Monday, April 6, 2020

Should I Keep My Routine Doctor Appointments During the COVID-19 Outbreak?


BY NEHA PATHAK, MD Board-certified internist MARCH 19, 2020
It’s hard to call anything "routine" anymore, but a lot of friends and family are reaching out to me to ask if they should keep their regular appointments while COVID-19 is spreading throughout our communities.
I have a family member who was scheduled for cataract removal in the coming weeks. My daughter is coming up for her annual “well child” visit. And I’m pregnant and due in about 10 weeks -- do I still go to my regular Ob appointments?
The most important thing to remember is that this is a rapidly evolving situation, so recommendations can change at any time. In the most recent set of recommendations, the White House is urging Americans all across the country to avoid gatherings of more than 10 people. Sitting in a waiting room with more than 10 people is probably not a good idea.
The biggest problem is that because of our problems with testing, we just don’t really know where the COVID-19 cases are -- so, we all have to behave like it could be anywhere.
Should I keep my “routine” appointments?
The best advice is, it depends -- are you being seen regularly for cancer treatments, pregnancy care, difficult to control lung disease? For some of these, your doctor’s office probably has a plan to help manage your treatment that may not involve face-to-face visits.
In general, at this time, it’s probably a good idea for people that are well to cancel or reschedule routine, non-urgent doctor’s appointments -- this would include physicals, annuals, and well visits.
Check your doctor’s office or healthcare center’s website for more detailed information about their plans. Most offices and healthcare facilities around the country are proactively canceling these appointments and setting up telephone/video visits when appropriate. If your doctor’s office has an online platform, that might be the best way to connect and find out what the plan is for your appointment.
This includes dentists’ offices. Many dentists are recommending against routine care – like exams, cleaning and fillings (especially because COVID-19 is a respiratory infection). Emergency care is still being offered for things like severe toothache pain, broken teeth from trauma, and infections.
For pregnant women, talk to your Ob about how they plan to monitor you for your regular follow-ups. Also, talk about potential labor and delivery plans. The situation continues to evolve, so keep that in mind, but at least you can continue to prepare. My Ob is converting most appointments to “virtual visits” which means she will speak with me over the phone, but there are some appointments for ultrasounds that I will still need to keep.
Cancer centers also seem to be setting up alternative plans to care for all of their patients with the main goal of minimizing unnecessary patient contact. Many are conducting telephone visits where appropriate and setting up lab and infusion appointments to minimize risk to their patients.
This is true for people with other serious, long-term conditions as well -- don’t just stop going to medical appointments. If you have heart disease, transplants, and other long-term conditions, talk to your doctor’s office about their recommendations for getting labs checked and being seen.
It’s very important not to assume. Contact your doctor’s office to confirm what their plans are to keep you safe. You may also find that a lot of offices and hospitals are limiting the number of people that can come with you to an appointment, so be aware of those rules as well. And, of course, keep taking your medicines as prescribed and don’t wait until the last minute to call for refills.
Always contact your doctor’s office before you go if you have a fever, cough, or shortness of breath so they can be prepared to take care of you while protecting other patients.
Why are doctor’s offices and clinics canceling appointments?
Doctor’s offices are following strict guidelines to keep their offices safe for people that need to come in, but also we need to work together to make sure our healthcare system can handle the numbers of patients that need care (or will soon need care), so postponing well care and maintaining social distancing definitely means you are doing your part to help.
For routine care, the risks to yourself and your community may outweigh the benefits. That’s why a lot of doctors’ offices and medical facilities are canceling/postponing well care and procedures that are not urgent -- think screening colonoscopies, elective surgeries like cataract removal, knee replacements, or cosmetic surgery.
Our health care providers have very limited personal protective equipment right now (gloves, facemasks, respirators, and gowns), so the more we can limit non-urgent care, the more protective equipment there is to go around to protect our healthcare workforce as they care for the growing number of people needing hospital and intensive care due to COVID-19.
What should I do if I feel sick or have an emergency?
If you, or a loved one, are not feeling well, it’s very important to contact your doctor’s office for advice. Don’t feel like you have to manage on your own. The key to our new normal is going to be triage -- that’s when you let your doctor know about any of your health concerns, and they decide the best place to help manage and treat those concerns. This might mean calling a prescription in to your local pharmacy, speaking to you over the phone, or asking you to come in to the office.
If you suspect you might have COVID-19, where you are seen for it really depends on how sick you are. It is important to let your doctor know if you have a fever, cough, shortness of breath, or difficulty breathing. Some people will be fine being tested and treated outside of the hospital, but others will need to be seen in the ER and may need to be hospitalized. It all depends on how severe your symptoms are.
You may need to go straight to the ER if you have high fevers and trouble breathing, but again, it’s critical to call ahead to let the ER know you are coming.
If we all work together, we will be able to stay healthy and keep others in our community healthy as well.
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