In late March, the Centers for Disease Control and Prevention recommended that non-emergency medical providers delay routine or elective visits from patients to preserve protective equipment such as masks and to mitigate the risk of spreading covid-19, the illness caused by the novel coronavirus.
But there’s a gap between what’s elective and what’s not, with fear and misunderstanding filling the void. And there’s growing evidence that patients might not be visiting health-care facilities when they need to, avoiding doctors’ offices and emergency rooms, even in the most urgent cases, for fear of being infected with covid-19.
Although the novel coronavirus has dominated the news, other health problems have not disappeared. So, when should you see your doctor? And should you do it through an in-person appointment or telemedicine?
The first person to turn to for guidance is your primary care physician or relevant specialist. Keep in mind that some states have rules about which appointments and procedures can proceed. These rules vary and will continue to do so as some states ease restrictions while others maintain stay-at-home rules.
In addition to those resources, here are some general guidelines about how to proceed with your health care during the pandemic.
When should I go to the emergency room?
Doctors across the country have noticed that patients with heart attacks, appendicitis, and mild strokes are arriving later than they should to the emergency room. “We don’t want people to delay getting emergency care,” said Bruce Eisenberg, a Physician here at The Medical Group of South Florida.
You should go to the ER if you are experiencing symptoms that could be potentially life-threatening or cause harm if they are not addressed immediately. Examples of these symptoms include “chest pain, difficulty breathing, face drooping, arm weakness or speech difficulty, or acute injury or trauma,” Eisenberg said. Similarly, if you are in immense pain, you should not hesitate to call 9-1-1 or go to an ER.
When should I call my doctor?
Perhaps you’ve noticed abnormal swelling in one of your limbs, pain in your abdomen, a strange lump, or sudden weight gain. According to Eisenberg, ideally, you should call your health-care provider for urgent symptoms that don’t require an ER visit. If you don’t have a primary care physician, you might call or seek out a local urgent care clinic.
If patients with preexisting conditions have developed new, worsening symptoms, Eisenberg often needs to see them in his office. These would be patients who have medical issues such as hypertension, diabetes, high cholesterol, heart disease or kidney disease, along with a change in health status, such as swelling in the legs, shortness of breath, chest pain or a temperature. “With an acute illness on top of chronic, it’s really hard to evaluate in an appropriate manner through telehealth,” Eisenberg said. He prefers that such patients call the office instead of emailing or using a patient portal, so he can triage over the phone and probably have them come in.
Specialists are also seeing patients for ongoing or urgent issues, so you should not hesitate to call their offices, either. Miral Subhani, MD focused on Gastroenterology is still assessing patients in the office. “We call some of our patients ‘frequent fliers,’ ” she said. “There is still a high demand for preventative procedures”. For those people, we definitely worry that they won’t come in, and we’ll have been rescheduling those whose procedures were postponed. For those cases, I would say, ‘We are available, and we want to take care of you.’ ”
Which in-person appointments should I keep?
Certain health issues will require an in-person visit, said Anthony Addesa, the Director of Radiation Oncology at The Medical Group of South Florida. “Some things just don’t work well for telehealth,” he said. “Anything needing a physical examination, or a formal assessment before treating, needs to be done in person.”
Patients receiving cancer treatment or those who are on dialysis also need to go to all their regularly scheduled appointments. Other regular health-care visits may require careful discussion with your provider. If you are unsure whether your appointment qualifies as essential care in your state, call in advance.
Which appointments can be done via telemedicine?
Telehealth is good for managing chronic conditions, especially because some patients with such conditions are in the high-risk group for covid-19. “People still need to have diabetes and hypertension managed,” Eisenberg said. “This is a wonderful opportunity for the use of telehealth to make sure care is not interrupted. We want to make sure they have avenues to get care.”
For patients with chronic conditions who will be coming in for visits less frequently, Eisenberg is encouraging them to order blood pressure cuffs, glucometers and scales if they do not already have this equipment at home.
Virtual appointments are particularly useful for postoperative patients or for those who have conditions such as Crohn’s or colitis who might need simple adjustments to their care. Similarly, patients who regularly see a mental health practitioner can usually convert to telemedicine appointments; many psychiatrists are still seeing patients virtually during the coronavirus pandemic.
If you simply have questions for your doctor, telehealth may also be right for you. Eisenberg has patients with respiratory issues who are using telemedicine to ask how they should approach the pandemic. “Telemedicine is more about advice, or where they are with their symptoms and concerns they may have,” he said. “For many, it’s a great way to ask their questions. A lot of my patients with asthma ask about their risk of getting or developing complications with covid, which I can address over the phone.”
For nonemergencies that may require in-person care, you may also start with telehealth. “We are trying to triage everything through telemedicine,” said Eisenberg. Are they having other systemic issues, as well? Are they sick?” This helps determine if a patient needs an in-person visit.
Which routine appointments should I reschedule?
If you are generally healthy, have no imminently concerning symptoms and have an upcoming physical with your primary care provider, it’s okay to reschedule that appointment for a short duration. “We are trying to give patients options with their regular, routine appointments,” Eisenberg said. “Some patients do not want to do telehealth and have said, ‘I will come see you and get my labs when I feel comfortable.’ ” In these cases, you or your doctor should reconnect in one month to see where you’re at or if you have new symptoms.
Routine cancer screenings for cervix, lung, breast, or colon cancer can also be postponed — unless you are having symptoms that may raise a red flag, such as a lump in the breast or bloody stool, for instance. In this case, you should talk to your doctor, who may order a screening test. If your screening is canceled, make sure to reschedule it as soon as possible when restrictions in your state ease up.
What precautions should I see at the doctor’s office?
If you are going in to see your doctor for a physical visit, call in advance and ask for guidance, if you are concerned. The medical facility can tell you which door to enter, what you should do when you enter, and they can educate you about the check-in process. At The Medical Group of South Florida, it is required that everyone wear a face covering. In addition, all medical staff is frequently washing their hands and practicing social distancing.
Everyone who visits our offices is screened. They are met at the door by someone who checks their temperature and asked appropriate questions. Then, and only then are they allowed to enter our office. Whether in the lobby or in a room, patients remain socially distant from others at all times.
Wherever you go, health-care staff should be monitoring their own potential covid-related symptoms before every shift and wearing appropriate face masks or other relevant personal protective equipment. If you have questions about the measures your doctor or health-care provider is taking to protect patients during the pandemic, please give us a call at 561.622.6111.