Last week, I received a call from a patient whom I have known for many years. “I heard you are opening up the office soon. Should I come in for my annual check-up?” she asked. She is in her mid-80s, and suffers from diabetes, chronic emphysema, and congestive heart failure. I missed seeing her, and I know she finds our visits reassuring, but I said that we should discuss the risks and benefits of her venturing out right now.
Many doctors’ offices, after a period of offering exclusively phone and video visits, are starting to resume some in-person care. Which is best for you? How are physicians deciding whom to see in the office? What measures are being taken to ensure your safety in the doctor’s office during the COVID-19 pandemic?
Now that we know more about the way COVID-19 is transmitted and have some standard distancing and hygiene practices to aid in prevention, medical offices are better equipped to reintroduce some traditional care. With continued high prevalence of infected patients, and those who carry the virus without symptoms, this is being done with careful thought and planning.
Telemedicine required that we familiarize ourselves and our patients with online communication platforms; reopening the office has a new set of challenges. We are rearranging the layout and adapting how many patients we see and how we work so that we can maintain recommended social-distancing guidelines. Protocols are in place for sanitizing exam rooms, and we all wear personal protective equipment, including masks, gloves and gowns, that are changed for each new patient.
We tell our patients they must wear masks, and may have their temperature checked on arrival. If you have a fever, cough or other symptoms which may suggest COVID-19, or other contagious illness, you might be evaluated and tested in a designated area, or referred to another site that is better equipped to protect you and the clinical staff.
These measures will reduce risk, but cannot eliminate it, so the decision on whether to go to your doctor’s office should be thoughtfully shared by clinician and patient. The first criterion is deciding whether your concern could be handled through telemedicine. For instance, the video screen may clearly demonstrate some skin conditions. Blood pressures and blood sugars, for patients who monitor them at home, can be verbally reported. Severe pain, lumps, and neurologic symptoms, in contrast, will usually require a careful physical examination, as will the evaluation and management of some complex conditions.
Next, there should be an assessment of your risk for severe consequences of coronavirus infection. Elderly patients, or those with chronic conditions or impaired immunity, should especially avoid nonessential, in-person care if at all possible.
The most important thing to remember is that the setting for clinical care now and for the foreseeable future is not one size fits all. Your doctor may be seeing some patients in the office, but that may not be right for you. If you and your doctor decide that an office visit is appropriate, make sure to ask what precautions the office is taking for your safety while COVID-19 is still in our midst. And if you do return to the office, keep in mind that it may not look quite as you remembered it.
As for my 80-something patient? After careful discussion, we decided a virtual visit was still best for her. I look forward to the day we can meet in person.