Telehealth Ontario: Is it doing more harm than good?

by Hans on 2007/01/17

A while back, I wrote about my experience using the Telehealth Ontario service. In my particular case, my experience was satisfactory.

As I understand things, Telehealth Ontario is meant to be a service that “can help you decide whether to care for yourself, make an appointment with your doctor, go to a clinic, contact a community service or go to a hospital emergency room”. Basically, the service is meant to advise people on whether they should wait to see their physician or go to the local emergency department (ED/ER). I think the rationale is to decrease the number of inappropriate visits to the ED/ER and (hopefully) decrease costs.

So far so good, right? Since I posted my experience, I’ve received several comments on the service both in support of and against the service (see the comments section at the bottom of the post). I’ve been mostly non-judgmental about the service so far, but a recent comment has made me wonder. “Dazed” shares his recent experience:

Disastrous.

We have a 6 week old daughter. Last night she was crying in a higher pitch than normal, and had not urinated in about 6 hours. My wife asked me to call telehealth for the first time. The “nurse” who answered started with questions about my daughter who essentially stopped crying about a minute into the call. She asked a question, I would give an answer and she would ask again. It became pretty apparent to myself my daughter was ok as she really didn’t have any symptoms. However the nurse kept asking similar questions. She then asked how often my daughter was feeding and I replied every hour or two. The nurse then about 5 times said every few minutes is too much. She wouldn’t listen to me. Eventually I grew frustrated and basically let her answer her own questions. Eventually she came to the conclusion my daughter was dehydrated. (Even after I had explained she had fed normally and had a dr. checkup 3 days previous and my daughter had been putting on weight very well). The nurse came back and said that I needed to get her to a hospital. I was a bit exhausted of her and frankly my daughter seemed ok just a bit cranky. To get off the call I finally said I would take her to an emergency centre.

This is where it gets bad. The phone rang about 3 minutes later, my wife answered and the nurse asked if we were taking my daughter to the hospital. We had spoken after I got off the phone, and we felt she was ok but would watch her. My wife said no to the nurse. The nurse immediately started asking about the welfare of the child, and why we were not going if I had said I was going to emergency. This went on for about 5 minutes when my wife, again to get off the call said we would visit a hospital.

My daughter calmed down, had a wet diaper and a stool movement and fell asleep.

2 hours later at 12:30 in the morning we get a call from CHILD SERVICES stating they had been contacted from Telehealth nurses and were fearful for my daughters safety. That we needed to report to an emergency room immediately and have a hospital official contact Child services that we had indeed arrived. We argued slightly but really just wanted this nightmare to go away. We asked for the nurses names and headed to the emergency room. Upon arrival we explained ourselves to the triage nurse who upon examing our daughter said this is a waste of time, that our daughter was fine, she said we seem like nice people and she called the Child services number. At first nobody answered. We had to wait 30 minutes (In the emergency room of a large Toronto hospital with a 6 week old infant-germs apparently had not entered the telehealth’s nurses thoughts) for a child care rep to call back. The triage nurse said “what is telehealth doing, this child does not need to be here.” The child services basically said the nurse at telehealth said the baby was in danger. The triage nurse said we were free to go, that if we wanted to we could see a doctor but it wasn’t necessary. By this time feeling we were awful parents, we stayed for 2 hours waiting to see a doctor just to be sure. By this time we scared to take off my daughter diaper, just to “prove” she had now urinated, nothing seemed wrong. The doctor finally arrived, we explained our evening. He laughed and said telehealth and child services do this alot. He inspectect my daughter for 30 seconds, my daughter urinated on the examination table. The doctor appologized for us having to come in and said my daughter was fine.

So it ends. No today child services calls and say that they have to come with a nurse to inspect our home and give our daughter an examination. They said they can only come during working hours. Now I need to miss work. They have to have someone inspect my home. I am sure this is recorded by either health canada or the provincial government. I believe our family doctor needs to be contacted.

Obviously I have contacted an attorney, and have been advised to have someone in the house with us when the inspection takes place.

Could anyone help me in the sense that has anyone else gone through something like this. It is humiliating. If anything we are new parents, likely overly cautious, phoned telehealth for information and an opinion. Because of a 5 minute telephone call, poorly asked questions and not listening to answers, it has turned into a weeklong and now possibly litigious affair.

I will NEVER consider calling again. And by the way most nurses and doctors in emergency centres I have spoken with today, Telehealth is a massive burden on emergency rooms, doing the exact opposite of what it was attended for.

Do I have legal recourse?

All I can say is “wow”. I don’t know what exactly happened, but this recount sounds quite crazy. What exactly is Telehealth Ontario’s boundaries, responsibilities, and/or expectations? From the few accounts I’ve read, Telehealth Ontario seems to provide limited value as a service – it works for some, but may be a burden to others (like the ER docs or the family in the quotation above).

In all fairness to those who work at Telehealth Ontario, they probably don’t have the freedom to use their own judgment and determine which cases don’t need to be followed-up or not. I suspect that staff are required to follow some sort of script and aren’t allowed to deviate from the script for fear of litigation and other liabilities.

Regarding Dazed’s case, I don’t know if this incident is an exceptional case where the “system” seemingly has broken down somehow, or whether this example is Telehealth Ontario “in action”. I’m not blaming the Telehealth Ontario staff – they have guidelines to follow and are doing their job. The issue is that when we build a system with inflexible rules, there are no opportunities for common sense and good judgment to be applied.

As for specific advice for Dazed, I’m not really sure what to say. The hassles that you will most likely go through are really unfortunate. Your idea to have an attorney present is probably prudent just in case something really goes awry. If things don’t get resolved to your satisfaction, I’d probably recommend making some noise by trying to reach someone at the Telehealth Ontario offices, then contact either your local politician (both Provincial and Federal), and perhaps even contacting a reporter to see if they can help in some fashion – if not for yourself, then to prevent this type of incident from happening again. Other than that, I really don’t know what else to suggest.

To close this post, I’m not passing judgment on the telehealth service. I believe that the concept of a “free, confidential telephone service you can call to get health advice or general health information from a Registered Nurse” is an excellent one. My experience as an evaluator has taught me that much of the challenges lie in the implementation of the idea. Another item that is somewhat concerning would be the complains and comments from health care providers. Something needs to be done to address these concerns to make the service better. My question still remains: is Telehealth Ontario doing more harm than good? If we don’t know the answer, then maybe we need to find out.

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