Is it safe to see my doctor?

One of the indirect health costs of the COVID-19 pandemic is that fear of infection has caused many patients to delay non-COVID-19 related healthcare visits. Stay-at-home orders in many States and, in the case of millions of newly unemployed Americans, the loss of healthcare coverage, have resulted in the postponement (or, in some cases, avoidance) of treatment.  

For example, a study by the Centers for Disease Control and Prevention found that emergency room visits nationwide fell 42% in April. And a Harris poll sponsored by the American Heart Association found roughly 1 in 4 adults experiencing a heart attack or stroke would rather stay at home than risk getting infected with the coronavirus at the hospital. The Hoag Memorial Hospital Presbyterian in Newport Beach, California, reported that mammograms have dropped by as much as 90% during the pandemic. 

As weeks turn to months and certain regions have experienced new spikes in infection rates, it is important to ask how long can we delay doctor visits without having an overall net negative effect on our health?  Recently on CNN, Dr. Peter Chin-Hong, an infectious disease expert at the University of California, proposed that, “Elective health is not optional health” should be our mantra during Covid times. Although there is some latitude in scheduling mammograms, colonoscopies and Pap testing, too much of a delay could result in the development of cancers that many of these procedures have been proven to avert.”

Joseph Allen, an assistant professor of exposure assessment at Harvard’s T.H. Chan School of Public Health, the director of the Healthy Buildings Program and the coauthor of “Healthy Buildings,” agreed, stating that he “would place medical visits in the category of trips out of the house that are essential, like food shopping and visits to the pharmacy. Do not delay on medical treatment or doctor appointments.” 

This sentiment was echoed by Melissa Hawkins, the director of the American University’s Public Health Scholars program and a professor specializing in epidemiology and maternal and child health care, who noted that her advice is “to keep the screening appointments and routine care visits. In public health, our focus is on prevention. Most conditions are much easier to treat if caught early. Significant delays and/or skipping routine screenings such as mammograms, colon cancer screenings, and Pap tests can have serious negative consequences. Consider how long you’ve delayed or postponed your appointment — this could make the difference between early diagnosis and a more advanced diagnosis.”

With regards to healthcare for children, Dr. Susan Bailey, an allergist and immunologist and president of the American Medical Association, emphasized “the importance of vaccines generally, and staying up to date on vaccines, specifically. Once again, talk to your pediatrician about your child’s care. Ask what is necessary and what can be postponed. Ask what may be doable via telemedicine. But whatever you do, stay up to date on your child’s vaccines.”

But as patients begin to re-engage with their healthcare providers, they need to be prepared to be met by the double whammy of increased demand (as other patients are also trying to reschedule their delayed appointments) and reduced supply (doctors, staff, beds and PPE which has been diverted to treat COVID or cut back in reaction to the pandemic).  As Dr. Edith Bracho-Sanchez, a primary care pediatrician, director of pediatric telemedicine and assistant professor of pediatrics at Columbia University Irving Medical Center, recently observed on CNN, “Unfortunately in areas where Covid-19 is rising, hospitals have had to divert personnel and resources away from elective and non-urgent procedures to be able meet the demand that treating very ill Covid-19 patients poses. All of these procedures will eventually need to take place, but as you can imagine re-scheduling them will take some time.” A survey by the American Cancer Society Cancer Action Network of cancer patients and survivors this past May revealed that almost one in four patients surveyed say the pandemic has made it more difficult to contact their providers and one in five say they are worried their cancer could be growing or returning due to delays and interruptions caused by the COVID-19 outbreak.  

To overcome these challenges, patients should reach out to their providers and get appointments on the calendar as far ahead of time as possible. In considering your specific needs, you should understand your providers delivery options designed to make care safer such as using telemedicine when possible and offering prescription delivery services. But when a face-to-face visit is necessary, there are a number of things you can do to help ensure your visits are safe.  As a good guideline, the Mayo Clinic offers these specific recommendations:

1. Do your homework
   1. Before you make an appointment, call the clinic or check its website to find out what's being done to keep people safe during the COVID-19 pandemic. Check for information about:
      1. Requirements regarding mask wearing by staff and visitors
      2. Cleaning protocols and sanitizing measures for exam rooms, waiting areas, restrooms, elevators and other frequently touched surfaces
      3. Social distancing practices at check-in, in waiting areas and in exam rooms
      4. Limits on the number of people who can be in the clinic at the same time
      5. Screening questions and temperature checks for staff and visitors at all entrances
      6. Special measures, spatial isolation or instructions for people who have or may have COVID-19
      7. How doctors and other staff are using personal protective equipment (PPE)
      8. Video (telemedicine) appointment options
   2. Before you head to the clinic
      1. Shortly before the day of your appointment, you may get a call from someone at the clinic asking if you have symptoms of COVID-19, such as fever, cough and shortness of breath. If you have symptoms, you may be given specific instructions.
      2. Clinic staff may tell you to bring and wear a mask. Some clinics may also ask that you bring only one person with you to your appointment.
      3. Ask questions you may have about safety procedures. For example, you may want to ask if the clinic can send your bill electronically or by mail. These may be good options so you don't have to worry about picking up germs when you check out at the clinic.
2. At the clinic
   1. Remember to follow these standard precautions when you're at the clinic, such as
      1. Wear a cloth face mask. Most clinics require that people wear masks during the COVID-19 pandemic. If you don't have one, your clinic may be able to provide you with one.
      2. Wash your hands with soap and water for at least 20 seconds or use hand sanitizer with 60% alcohol before or after touching any surfaces in public areas, such as in the waiting area.
      3. Avoid touching your face, including your eyes, nose and mouth.
      4. Cover your cough or sneeze with a tissue or your elbow and throw away the tissue. When wearing a mask, cough or sneeze into the mask.
      5. Aim to keep social distance, or about 6 feet (2 meters) away from others while at the clinic, including when you're in line and in the waiting area. Some clinics have signs or markings on the floor to help visitors maintain physical distancing (social distancing). If an area looks crowded, move to another part of the clinic.
      6. Try to avoid contact with frequently touched surfaces, such as doorknobs, elevator buttons and touchpads. While they're cleaned regularly, there's still the chance they have germs on them. Wear gloves or use a tissue to open doors and press elevator buttons. If you need to use a touchpad or touch a commonly used surface, wash your hands or use a hand sanitizer afterward.
      7. When it's time to check out, opt for touchless payment if possible, such as a mobile payment system. If that's not an option, use credit cards, cash or checks, and then use hand sanitizer containing at least 60% alcohol. When you get home, wash your hands well with soap and water.
      8. Ask your doctor about telemedicine appointment options, such as a video consult. It can be an effective way for you to follow-up with your doctor from home. Or you may be able to have a telemedicine appointment instead of an in-person visit. You also may be able to have a phone consultation with your doctor. Ask your doctor if you can send secure messages or emails with questions.
      9. If you have a new prescription or need to refill existing ones, consider mail order. Check with your doctor about getting larger supplies of your prescriptions that last longer and require fewer pharmacy visits. If you need to get a prescription locally, call ahead or order online. Ask if delivery is an option or whether the pharmacy has drive-through or curbside pickup options.

While it is important that we keep up our diligence to minimize the chances of contracting COVID-19, it is also critical that we develop strategies to incorporate normal healthcare routines back into our day-to-day lives. The risk of continuing to neglect non-COVID-19 related healthcare can be greater than the risk of getting infected during a doctor visit if we are prudent and follow best practices.