It’s time to resume in-person doctor visits

At the beginning of the COVID-19 pandemic, healthcare providers urged patients to stay home and avoid public places as often as possible.

When it came to doctor visits, they advised patients to schedule video or telephone chats instead of in-person appointments. They recommended postponing procedures or screenings that weren’t immediately necessary. And they were asking residents to only go to the emergency room if they had a life-threatening injury or illness. There was a concern that emergency rooms might become overwhelmed with patients.

Those precautions were good advice at the time, but we have a new understanding of how to protect ourselves from COVID-19. In the spring, the healthcare community was still understanding how this virus operates. Many hospitals and clinics wanted to make sure they had enough beds, masks and ventilators to handle a surge. They needed time to put practices in place to prevent transmission of this highly contagious disease.

As it turned out, many of us listened to that advice – but may have taken it a little too far.

Avoiding trips to the emergency room has put patients at risk

When a U.S. Centers for Disease Control study compared four weeks in April 2019 with the same period in April 2020, it found non-COVID visits to emergency rooms across the country had dropped 42%.

“I don’t believe people had suddenly gotten healthier. People were just nervous about getting out of their houses and seeking that care,” said Dr. Monika Kapur, president and chief executive officer for University Medicine Associates, a physicians’ group at University Health System.

Among the biggest concerns identified in the study was what was happening with patients at risk for heart attacks and strokes, the two biggest killers worldwide.

The number of patients reporting heart pain dropped, suggesting those patients were willing to forego emergency care in hopes their condition would get better. That, however, may have resulted in them waiting until they were in jeopardy of dying. The number of patients with the often-fatal diagnoses of cardiac arrest and ventricular fibrillation increased.

When to visit the ER

Dr. Kapur and other physicians have been quick to respond to the fear of seeking emergency treatment by reassuring patients that healthcare community has taken steps to protect against exposure to COVID-19.

At University Health System, for example, patients at the hospital and clinics are screened and have their temperatures taken before being allowed inside. Everyone wears masks and a limited number of people are allowed in waiting areas.

Doctors want patients with alarming symptoms to seek immediate help at an urgent care clinic or emergency room:

  • Chest pain or difficulty breathing
  • Upper belly pain lasting two minutes or more
  • Fainting, sudden dizziness, weakness
  • Changes in vision
  • Confusion or changes in mental status
  • Uncontrolled bleeding, coughing or vomiting blood

Schedule face-to-face medical appointments

While healthcare providers have found telemedicine to be a useful tool for limiting exposure to COVID-19, University Health System physicians are now urging more face-to-face medical visits because patients have fallen behind with routine care.

“Some of these patients have not been seen in over four or five months and these people have chronic medical conditions which truly need a physical exam that can be done only during face-to-face visits,” Dr. Kapur said.

Well-child visits and immunizations should be in person

In-person appointments for children is a high priority.

The American Academy of Pediatrics is reporting a “significant drop” in well-child visits and delays in vaccinations and screenings since the pandemic began.

“That is creating a high risk of an outbreak of preventable diseases in a few months from now. Pertussis and measles could be a big problem,” warned Dr. Mario Martinez, a University Health System pediatrician.

Dr. Martinez and the AAP are recommending in-person well child visits whenever possible so doctors can check a child’s growth and development and ensure they’re up-to-date on vaccinations. The AAP publishes a schedule of recommended check-ups for children from their first week of life until they’re 21 years old.

Adults also need to show up for health screenings

Adults need to keep up with preventative health screenings and immunizations that can’t be done over the phone.

Recommendations call for young adults in their 20s to be tested for conditions including high cholesterol, hypertension, some sexually transmitted diseases and cervical cancer.

As adults age the importance of regular doctor visits grows. Cancer and diabetes screenings can catch problems early. Flu shots can prevent illness or death.

Doctors with University Health System say they postponed mammograms and colonoscopies because of COVID-19. They’re now urging patients to schedule the screenings which often catch breast and colon cancer early.

Dr. Pam Otto, a radiologist, wants patients to know the mammography staff practice social distancing and the testing areas are sanitized.

Dr. Glenn Gross, a gastroenterologist, says patients should feel confident they’ll be safe.

“I would emphasize that we are following very strict safety and cleaning protocols. All patients must come in to be COVID-tested before the colonoscopy. That is an extra trip for the patients, but it is the price of safety,” Dr. Gross explained.