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August 18, 2020

Is Seeing Your Doctor Safer Than Going Grocery Shopping?

With many states across the country moving into varied “phases” of reopening, and with reopening itself having a wide variety of definitions, there is understandable confusion about which activities are safe to resume and which ones should be kept on the backburner.

One of the trickiest things to understand is when it’s safe to resume seeing your physician for everything ranging from wellness check-ups to elective procedures and chronic care. For many patients, there is a fear that hospitals and doctor’s offices are hotbeds for the COVID-19 virus infection and should be avoided at all costs. But for allergy and asthma patients, that fear also means the potential for putting off much-needed care.

To help gain some clarity, we spoke to Christina Canody, M.D., a board-certified pediatrician and part of BayCare Medical Group in Tampa, FL. Below she discuses her own office safety practices, what patients should expect of their healthcare providers, and what patients should do to help keep their providers safe.

[Please note: portions of this interview have been edited for length.]

What are some of the factors you're taking into consideration when asking your patients to come into the office versus participating in a phone or a telehealth appointment?

In the pediatric population, what’s different is a lot of kids can’t tell you what’s actually wrong with them. So, we base a little bit more of what we do on the physical examination. For example, if there’s any respiratory concerns, any kind of ear pain, we really need to be able to take a look at the patient. When a physical exam is necessary, that’s where we really need to see kids in person. For most acute complaints we need to do that.

With well visits—if they’ve had a well visit in the last year, some people are conducting online well visits and just postponing the physical exam to a different time. Additionally, we do offer a modified physical exam where, with the help of a parent, we can determine does the child have any swollen lymph nodes, is the belly tender, can they move all around, and so on. We can assess some of those gross motor things and gross physical things over the phone or over video.

For adult patients— is the threshold of when they need to physically come in basically the same?

For new or sudden changes, that’s when adults really may need to be seen in person. But for ongoing chronic healthcare maintenance, telemedicine is extremely beneficial. Some physical exam findings are easy to follow via the video chat. Additionally, for some of those patients, what you really need to do is get more information. And so telehealth allows for an easy way to converse with the patient in a secure setting that’s HIPAA-compliant. And it keeps them from having to travel to and from the office, which may be a good thing for families, because sometimes transportation is an even bigger issue when they have assistive devices to get them around—wheelchairs, walkers, things like that. So many patients actually prefer that kind of visit. And they can do all the elements needed to take care of the problem over the telehealth visit.

Would you say coming into your doctor’s office is safer than other essential tasks like going grocery shopping?

At this point, everybody’s safety, for not only our patients but also our team members and staff, is of utmost importance. In my own office, for example…

  1. We’ve screened every patient walking into our office.
  2. We’re taking temperatures on every patient walking through our doors—and their family members as well.
  3. You’re required to wear a mask at all times when you’re in the office.
  4. The cleaning process in our office goes above and beyond what you get in other public environments. So, given the fact that we’re a public environment, we’re doing more of what you would expect in a private environment. Rooms are washed down and we’re using an aerosolized cleaner as well after surfaces are cleaned. The rooms are also left to dry independently for a specific amount of time before we use them again. So, if there are any leftover respiratory particles, then those should be taken care of.
  5. All of our outpatient offices have gone to twice-per-day temperature screenings for all team members.
Have you made any physical changes to the layout of your office, or has BayCare made physical changes in other parts of the system, to decrease the risk of COVID-19 virus infection?

I can’t speak for all of BayCare, but in my own office, we are avoiding the use of waiting areas where possible. If they need to be utilized, we’re definitely practicing social distancing and using face coverings. In most cases, we have decreased the amounts of entrances and exits to our facility. Obviously, they can be used to leave the building in the case of an emergency, but our entrances have been streamlined so temperature checks for everyone, including employees, can be performed.

In our offices, we have designated sick and well rooms, and we’re sticking very consistently to that. So, if anyone has any illness symptoms, they’re being seen in rooms that are getting an extra special sanitation spray-down where they’re being left for an additional 10 to 15 minutes before anyone else is seen in that room.

We’ve made changes to our scheduling so that all our well appointments are in the morning and early afternoon. And at a certain time, we cut off those appointments, and then start seeing patients with symptoms or concerns at the end of the day. A lot of other offices are doing this timing as well.

