Doctor kneeling with metal shield

While all of us were in lockdown, Tirmizi faced COVID-19 head on as a family physician and a doctor in long-term care. She talks about her experience, and explains why med tech is so essential.

My memory of the pandemic starts in the beginning of 2020. I remember reading multiple academic articles about how this new virus Coronavirus–19 in other parts of the world was slowly moving here. Being the lead physician of our family practice in Pickering, Ont., I panicked and almost felt a bit paranoid ordering hundreds of surgical masks and gowns for our clinic. The SARS stories from the early 2000s haunted me.
February was a typical month: coughs and colds, influenza outbreaks in my long- term care homes and many unfortunate but expected deaths. Little did I know, our start to March was going to take an unexpected turn. Many physicians are often grateful for the slowdown after “flu season,” as spring starts and our offices have catch-up time. March 2020, however, took us in a completely different direction.  
In those early days, I received an email from the chief of staff of Lakeridge Health, Dr. Tony Stone, asking for interest in participation in the COVID Planning Committee for Durham Region. As the primary-care lead for the Central East Local Health Integration Network (CE LHIN), I felt it was my duty to get involved, so I raised my hand not knowing what was around the corner. I remember meeting in the corporate boardroom of Lakeridge Health with experts from all sides of the health sector in Durham. We had no masks and we weren’t practising social distancing. There was no hand sanitizer or signs down every corridor — it was pre-pandemic life. There was an insightful planning discussion led by Lakeridge, Durham Public Health and others. Dr. Robert Kyle, Durham’s medical officer of health, really stood out to me. It was like he had lived the “pandemic experience” before, whatever that meant. He was poised, organized and informative. As a family physician in the community, I felt a little alone as we often travel without a team. We have a lot of people and patients to serve in the community, but we are not really employees of the hospital, long-term care or public health. I felt it was my mission to gather this valuable pandemic information and deliver it to my many colleagues and patients. The problem, however, was there was hardly any information. No experts had been through this before; it was new to all of us. I left the meeting thinking, “We have a lot of work to do.”
The rest is history. Each week since mid March has meant three or four virtual meetings for the regional command tables for Durham, the COVID executive committee, the response partners and many working groups. At times, these meetings have slowed down, but the work continues — there are reviews of COVID testing centres, updates from public health, home and community care, infection prevention and control, and finally primary care. I have gained a new level of respect for every level of command in each sector of this pandemic. And then there’s long-term care. I remember the Orchard Villa outbreak — it’s so close to my clinic. The orchestration of care and compassion was unparalleled. Lesley Motz, Dr. Joel Kennedy and their team from Lakeridge Health, alongside the amazing staff at CE LHIN, guided the road to recovery from COVID.
You’ll remember that mid March also brought the “lockdown.” What did that mean for all of us community physicians who were not hospital-based? We took inventory of our personal protective equipment. We started chat groups online to get our staff and doctors coordinated. We activated alternative phone lines and updated our answering machines. We sought guidance from our go-to sources such as the Ontario Medical Association, provincial and national colleges and others. We wanted to make sure our patients could reach us and feel safe, even if it meant virtually. 
Health express cellphone with apps

“The lockdown also birthed an incredible amount of telemedicine solutions; we as doctors scrambled to see which ones actually worked and did what we needed it to do.”

The lockdown also birthed an incredible amount of telemedicine solutions; we as doctors scrambled to see which ones actually worked and did what we needed it to do. Many doctors who work fee-for-service suffered enormous income losses, along with the rest of the workforce. For me, it became clear that I’d need to stick to a system that worked for our clinic and our patients. We started using OTN (Ontario Telemedicine Network) visits, but the platform, as expected, was slow — it’s free and everyone was thinking along the same lines as we were. I slowly started seeing the gaps in med tech as the pandemic unfolded over the next few months. Could it be filled? There were so many questions.

Since 2018, I have been working on connecting the dots in information sharing in healthcare. Why could patients not be the CEOs of their own health? Why could a regular family doctor like me not have access to all records for my patients? This became more important than ever during the pandemic. At times, I have felt so disconnected from my patients. I soon realized that the work I’ve been engaged in for Health Espresso Home for the last two years, I took for granted. Rick Menassa, the founder and CEO, and I (as chief medical officer) spent the last two years with our development team led by Amit Maraj, trying to solve the puzzle of connecting the patient, home care and physician ecosystems. Suddenly during the pandemic, it all made sense. Health Espresso is not a mobile patient portal — it is a way for patients and their world to connect to their health system. Rick and I spent so much time with our wonderful development team listening to patients (special acknowledgement to Randy Filinski, an Ontario health patient and family advisor) and caregivers on what they wanted to report to their medical team, be it their oncologist or family doctor. We did not stop there. We researched the needs of all providers — physicians, nurses, personal support workers, dentists, etc. — and implemented this feedback into Health Espresso.  

Where are we now in this pandemic? I am like you — I wear masks and listen to instructions from public health experts. As a doctor in Durham, I stand proud — we as a health system and community have come together; we’ve supported each other during each death we’ve faced, whether it be family members or patients. We’ve learned technology like Health Espresso can go the extra mile and connect the dots. We will continue to learn from this technology and from each other. And we’ll hope we beat this pandemic and come out stronger, smarter and safer. 

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