Dear Dr. Laberge, Ms. Brisson, Mr. Arcand,

We listened with great interest to the comments of Dr. Christiane Laberge, Ms. Catherine Brisson, and Mr. Paul Arcand on Mr. Arcand’s 98.5 FM broadcast on Tuesday, October 25, about the issue of online health care. We wish to address the issues raised during the discussion in this post.

Of course, we should always have a careful and critical look when a new service is offered in the field of health. However, the service offered by Dialogue in Quebec, telehealth, has long existed elsewhere in the world and even in other Canadian provinces. It is a tool that has proven itself and is becoming increasingly common, especially for patients in remote areas or who have physical or other constraints which make travel difficult, or who simply do not require a physical exam and can therefore receive health care without losing valuable time in a clinic waiting room or in emergency.

Medicine, just like all other aspects of our lives, is being transformed by technology to accomplish more by making care more accessible and reducing costs. Investments by our governments have made possible telehealth videoconferencing in 98% of hospitals across Canada and, increasingly, in many regions. Moreover, world renowned medical institutions, such as Kaiser Permanente, believe that there will be more virtual visits than visits in-person by 2018.

In this spirit, the Collège des médecins du Québec in 2015 sought to ensure that telemedicine and the use of information and communications technologies should be done in an environment conducive to a significant improvement in the quality of professional practice and the protection of the Quebec public. They therefore issued the guidelines, “The Physician, Telemedicine and Information and Communications Technologies”, which our company complies with to the letter:

  • The privacy and security of medical information meets national standards established by Canada Health Infoway.
  • As indicated in the Collège document, “When a physician provides telemedicine services, his liability is no different than that assumed in his other professional activities.”
  • Teleconsultation allows for a partial physical examination, given that health professionals see the patient in front of them on a screen and can interpret nonverbal signs, assess wounds, and see the state of the patient. Furthermore, during primary health care visits, we know that in 30% of consultations there is no physical examination, including for example the vast majority of visits for mental health reasons.
  • For all cases where teleconsultation is not the appropriate service, we have protocols in place to redirect patients — just as a practicing physician in a physical office would do in sending a patient for specialized tests not available in his office.

Furthermore, each clinic defines its own capabilities and prescribing opiates and benzodiazepines is not part of the services we offer — even if there are already in existence telemedicine clinics for monitoring substance abuse patients. Our approach is that caution should be exercised at all times.

Despite the fact that we do not offer a physiotherapy service through our virtual platform, the literature has shown the advantage of this type of consultation for patients following a stroke.

In conclusion, the Dialogue team offers a range of health care services in telemedicine in a safe manner by recognizing the appropriate scope of practice for telemedicine, by adhering to safety standards for electronic data, and by respecting the professional rules and standards in effect in the province.

If you have questions about our virtual platform, we would be happy to meet with you to discuss it further.

Yours Sincerely,

Natalie Anne Skinner, MD
Medical Director, Dialogue
Family Medicine (McGill 2008)
Fellowship in Emergency Medicine (Université de Montréal 2009)
Diploma in Practical Dermatology (Cardiff 2014)

Dr. Natalie Skinner