The Doctor Is (Back) In?>

The Doctor Is (Back) In

by Peter Jaret

The Covid-19 pandemic has turned many aspects of life upside down, including the way we get medical care. When the novel coronavirus first began to pose a threat in the United States, federal health officials recommended delaying all nonessential medical exams and procedures. The goal was to prevent the risk of coronavirus infection for patients and health care workers alike and to ensure that resources would be available to fight the pandemic.

Since then, many of our routine examinations, cancer screenings, eye exams, dental care, and even ongoing treatments have been postponed. The pandemic has significantly disrupted or delayed health care, including some essential medical treatment.

Now that states are cautiously reopening, health care experts have begun to chart a path forward to restoring routine care while continuing to limit the spread of the virus. The effectiveness of these efforts is important to everyone, of course, but especially to older Americans. People over 50 are more likely than younger people to have chronic illnesses that often require in-person visits for medical care.

When is it OK to see the doctor?

You may be hesitant about visiting your doctor if you fear being exposed to the coronavirus. How can you know when it’s appropriate and safe to return for medical care? The answer depends on several factors, including:

  • The status of the pandemic in your community
  • The protocols set up by your health care providers
  • The kind of care you need
  • Your general health status
  • Your risk of complications if you develop Covid-19
  • Your access to the required technology to engage in virtual, or telehealth, visits

The CDC has advised resuming regular care practices when Covid-19 cases are isolated and there’s no to minimal coronavirus transmission in the community. Many states have now reached this phase and are loosening their restrictions regarding routine health care. In addition, medical societies and associations are drawing up guidelines to help providers minimize infection risk for both patients and health care workers and offer safe routine care.

The CDC recommends that clinicians deliver care remotely, such as using telehealth methods where appropriate. As a result, many medical practices are encouraging patients to engage in virtual visits to reduce their risk of exposure to the virus.

Prioritizing Care During the Pandemic

These non-Covid-19 conditions or symptoms are most (and least) likely to result in patient harm if care is delayed during the pandemic, according to the CDC.

In-person visits

The next time you seek health care, your in-person experience is likely to be quite different from what it was before the pandemic began as providers take extra precautions to reduce your risk of being exposed to the coronavirus. Below are some safeguards you can expect to encounter.

If you’re hesitant about visiting your doctor, call the office and ask if they have measures such as these in place to protect you from the risk of infection. You can also ask what you can do to protect yourself.

  • Prescreening. When you call your doctor’s office to make an appointment, the staff and your doctor will work with you to decide if an in-person visit is necessary or if a virtual visit (via telehealth or aphone conversation) will suffice. If you’re instructed to visit your doctor in person, the staff will ask you a series of questions to ascertain whether you may have been exposed to the coronavirus or have Covid-19 symptoms. If you’ve been exposed, special arrangements can usually be made to accommodate your visit with extra precautions. Some facilities may have separate areas for providing routine care to people who have tested positive for Covid-19.
  • Temperature checks. Most practices and facilities now take the temperature of visitors before they enter the building or office suite to screen for fever that could indicate possible infection. If you have a fever—the CDC defines one as 100.4°F or higher—you may be turned away, but the practice should give you instructions on what to do next, which might include a referral for Covid-19 testing.
  • Empty (or almost empty) waiting rooms. Fewer appointments than usual will be scheduled each day so visits can be spaced out to lessen the chance of patients coming into contact with another patient who might be infected. This modified schedule also allows for additional time to disinfect rooms and instruments in between patient visits. Furniture in waiting areas may be rearranged to accommodate social distancing. Surfaces in and around the waiting area, such as reception counters, chairs, and touchscreens, as well as door handles, railings, and elevator buttons, should be disinfected frequently. Offices are removing items such as magazines and toys from waiting areas to guard against transmission of germs. You may be told to keep the pen you’re given to use, although it’s probably a good idea to bring your own. In some cases, you may be asked to wait in your car until the office texts or calls you with the OK to come in.
  • Facemask rules. You’ll be asked to wear a cloth face covering when entering the building or office before accessing care. Your doctor and his or her staff will also be wearing personal protective equipment such as facemasks, face shields, and goggles.
  • Going it alone. To reduce the number of visitors in the facility and thus the risk of infection, you may be instructed to arrive unaccompanied. Exceptions can be made for patients who need assistance and young children.
  • Redesigned facilities. In hospitals, doctors’ offices, pharmacies, and other health care facilities, clear plastic barriers have been installed to shield patients and staff from one another. Some facilities are redirecting the flow of people by instituting separate entrances and exits to maintain social distancing. Markers on the floor might indicate where to stand and wait.
  • Staff checks. Health care facilities and doctors’ offices should instruct support staff to stay home if they have any Covid-19 symptoms or signs or if they’ve recently been in close contact with anyone who tested positive for the virus. Some routine specialty care poses additional challenges. Dental care and most eye care are two instances where telehealth can be impractical, although it can be used for online consultations. Extra precautions are needed for in-person visits because of prolonged periods that providers spend in close proximity to the patient’s face during which respiratory droplets might be transmitted.

