Quebec patients seeking to book appointments with their doctors will soon find they have to answer questions about their symptoms generated by artificial intelligence — some of them highly personal — before potentially being referred to another health professional.

There with you then. Here with you now. As a critical part of the community for over 245 years,The Gazette continues to deliver trusted English-language news and coverage on issues that matter. Subscribe now to receive:

Unlimited online access to our award-winning journalism including thought-provoking columns by Allison Hanes, Josh Freed and Bill Brownstein.

Opportunity to engage with our commenting community and learn from fellow readers in a moderated forum.

Support local journalists and the next generation of journalists.

Montreal Gazette ePaper, an electronic replica of the print edition to view on any device, where you can share and comment..

There with you then. Here with you now. As a critical part of the community for over 245 years,The Gazette continues to deliver trusted English-language news and coverage on issues that matter. Subscribe now to receive:

Unlimited online access to our award-winning journalism including thought-provoking columns by Allison Hanes, Josh Freed and Bill Brownstein.

Opportunity to engage with our commenting community and learn from fellow readers in a moderated forum.

Support local journalists and the next generation of journalists.

Montreal Gazette ePaper, an electronic replica of the print edition to view on any device, where you can share and comment..

There with you then. Here with you now. As a critical part of the community for over 245 years,The Gazette continues to deliver trusted English-language news and coverage on issues that matter. Create an account or sign in to continue with your reading experience.

Access articles from across Canada with one account.

Share your thoughts and join the conversation in the comments.

Enjoy additional articles per month.

Get email updates from your favourite authors.

Create an account or sign in to continue with your reading experience.

Access articles from across Canada with one account

Share your thoughts and join the conversation in the comments

Enjoy additional articles per month

Get email updates from your favourite authors

Sign In or Create an Account

Calling with a suspected urinary tract infection? Medical receptionists now have to follow an AI script that includes questions like ‘Are you pregnant?’ ‘Do you have a urinary catheter?’ or ‘Have you had unprotected sex with a new partner?’ that possibly suggests visiting a pharmacy instead.

The Quebec government is rolling out the Navig platform in family medicine groups across the province, making it mandatory for clinics under the new GMF contract. The system is supposed to save time for receptionists, triage appointment priority, and redirect patients to alternative health professionals depending on their responses to the prompts. According to its website, Navig promises to “add the equivalent of two medical secretaries and three professionals to your clinic thanks to AI,” and “redirect (patients) to the right provider, at the right time, in less than 60 seconds.”

Although the intentions are noble, some Montreal clinics where the filter has been deployed say the new tool does not live up to the hype — and is not going over well with either staff or patients.

“It’s utterly useless,” said Dr. Mark Buch, a family physician who is the medical director and co-owner of Santé Mont-Royal, where Navig arrived in January. “You’re creating yet another barrier to access for patients. Patients aren’t fond of the idea when we tell them ‘Well, you don’t need to see a doctor for this problem.’ They’re very upset because they want to see a doctor. Second of all, you’re asking non-medically trained personnel … to ask very, very personal questions. And they want us to ask these questions when patients call by phone or when patients come in person for an appointment.”

Tina Donaldson, the office manager at Santé Mont Royal, said it’s awkward for receptionists to have to quiz patients about their symptoms. Doing so in front of a crowded waiting room can also compromise confidentiality.

Hanes: The bitter pill of a doctor deal at the 11th hour

Hanes: Quebec's new health minister has her work cut out for her

Advertisement 1Story continues belowThis advertisement has not loaded yet, but your article continues below.document.addEventListener(`DOMContentLoaded`,function(){let template=document.getElementById(`oop-ad-template`);if(template&&!template.dataset.adInjected){let clone=template.content.cloneNode(!0);template.replaceWith(clone),template.parentElement&&(template.parentElement.dataset.adInjected=`true`)}});

“If someone has mental illness, it asks them do you feel like you’re suicidal. A lot of my staff is not comfortable asking ‘Are you suicidal, do you think you might harm yourself or others?’ It’s more something that should be asked by a nurse or a more qualified person,” Donaldson said. “One was (about) vaginal discharge if someone had a yeast infection. You would ask them if there’s an odour, if there’s a discharge, had they had sexual relations recently.”

