I am a board-certified internal medicine physician practicing in a small outpatient clinic with a highly reputable academic organization in the greater Boston area. Regarding COVID-19, I am not panicked, but I am concerned– concerned for our patients, concerned for our workforce and health care providers, concerned for our parents and loved ones.
The situation in Massachusetts and across the country is evolving rapidly in response to COVID-19. In the past several days, our local academic centers and area hospitals have enacted changes in practice and protocol that have not been witnessed in any of our careers as physicians- including bans on domestic and international employee business travel and cancellation of in-person conferences and meetings. Schools and universities have moved to virtual classes. Members of Congress are pressing leadership to take steps to protect lawmakers, even potentially recessing for a period of weeks.
We are seeing more community spread of COVID-19, and this will likely escalate in the coming weeks. There is much we do not know yet about how this virus spreads; it is possible that healthy seeming individuals or those showing very mild symptoms may have the virus and contribute to the spread. While we are infinitely thankful that the virus appears to be sparing our children, for the most part, it is possible and likely that they are functioning as vectors of the illness and further contributing to community spread. Our older, more vulnerable population is at risk as well as our health care providers and staff. Many small primary care offices across the country are not prepared to handle the very likely scenario that an infected patient presents to their clinic, meaning that they do not have N95 masks, personal protective equipment, a HEPA filter, or protocols for the use of such equipment.
In the absence of clear protocols and guidelines from the government, we as health care providers must be proactive rather than reactive in controlling the rapid spread of this virus. I am imploring medical centers and hospital systems across the country to offer virtual and telehealth options to their health care providers to increase patient access and help protect our patients and the workforce during these unusual times. Many patients in a primary care setting do not need to be physically evaluated at this time. The majority of our patients are scheduled for the following: symptoms of upper respiratory tract infections (cough, fever, sore throat), follow-up visits for chronic diseases like hypertension or diabetes, health care maintenance/preventative exams, or medication refills. At this time, the risk far exceeds the necessity to be physically evaluated.
To the patients out there, not just my patients but all patients across our nation, particularly the elderly and those with chronic medical conditions, please re-consider scheduling an in-person visit with your primary care physician. Given the current climate, I assure you most of your questions and concerns can be just as easily and much more safely addressed virtually by your provider. We, as physicians, do not want our patients coming to our clinics for non-urgent appointments where the likelihood of exposure to this virus is higher than average. These visits are potentially jeopardizing your health and the health of your health care providers who you will so desperately need to count on in the weeks and months to come.
To our administrators, most of our primary care visits can be easily converted to telephone encounters and billed for time. Patients with mild upper respiratory tract symptoms such as cough, congestion, low-grade fever do not need to come in and expose our more vulnerable population to potentially severe illness. Under the current guidelines and simply because of lack of testing kits, this population with milder symptoms will likely not be tested for coronavirus. These visits can be done virtually by telephone, and appropriate medications can be prescribed if deemed necessary, such as antibiotics or antivirals like Tamiflu. Patients with more severe symptoms such as shortness of breath or chest pain should call their primary care office for guidance-these cases will likely need to be triaged to a higher level of care. Patients who are scheduled for routine follow up visits such as diabetes and hypertension are typically our older population and are placing themselves at risk for coming into the clinic. These visits can also be converted to telephone encounters during which a detailed history and review of symptoms are elicited, medications refilled, and pertinent orders placed. And finally, those healthy patients scheduled for routine health care maintenance exams should postpone these non-urgent preventative visits until the situation is deemed safe. There is absolutely no reason to place our patients at risk.
As an internist and the mother of two small children ages 20 months and four years old who are both sick at the present time and the daughter of a 72-year-old mother who lives with us, I have a duty to protect my patients and my family who I love more than anything. As physicians, our top priority right now is preventing new cases of this disease. In addition to hygienic measures of washing hands, wiping down surfaces, avoiding shaking hands and coughing/sneezing into elbows, converting patient care to a virtual platform during these uncertain times is one critical type of social distancing we can implement as a health care system that will have a profound effect on saving the lives of our patients, health care providers, and families. As we learn more about COVID-19, converting to telemedicine will not only help prevent the spread of this disease, but will also reduce the impending massive burden on the health care system, allowing it to provide adequate care to our patients who really do need it.
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