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What to Do About Routine Doctor Visits During Coronavirus

US News & World Report - Health logo US News & World Report - Health 3/25/2020 David Levine
a man and a woman sitting on a table: Doctor is checking a patient © (Getty Images) Doctor is checking a patient

Everyone’s attention these days is on the coronavirus – and rightfully so. The pandemic is a historic and ongoing event. The news changes daily, even hourly. All our lives have seemingly ground to a halt.

While we all can and should, however reluctantly, cancel our plans to go to that party, the concert we’ve had tickets for since July or the trip to visit the in-laws, should we also cancel the important health care appointments we have on our refrigerator calendars – the routine medical checkup or the dental cleaning? What about periodic health screenings such as a colonoscopy or mammogram? Or an elective surgery, such as a hip replacement or a face-lift?

On March 18 at the White House Coronavirus Task Force press briefing, the Centers for Medicare & Medicaid Services announced that all elective surgeries and nonessential medical, surgical and dental procedures be delayed the during the outbreak.

The recommendations suggest that patients consider postponing their procedures based on the individual’s personal risk factors, availability of beds, staff availability and the urgency of the procedure. These are just recommendations, however.

“The decision about proceeding with nonessential surgeries and procedures will be made at the local level by the clinician, patient, hospital, and state and local health departments,” CMS said in a press release.

So, the answer, as with many questions about the coronavirus, or COVID-19, is not cut and dried. Simply put, it depends – on how old you are, what the appointment is for, what your personal physician recommends and how stressed your local health care providers are. It is a matter of weighing the risk taken in keeping the appointment against the benefit of that appointment.

“The risk-to-benefit ratio of making a trip to the doctor’s office has changed radically in the last few days,” says Dr. Jeffrey A. Linder, professor and chief of the division of general internal medicine and geriatrics at Northwestern University's Feinberg School of Medicine.

Keep or Cancel Your Appointment?

Dr. Gary LeRoy, a family physician in Dayton, Ohio, who is also president of the American Academy of Family Physicians, sees the problem both on the ground and from the heights of public health policy.

“What we have been doing in my practice is calling individuals who do not need urgent care and seeing if they would be willing to forego their appointment this month and possibly next month,” LeRoy says. “We are also seeing if certain needs they have, we can address over the telephone.”

This serves two purposes, LeRoy says. One is social distancing. “It brings fewer people into the office, especially those coming in with cardiovascular disease or lung or immune disorders,” who are at higher risk for complications from COVID-19, he says. It also keeps those who may be unknowingly carrying the virus from exposing others. “That is helping our staff feel more secure, too,” he says.

Linder adds anyone over age 60 – another risk factor – to the list of those who should reconsider a routine appointment. “In primary care, we are doing that proactively. For my patients over 60 or at high risk, I tell them don’t come in. Let’s touch base over the phone,” he says. Those who have cold or flu symptoms, particularly fever or cough, should not go to a routine visit.

“You need to stay home for 14 days or until symptoms are gone,” he says. “We need to think, can we be delivering care over the phone or via the web, because rationing care has changed so drastically.”

Patients who are experiencing new symptoms of any kind, or are living with a chronic condition like congestive heart failure, may need to be seen in person. “If you are unstable in some way, talk to your doctor and ask if it’s worth the risk to come in,” Linder says.

LeRoy adds, “If you are concerned about it, then sure, keep your appointment. But if it’s something routine where you see the doctor two or three times a year, and this is just a visit, not of an urgent nature, you can call in, ask for a refill of medications and see him later.”

Deciding Between Routine or Urgent

The U.S. Department of Veteran Affairs has posted its recommendations for veterans seeking care at VA hospitals and other health care providers on the website Military.com. It’s smart advice for civilians as well:

  • Request prescription refills. Ask your doctor to authorize a refill over the phone or through the office’s internet portal, if it has one, and have it sent electronically to your pharmacy.
  • Reschedule a routine appointment. If it is not urgent, call your doctor and ask if it’s OK to reschedule the appointment to a later date.
  • Inquire about an online appointment. More and more medical practices are using telehealth, including online chat and live videoconferencing tools to connect with patients. These technologies are secure and private, and they meet all privacy law compliance requirements. Ask if your doctor can meet with you remotely.

For elective surgeries or important screenings, it’s best to talk to your doctor to make the proper decision. Again, it’s about weighing the risks and benefits, and each person has a unique set of factors to consider in consultation with his or her provider.

“You should call them, and if you feel you really don’t need this now and would put yourself at potential risk where really sick people are, this is not a good time to do that if you don’t have to,” LeRoy says.

This advice pertains only to routine or elective appointments. If you are newly ill or injured but your life is not in danger, call your doctor or closest urgent care center or hospital and ask their advice. For a true emergency, call 911 or get to a hospital immediately.

How long will this go on? No one knows. “It will probably take weeks to months to calm down,” Linder says. “We still need to deploy widespread testing to see how far it has spread. Two weeks from now I would love to be wrong, but that’s where it stands now.”

Copyright 2020 U.S. News & World Report

Related video: How long does the coronavirus live on the surfaces we touch every day? [via Buzz60]

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