Going through the AI checklist, is also turning into a time suck rather than a time saver.

“They said that it takes one and a half minutes to do the questionnaire, but that’s not the reality of it,” Donaldson said. “That’s what they’re telling you, it’s a yes or no question, but patients don’t always give yes or no answers. They kind of go into a whole story and it’s longer.”

Dr. Andrée Vincent, who is the GMF lead at Clinique Medic-Elle, said some patients are already resistant to sharing their health concerns with anyone other than their physician. Now they are giving the medical secretaries grief over the invasive questionnaire, which is demoralizing for staff.

On top of that, she said the information being collected is not helpful to her as a doctor when she finally sees the patient.

“It’s like we asked for a drill and they gave us a hammer,” said Vincent. “This isn’t really a tool that we needed at this point. If we could lower the volume of calls so that we’re not so rushed and we can actually take the calls for people who are really concerned and have complex questions, and we can help them thoroughly rather than rushing through our phone lines — great! But a lot of (staff) are like ‘I don’t really understand why I have to use this tool when I know confidently that I could have booked multiple patients in that time frame.’”

Implementing Navig is a preliminary step in the broader adoption of the Votre Santé platform, a single online entry point to front-line health services, said Marianne Paquette, a spokesperson for Santé Québec. The tool must be used for all appointments being booked at GMFs or through the Guichet d’accès au première ligne, which connects patients who don’t have a family doctor with clinics that have appointments available.

The government is covering the $20.6 million cost of the technology.

So far Navig has been set up in about 500 clinics across the province, with plans to implement it in 650 by the end of June, said Bertrand Bolduc, general manager of vitr.ai, the Quebec-based company that developed the software.

The ultimate goal, he said, is to free up precious appointments with doctors and optimize access to care in a health system where getting seen is often difficult and physicians are overburdened. The filter is customized for each clinic and can redirect patients to other professionals internally, like nurses or social workers, or to outside resources like emergency rooms, CLSCs and pharmacies.

“If (patients) call the clinic to see a doctor, they have a good reason. And I would say 80 to 85 per cent of the time they’re right,” said Bolduc, former head of the Ordre des pharmaciens du Québec. “But between 13 and 18 per cent of the time, they could be handled by somebody else.”

About 1.6 per cent of cases are sent to the emergency room. For instance, he said the possible UTI scenario (one of the longest questionnaires with up to 14 steps) could send a man also experiencing back pain to the ER on suspicion of a kidney stone, which wouldn’t be treated at a clinic anyhow. So there would be a savings of time and resources.

In addition to liberating appointments with doctors, Bolduc said Navig collects anonymous data that can be used to analyze what GMFs need.

“If you use it properly for everybody, it’s going to measure the care demand that you get. And we’re going to tell you how to improve or fine-tune your care offering,” Bolduc said. “We’re going to give you the data to say ‘Hey, Santé Québec, we need a nurse.’ ‘Hey, Santé Québec I need a physiologist.’ ‘Why do you need one?’ ‘Well look at my results for the last three months.’ But if you don’t ask the questions, if you don’t know what’s coming in, you’re never going to know what you need to put forward in terms of care offerings.”

Dr. Michael Kalin, a family doctor who owns Santé Kildare, said his clinic got Navig last week and there have already been a few unexpected outcomes generated by the AI tool that staff had to override. A parent calling to make a well-baby checkup was urgently referred to a CLSC and a patient calling about back pain was redirected to a physiotherapist when what they really needed was pain medication.

“It still requires a heavy human touch — and not in a good way. It takes away human decision-making and let’s say input and it’s just replaced with a human typewriter,” Kalin said. “I think we can recognize that this idea is maybe a good one, but it seems silly to be forcing it upon us when it’s really in its very early stages of development. I would hope that the system can learn and then we can gradually implement it. But what I’m trying to express is the frustration the GMFs are feeling and the aggravation that patients will express.”

© Montreal Gazette