Friday, April 24, 2020

Amid a global pandemic, how do Dallas doctors get patients to want to come back?


With extra precautions, one surgeon says, ‘They’re safer in my center than the grocery store.’
6:00 AM on Apr 24, 2020
In the third week of April, the medical office of North Dallas Ear Nose & Throat got just one phone call from a patient.
Usually, about 80 people a week come to see Dr. Morris Gottlieb and his staff, and he typically performs about 40 surgeries a month.
That was before the pandemic, of course, and the stay-at-home orders and the restrictions on elective surgery.
On Wednesday, Texas’ rules on elective procedures were loosened, and Gottlieb has started rescheduling sinus surgeries, tonsil removals and the insertion of ear tubes -- interventions generally aimed at stopping chronic infections.
While he’s back in business, he knows it’s not going to be business as usual.
“People are a little nervous about going out,” he said. “And there’s definitely a lot of fear about picking up the phone and making that first appointment with the doctor.”
For his practice, as with many companies, it’s not enough to simply say business has reopened. They have to show that it’s safe for the public to come back again -- without being endangered personally or undermining the community progress that’s been made in slowing the spread of COVID-19.
How to restore consumer confidence while the biggest threat remains top-of-mind?
Gottlieb’s strategy is to proceed as if everyone in the facility has the disease and isn’t showing symptoms -- at least until he gets enough tests for every patient and worker.
“We assume they’re shedding the virus,” he said.
As a result, everyone wears a mask, including patients. And he said he wears an N95 mask “at all times in the facility” where the surgery is performed, Baylor Surgicare at North Dallas.
Visitors must wait in the car while their friend or family member enters the building. Patients go through a temperature check and answer a questionnaire on current health conditions and recent travels.
After surgery is finished and the breathing tube removed, he said doctors and nurses remain in the operating room for 15 minutes. That’s supposed to give the micronized filtration system enough time to clean the air before the doors are opened and the patient is moved to recovery.
As a surgeon who works on people’s throats, Gottlieb is accustomed to dealing with the threat of airborne diseases, but he’s ramped up his safety measures. He believes the risk of contracting COVID-19 in his medical setting is lower than in random locations people visit regularly.
“They’re safer in my center, getting surgery, than going to the grocery store because of all the precautions we’re taking,” Gottlieb said.
As Texas starts to reopen parts of its economy, health care is a good place to start the process. Doctors and nurses are among the must trusted professionals in America, and they’re experts in limiting infection. They have the training, experience and equipment to do their job and guard against the virus at the same time.
They also have a service that people often need badly and can’t get anywhere else, which means pent-up demand could unfurl more quickly.
“It’s completely different than a person who needs a haircut,” said Vivian Ho, an economics professor at Rice University.
She supports reopening the economy gradually and carefully, and wants local leaders to have enough time to ratchet down activity if COVID-19 cases spike again. She likes the idea of starting the reopening process with health care because workers have great expertise and the industry has a big impact.
“It’s the safest way to add growth back to the economy,” Ho said.
Health care accounts for more than 1.5 million jobs in Texas, over 14% of private employment. Many health care workers have been furloughed and laid off, and as patients return, those job numbers will bounce bank.
Gottlieb has furloughed five workers but expects business to pick up next month, maybe to about half its usual volume.
“All my patients need [help] sooner rather than later,” Gottlieb said.
In other specialties, it may be easier to delay treatment. Each case is different, said Dr. David Hassinger, an orthopedic surgeon and founder of Direct Orthopedic Care.
His practice, which has five locations in North Texas, has been rescheduling knee replacements and rotator cuff surgeries that were canceled a month ago. He said he’s asking patients: “How bad is it for you?”
Some may be able to wait a few months, but most are in too much pain to delay for long. To make them comfortable about coming in for surgery, he reviews the cleaning and safety procedures. And he emphasizes that they won’t be at a hospital dealing with coronavirus.
“That’s the best way to minimize your risk -- don’t be near patients with COVID,” Hassinger said.
Sulman Ahmed, CEO of Ideal Dental, has temporarily closed most of its 85 offices in Texas because of the suspension of non-essential services. But some of his dentists have been performing emergency procedures, such as tooth extractions and root canals.
And their record during the pandemic will be part of how they reassure customers when the business reopens in coming weeks.
“We’ve treated more than 2,500 patients who might have otherwise ended up in the emergency room -- and not had a single instance of COVID-19,” Ahmed said.
In the dental business, providers are well-schooled in infection control, and they’re used to isolating teeth, sterilizing equipment and using hospital-grade cleaners, Ahmed said. But the company is adopting additional safety measures for the coronavirus era.
Dental hygienists will use a manual process to clean teeth because the usual machine cleaners would increase the risk of spread, he said. Staffers will enter and leave through a back door rather than the front lobby to reduce unnecessary contact. Educational videos about what to expect at the facilities have been prepared for patients and employees.
Perhaps most important, each office plans to treat one patient at a time, rather than a handful in various dentist chairs -- at least for a while.
“We’re not saying, ‘Hey everyone, just get back to normal,’” Ahmed said.
Editor’s note: The number of Ideal Dental locations has been updated to 85 after the company said it had been using an outdated figure on its website.

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