Non-coronavirus medical care: Going to the doctor has changed, so what can you do?

Filed Under: Costs, Health plans, Patients

The simple act of going to the doctor has changed in the era of coronavirus (COVID-19). In general, most of us don’t want to go to the hospital or doctor’s office unless we absolutely have to, and that feeling is multiplied exponentially in this time of coronavirus, when it seems obvious that a hospital is a good place to get sick, not to get well.

So what should you do? Here are some opinions, from doctors, patients and others.

In this era of crisis, things may change — so call first to confirm.

First and most important: The telephone is your new best friend. This is a dramatic change from pre-coronavirus days, when telemedicine or telehealth was not the norm. We think this is one of the biggest, longest-lasting changes we can expect from the post-coronavirus era: Doctors, hospitals, insurers and everybody else will recognize the value of phone, text or videoconference medical visits.

“For non-urgent issues I recommend that they call their primary care physician’s office so they can help you triage. In our medical center we triage all respiratory patients to our emergency department, which I think is rational. For other non-urgent issues we are trying to see as many of these patients as possible through non-visit-based care, using video or telephone.

“And what’s really interesting (although not a surprise to some of us who have preached it for years), most of us are realizing that we can take care of most patients just fine and don’t actually need to meet them in inefficient face-to-face visits.

“The only reason we see patients in the office is that’s what we get paid for. If we change the broken payment system we will find lots of innovative ways to care for patients, many of which don’t include seeing patients in the office very frequently.” —Dr. Danny Sands, Beth Israel Deaconess Medical Center, Boston

“We are seeing wells in the morning when it’s ‘Clean’ but only visits that have necessary vaccines to prevent a different epidemics (newborn, 2 month, 4m, 6m, 12m, 15m). Everything that has to be seen in person but is not a baby check up is during the ‘sick’ hours in the afternoon. Then the place gets a deep clean for the well babies in the AM. Anything at all that can be done via telemedicine/phone is being done via telemedicine/telephone to minimize exposure to patient/parent/ and staff. ” Moneeka Zaman, a pediatrician in Westchester County, N.Y.

“The Mount Sinai Adolescent Health Center is open for business, providing confidential services to all teens and young adults ages 10-22 with no out of pocket charges regardless of insurance or immigration status. We are located at 312 E 94th Street and are currently open Monday through Saturday 8:30-4:30. The phone number is 212-423-3000. We encourage our patients to observe social distancing recommendations and ONLY come for a visit if it is medically necessary. The majority of our patients are seen for reproductive health issues, but we provide general primary care as well and have social workers and health educators on site. We are not a general Covid Testing Site. Only patients who meet DOH/ CDC criteria for testing will be eligible, so if you have fever, cough, etc, please self-isolate and don’t come in for testing. We screen for COVID-19 symptoms at the door, advising patients with those symptoms to go home and self-isolate. If you are severely ill with shortness of breath or other severe symptoms, please call your primary care doctor or 911.” Dr. Marti Arden, Mount Sinai Adolescent Health Center, New York, N.Y.  

“Call 911 for emergencies involving things that will stop breathing (heart attack, stroke, any loss of consciousness.) For issues like possible concussion or severe bone break (thinking things my kids would get into even in the backyard😬 ) drive to the emergency room where they have all been divided into Corona and non-Corona, however no one knows how effective that is in keeping areas free from virus contamination.

“At this time best to avoid the emergency room as much as possible as previously stated by so many health care providers (unless you have compromised breathing) because they are beyond overwhelmed. If anyone needs stitches I would call urgent care. For all other sick issues, call your doctors. Most are doing telemed visits. ” An NYC emergency room doctor

“I’m retired, so not actively seeing patients, but actively answering questions and helping friends and former patients talk through their situations and concerns. One of the things that is clear from my conversations with both patients and clinicians is the amazement they experience as they realize how much primary care can be done with attentive and unhurried conversation rather than a monetized face:face encounter. Another comment I am hearing repeatedly from clinicians is that they ENJOY the conversations with patients and find that making a follow-up call 1-2 days later to close the loop is rewarding for both. It may be hard to force them to go back to rushed and monetized visits that they now know are less effective and less enjoyable.” Dr. Peter Elias, central Maine,  retired family physician.

From Facebook group in southern Westchester: Woman posted about husband needing stitches and being reluctant to go to urgent care. “There are loads of docs in the city offering this service (I’m in facebook groups) – e.g. “In an effort to keep people away from the hospital, my husband, Marc Everett, MD (Board Certified Plastic Surgeon) is available for such unexpected emergencies – house calls or in the privacy of our Upper East Side, Plastic Surgery Office. Call 212-774-7715 available 24/7!””

“I would suggest more frequent use of patient portal, for non emergent situation if your primary care clinic offers it. Physicians have direct access to your questions and complains, can respond more promptly.” Southern Westchester health care provider.

“My spouse‘s doctor has a new bench out in the parking lot. Keeps the waiting room emptier. They are a small satellite office. The bench is in sight of the receptionist’s desk. Yes. The virus is just starting to hit here. Thought it was a great prep move.” Friend in Asheville, N.C.

“Louis Catalano, MD, orthopedic and upper extremity surgeon is doing office visits one day per week at his office in Manhattan and televisits daily.  Louis Catalano web site.”

“My G.P. just sent a house-visiting phlebotomy service to get blood and urine samples (unexplained elevated temp and fatigue for a month). The tech said they’re at 2-3x normal volume. I did a curbside visit to my doc two weeks ago for viral swab.” Friend in Los Angeles.

“I have epilepsy and meds need frequent tweaking. But my epileptologist at Mt Sinai can’t do any of that —especially an overdue EEG — cuz she won’t let me come to the hospital. Same is true with all other doctors and dentists but the epilepsy is the scariest.” New York area friend.

People with other serious health conditions are feeling how strained the health system is. Take this article about a child with cancer whose family is hoping to get time in the system, as his mom, Jennifer Mulligan told a reporter at Lohud.com. “‘We are literally at a standstill, hoping that we can make an appointment,’ Mulligan said, adding they already had one medical visit cancelled as coronavirus patients and health risks took precedence. ‘We are at the bottom of the list in regard to treatment.’ The odds will only get worse as New York’s outbreak battle is poised to strain the health system to its breaking point, forcing hospitals to cancel all elective procedures to free up beds for patients infected with COVID-19, the disease caused by the virus.”

Any number of elective surgeries have been postponed: Hip replacements, bariatric surgery, transplants, anything that is not an emergency has been postponed in the New York area and other hot spots. There is a shortage of doctors, with many being redirected to work in hospitals, outside of their specialties — urologists working as emergency doctors, for example. The best thing to do in these circumstances is to stay in touch with your provider to know when and if things change.

Some doctors have coronavirus and yet are continuing to treat patients virtually, as noted in this article from The Philadelphia Inquirer. “’When you get something yourself, you can actually understand what people mean,’ said [Aditi] Joshi, who works for Jefferson Health, in the article. ‘And for me, there’s something helpful about feeling like I don’t have to sit back and do nothing about it.’”