine facility. Using “doc in a box” to provide care from more convenient spaces such as a physician’s office, home or hotel room, as Dr. Purnell does, is not covered. This is a gap that the SMA is working with the Ministry of Health to address.
In the meantime, Dr. Purnell, Wollaston Lake’s resident docin-a-box, continues to nourish relationships with his colleagues in the north with a monthly Costco run for fresh fruit and vegetables to bring with him when he visits. “A little bit of food never hurts, you know? You can win hearts and minds with food. I really appreciate the work they do for me.” ◆