Vision health

No one was surprised that frontline medical workers in emergency departments and intensive care units were at increased risk of coronavirus infection. But experts discovered that ophthalmologists are, too. In fact, one of the first doctors to sound the alarm when the outbreak began in Wuhan, China, was an ophthalmologist who later died of the disease.

In hindsight, the risks of providing eye care are obvious. Ophthalmologists and optometrists work in close proximity to patients’ faces, which exposes them and their patients to potential virus transmission. As a result, some eye specialists are using safeguards specific to their field as well as the general precautions used by most other practices. For instance, your ophthalmologist may employ a breath shield when examining your eyes. This clear barrier between your face and the doctor helps protect against the spread of some respiratory droplets during an eye exam.

If you’re being treated for a sight-threatening condition such as macular degeneration, diabetic retinopathy, or glaucoma, it’s important to be in contact with your doctor for advice on continuing your treatments, since delay could cause harm. Also, call your eye doctor immediately if you notice sudden changes in your vision, such as blurry, wavy, or blank spots in your field of vision.

If you’re scheduled for cataract surgery, your procedure might be postponed. However, some cataract surgeries may be considered more urgent, such as when poor sight interferes with activities like driving, working, or self-care or may increase a person’s risk of falls.

For other appointments, such as routine eye tests and office procedures, contact your eye care specialist to discuss whether you should reschedule for a later date. A word of warning: Some companies are advertising devices for sale that purport to enable you to conduct a vision test on yourself at home. The American Optometric Association warns that these self-exams—none of which are approved by the FDA—cannot substitute for a comprehensive eye exam by an eye specialist.

Dental care

Like ophthalmologists, dentists and dental hygienists must work at length in close proximity to patients’ faces, increasing the risk of virus transmission. During the pandemic’s peak, dental offices canceled nonessential visits and concentrated only on dental emergencies and urgent dental care, such as severe dental pain, uncontrolled bleeding of tissue, fractured teeth, painful cavities, improperly functioning dentures, and abscesses and other serious infections.

Some dental practices have begun reopening for more routine care like cleanings and filling cavities. To help guide them, both the CDC and the American Dental Association have issued recommendations on ways to provide dental care while at the same time minimizing any risk of coronavirus transmission.

Depending on the care you need, you may see some changes to your routine dental visit. Much dental care involves the use of high-speed dental instruments that can generate aerosols, which can transmit the coronavirus from a patient to dentists and their assistants. For example, if your dental hygienist typically uses an ultrasonic scaling tool when cleaning your teeth, he or she may revert to using a hand tool to reduce the amount of aerosol drops generated.

As you would with other specialists, confer with your dentist to determine how soon you should schedule a visit for your particular needs.

Cancer Screenings During the Pandemic: Do Now or Wait?

Here’s what to consider with your doctor if you’re due for a preventive cancer screening while the coronavirus is still circulating.

Care that can’t be delayed

Early on, the CDC advised doctors not to defer patient services that were highly likely to cause harm if in-person care were delayed. Some patients, such as those undergoing cancer treatment or dialysis, don’t have the option of waiting for care until the pandemic is under better control.

People who have certain cancers are among those with heightened risk of Covid-19 infection as well as its more serious complications, according to emerging evidence. If you’re undergoing cancer therapy, ask your oncologist whether you can postpone or skip any treatment. If not, your cancer care team will arrange for you to continue ongoing therapy; infusion centers and radiation practices have updated their protocols to reduce transmission risk. In some cases, intravenous chemotherapy drugs may have oral equivalents you can use to avoid visiting an infusion center where you run therisk of being exposed to the virus.

People who have chronic kidney disease are also at increased risk of complications from Covid-19. If you’re undergoing dialysis, it’s important that you don’t miss your scheduled appointments. Dialysis centers should be performing the same safety protocols that other health care facilities are following. People infected with the coronavirus should be separated by at least six feet from non-Covid-19 patients or dialyzed in a separate room when possible.

Similar precautions should be taken for other patients whose treatment can’t be postponed. If you’re getting ongoing therapy, it’s important to work with your doctor to ensure that you continue to receive care without interruption or discuss safe and effective alternatives.

What lies ahead

Shelter-in-place orders helped flatten the epidemic curve in many communities, preventing hospitals from being overwhelmed. Still, the Covid-19 pandemic is not yet over. Indeed, some experts worry that parts of the country may experience multiple upsurges of infection, predicting a second wave of coronavirus infections in the fall.

But no one can be sure, as much remains to be learned about the new coronavirus. As the nation reopens, medical professionals are working hard to reassure people that it’s safe to come in for care. Ironically, a significant danger many of us might face could be not getting the screening tests or treatments that could keep us healthy.

Pandemic or Not, Don’t Put Off These Vaccinations

As the coronavirus pandemic surged, the number of people getting routine immunizations fell dramatically. That's a problem, especially when it comes to these particularly important vaccinations.

This article first appeared in the August 2020 issue of UC Berkeley Health After 50.

Also see How to Fortify Your Immune System.