With COVID-19 spreading,
many people are thinking twice about medical visits. But some conditions
shouldn't be ignored.
By
Kevin Loria April 03, 2020
The health problem on everyone’s mind—and the
one filling up emergency rooms and hospital beds around the country—may
be COVID-19, but
that doesn’t mean that other medical needs have disappeared.
With the health system strained and social
distancing guidelines in place, many doctors' groups have already recommended
that patients postpone routine visits and elective procedures. But people still
get sick and injured, develop dental problems, and—especially for people with
chronic conditions—need regular treatment to maintain their health. Some of
these problems can be resolved remotely,
but others still require in-person treatment.
To understand when you need to be seen in
person, when a remote visit is a better option, and when you should stay home,
CR reviewed guidance from medical and dental organizations and spoke with
several physicians still working to see patients when possible.
“I wouldn’t say the bar has changed” with regard
to whether patients should see a doctor about something that ails them, says
Robert McLean, M.D., a practicing internist and rheumatologist at Yale New
Haven Hospital and president of the American College of Physicians. “What’s
shifted is how we evaluate it,” he says, with a preference for telehealth via
videoconferencing or phone when possible.
Here’s what you should know if you need to seek
medical care for something other than the coronavirus now. (You can find
our guide for evaluating
COVID-19 symptoms here.)
Is It an Emergency?
Emergency situations still
clearly need to be addressed, but many hospital emergency departments are
treating or getting ready to treat a surge of coronavirus patients. This means
that patients should try to gauge whether their situation is urgent enough to
need immediate attention, because wait times may be longer than usual and there’s
a significant risk of being exposed to the coronavirus in an ER.
But “it’s difficult to know from a patient’s
point of view when something is an
emergency and when it is not. It’s our job to sort through the
complaints,” says Avir Mitra, M.D., an emergency medicine physician at Mt.
Sinai Hospital in New York City and a spokesperson for the American College of
Emergency Physicians.
Not all emergencies are painful, but there are
certain signs that you may be suffering a medical emergency that needs
treatment, says Mitra. These include signs of stroke (slurred speech, weakness
on one side of the body, or facial droop); chest pain or severe shortness of
breath that could indicate a cardiac or lung problem; uncontrollable vomiting;
an anaphylactic allergic reaction; or severe trauma, like from a car accident.
Such symptoms generally require immediate attention.
Otherwise, however, it’s become more common for
hospitals to offer a 24-hour telehealth service for
the initial evaluation of a potential emergency, says Mitra. If this is an
option, make use of it. It could help you determine whether you need to expose
yourself to what’s in an ER, and it may help ensure you get any treatment you
need.
If you do need to call 911 or go to an ER,
hospital staff are doing what they can to keep COVID-19 patients away from
other patients, Mitra says. People with respiratory infections are being
triaged into isolation rooms when possible. If you're having respiratory
problems and have a mask, wear it to help protect the people treating you (and
other patients).
In general, if you can’t tell for sure whether
something is an emergency and you can’t get in touch with your regular doctor
or someone at a hospital to guide you, err on the side of getting treatment.
“Just come and we’ll help you,” Mitra says.
What Other Times Should
I See My Doctor?
To avoid having too many people in the same
place at the same time, especially around sick people, telehealth has become an
important tool. It's a preferred option for many nonemergency visits
where people still require a consultation with a doctor, according to medical
groups including the American
Academy of Family Physicians and the American
College of Physicians. In other cases, it’s been recommended that
routine visits simply be postponed.
For pediatric practices, the American Academy of
Pediatrics has recommended keeping kids out of healthcare offices when an in-person visit
isn't necessary. Pediatricians in areas with significant
outbreaks should also consider doing only routine visits with newborns and
younger children who need vaccines, the AAP says, or having routine visits
and sick visits take place at different times of day.
Pregnant women should continue to receive
prenatal care, according
to the American College of Obstetricians and Gynecologists, but
should expect some potential changes to their schedule, including visits that
are more spaced out and fewer in-person visits, with some visits done via
telemedicine.
In general though, people are still getting lots
of medical care, but it’s largely being done remotely, says McLean of Yale New
Haven Hospital. “The phones are just as busy as they’ve ever been, if not
busier,” he says. But he says that at this point, he’ll have people come in
only when there’s something that needs to be done or seen in person, like a
steroid injection, draining an abscess, or following up to get a closer look at
a bump first examined via video.
In the office, many practices are trying to
ensure that people can follow social distancing practices, which means limiting
the number of interactions and people in waiting rooms, according to McLean.
And depending on where you are, doctors might
take other precautions to protect their patients and themselves. McLean says
that in Connecticut, his practice isn’t seeing patients who have had
respiratory symptoms. They are being asked to wait for symptoms to resolve at
home or to seek emergency care if needed. Doctors in his practice are also
generally keeping more of a distance from patients when possible. Officials in
some places have recommended that everyone wear a cloth mask when possible,
including to a doctor's visit.
You can expect your doctor to be taking
additional steps as well, such as wearing protective equipment like a mask and
eye protection. In New York City, for example, where Mitra sometimes works in
an urgent care facility along with his ER shifts, he says he’s wearing more
protective gear than usual to avoid potential coronavirus transmission. He gets
geared up in full protective equipment even if someone comes in asking for a
pregnancy test or with stomach pain, he says, because we don’t yet know just
how many people are carrying the coronavirus.
When you call your doctor to make an
appointment, ask about the precautions he or she has put in place. And keep in
mind that urgent care may also be an option, though those facilities also pose
the risk of potential exposure to COVID-19.
What About a Dental
Emergency?
The American Dental Association (ADA) has asked
dentists around the country to postpone nonurgent dental
procedures through at least April 30 to slow the spread of COVID-19. That means
now is not the time to get a cleaning, X-rays, whitening, or treatment of a
nonpainful cavity. But if you're in pain or if you’ve recently had dental
surgery that needs follow-up treatment, the ADA says that it should be looked
at.
An ADA website has guidance for patients
outlining the sorts of issues
that should be treated: gum infections, broken teeth, bleeding that
doesn’t stop, abnormal tissue, and anything painful. Some dental problems can
even be life-threatening, for example, if you have bleeding that doesn’t stop,
an infection that’s swelling your airway, or bone damage that could compromise
your ability to breathe.
If you need to go in for a procedure, you
can expect
your dentist to be wearing a surgical mask along with eye
protection or a face shield, which he or she may have done even before the
current health crisis. Offices will also be taking other precautions to help
people maintain social distancing, like limiting the number of those in a waiting
room. (Call ahead to make sure your dentist’s office is taking these sorts of
precautions.)
In all of these cases, what you should expect
will change as the coronavirus becomes more or less common in your area.
Guidance from professional organizations on what requires treatment—and how
it’s accomplished—will continue to be updated.
Kevin Loria - I'm
a science journalist who writes about health for Consumer Reports. I'm
interested in finding the ways that people can transform their health for the
better and in calling out the systems, companies, and policies that expose
patients to unnecessary harm. As a dad, I spend most of my free time trying to
keep up with a toddler, but I also enjoy exploring the outdoors whenever
possible. Follow me on Twitter (@kevloria).
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