We’re also making sure families are aware of what we’re doing. They don’t walk in the front door by themselves. They call when they arrive at our offices. We greet them at the front door and walk them to their appointment room. Additionally, when they get into the appointment room, we have a sign that says “This room has been sanitized” so they know the room was cleaned before they came in.

All of our patient registration has to be done online before patients come in. If someone drives up and they haven’t finished their registration, we make them wait and do that in their car so we have everything that we need to expedite their visit. And then as far as our staff members go, we wear masks at all times except when we’re eating and drinking. Even when we’re in our common rooms, we all practice social distancing as well. We take the care to only walk one patient in and out at a time, so they aren’t passing each other in the hallway. So, we’re taking lots of precautions! 

What are the top essential safety precautions all patients should expect when coming into their doctor’s office?
  • Everyone, staff and providers included, should be wearing masks.
  •  Patients should expect to wear a mask themselves.
  • Patients should expect that everything will be switched over to electronic means when applicable to avoid contamination via the use of paper, pens, etc.
  • And they should expect all equipment that’s being reused, like exam tables, to be sterilized between patients. 
What precautions can patients take to protect the health and safety of healthcare providers and office staff beyond just wearing a cloth mask to their appointment (which they must do)?

It’s important that all patients be open and honest with their provider. If they have any risk factors, extra precautions can be taken. For instance, if a patient is having new symptoms or feeling ill when coming in for treatment, we include eye coverings as well as masks to protect our providers. If we’re doing any specific lab testing that involves respiratory or nasal secretions, most likely our providers are going to have on an N95 mask, eye coverings, gown, gloves, etc. We even wear shoe coverings in our office. Patients should just be open and honest. We want to protect not only our patients, but also our staff so they can be there for the next patient that’s ill.

Where does elective testing, such as allergy testing or autoimmune testing, fall on the necessity scale during this time? In your opinion, is it worth going in for a physical appointment to get this kind of testing?

Honestly, I think we’re in a time where COVID-19 is going to be around for a while.

At this point, we’ve already paused for about three months, and a lot of people have put off some of their health issues. So it’s important to not only pay attention to those chronic conditions, but also any new symptoms. In fact, it’s even more important now that they start to follow through on a plan or get evaluated. Because putting it off even longer may be detrimental to their health. So, I feel like, it’s time.

There are a lot of physicians who worry that even people having heart attacks are afraid to go to the emergency room. But definitely for asthmatics, people who have chronic infections, with underlying heart disease, you can’t put those things off any longer. And at this point, at my office, we’ve taken every precaution to protect those patients, so they should feel safe getting their health needs taken care of.

We’ve probably got another 12 to18 months to go of really understanding this virus. So many illnesses that we’ve been studying, we’ve known about for decades. We’ve known about COVID-19 for less than a year. The amount of knowledge is vast at this point, but we don’t know where that brings us. It all remains to be seen, and we’re all anxiously awaiting those answers and hope we’ll uncover them soon. 

Is there anything else you want patients to know?

I think one of the other important things is to be prepared when you go in for your visit. Make sure you read whatever information is sent to you ahead of time and know what’s expected of you.

I’ll get patients that show up at my door and walk up and suddenly they realize there’s a sign there that tells them what to do, and they’re like, “Oh!” It was probably communicated to them no less than three times before they came to the office, and they didn’t pay attention.

The other thing is, be patient. We’re trying to keep the environment safe, so sometimes it does take a little longer to clean the rooms and protect all of us. It does take time to put on all those layers of equipment and take them back off in a safe manner. For an office visit, you have to take your time to make sure that everybody is safe.

Also, wash your hands and wear a mask! Blog-End-Cap.png

 

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References
  1. Brough, HA et al. Managing childhood allergies and immunodeficiencies during respiratory virus epidemics – the 2020 COVID-19 pandemic - A statement from the EAACI-Section on Pediatrics. Pediatr Allergy Immunol 2020; doi: 10.1111/PAI.13262
  2. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html#asthma. Retrieved July 2020
  3. Millard M, Hart M, Barnes S. Validation of Rules of Two™ as a paradigm for assessing asthma control. Proc (Bayl Univ Med Cent). 2014;27(2):79-82. doi:10.1080/08998280.2014.11929063