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Go In Or Call In? Here's Some Basic Guidance For Routine Health Care During COVID-19

Un cuarto médico de hospital vacío. (Thomas Barwick/Getty Images)
Un cuarto médico de hospital vacío. (Thomas Barwick/Getty Images)

En español, traducido por El Planeta Media.

Fear of COVID-19 has kept too many people from going to emergency rooms with life-threatening chest pain, persistent vomiting or numbness that might signal a stroke. If you would have called 911 or had someone drive you to an ER before COVID-19, you should do that now.

But what about routine care? There’s a call to use telemedicine when possible to help prevent crowding in hospitals, clinics and offices. But now that your doctor or nurse practitioner is booking non-urgent visits again, when should you see someone in person, and when is a phone or video chat sufficient?

We asked a range of physicians for help clearing up a bit of the confusion. This is general guidance. Call your primary care provider to figure out what’s best for you, your parent or your child.

Well-Child Visits? You Should Go To The Doctor's Office.

“There are some things we only have one shot at,” says Jeanette Callahan, a pediatrician with Cambridge Health Alliance. “We don’t want fear to shut us down in areas that we won’t get another chance at.”

This includes vaccines that are most effective at certain ages, hearing and vision tests, cognitive assessments, growth milestones, speech and other developmental screenings. The American Academy of Pediatrics agrees: if at all possible, have an annual check-up in person.

Adult Annual Physicals? You Should Go To The Doctor's Office. 

“We need to return to both preventive and acute care,” says George Abraham, chief of medicine at Saint Vincent Hospital in Worcester and president-elect of the American College of Physicians.

A delay may be acceptable at this time for younger, healthy patients, says Abraham, but is not advisable for anyone with a chronic condition.

Mammograms, Colonoscopies, Other Cancer Screenings? A Slight Delay Before Heading To Doctor Might Be OK.

Dr. Abraham says the delay of a few months probably won’t make a difference for some patients.

“On the other hand,” he says, “that few months may make the difference between early diagnosis and a more advanced diagnosis.”

There is a growing concern that postponing these tests will boost cancer rates. But many Massachusetts providers don’t have appointments right away as they reopen offices and clear up a backlog. You might request an earlier appointment if you have any cancer history or other risk factors.

Chronic Care (Diabetes, High Blood Pressure, Asthma)? Consider Both In-Person And Telemedicine.

“If there are patients who require routine monitoring,” says Dr. Asad Khan, “there should be no delay because the complications can be severe, if not fatal.”

Those patients will most likely need to see a doctor in person at first.

Dr. Khan, an internist who specializes in pulmonary and critical care in Springfield, says a lot of the follow-up care can be managed with telehealth apps that monitor blood sugar levels for patients with diabetes or high blood pressure.

Headaches, Back Pain, Other Common Discomforts? Try Telemedicine (At Least At First). 

If it’s a chronic problem that flares up, without any new features, it’s perfectly reasonable to start with a call to your primary care provider, says Dr. Jesse Rideoeut, who works in the emergency room at Tufts Medical Center and is president of the Massachusetts College of Emergency Physicians. But...

“You can pick apart almost any symptom and find something that is more emergent with that,” he says. “Even a bad sore throat could be an abscess.”

Rideout says he’s grateful that people stayed home to help slow the spread of the coronavirus.

“But unfortunately, we’ve gone too far in the other direction and some people have been hurt,” he says.

Depending on the symptoms, your doctor may recommend that you come for an in-person visit following that initial call or video chat.

Rashes? Try Telemedicine.

“I have discovered that a majority of rashes,” says Callahan, “are literally textbook pictures that the parents have taken.”

Callahan says telemedicine also helps with cases she needs to refer to a dermatologist for consultation. Some need to be examined, but she says many can be diagnosed and treated over the phone.

Abraham agrees.

“Clearly we’ve learned that not everything needs to be seen in the office,” says Abraham. Before the pandemic, when insurers weren’t paying for telemedicine or weren’t paying at the same rate, “there was almost a perverse incentive to bring someone into the office and create that face to face encounter, just so someone could be paid for their services.

Colds, Fever, Vomiting, Diarrhea? Try Telemedicine (At Least To Start). 

These are some of the most common reasons both children and adults seek medical care. These doctors say many can be managed with a phone call or video chat to let the patient rest and avoid spreading an infection.

“In a sense, the big advantage is that we bring care to them as opposed to expecting them to come to us,” says Abraham.

“But it’s tricky now with COVID,” says Callahan because a fever, diarrhea and vomiting, can be signs a patient is infected with the virus. Callahan says these symptoms can still be monitored over the phone, as long as the fever comes down with over the counter medicines, and the patient can stay hydrated.

The exception, says Khan, is elderly patients, those with shortness of breath, a recent exposure to the coronavirus or some other “red flag.” These patients should be seen right away.

Finally, Keep In Mind That Guidance Will Vary

This guidance is just a snapshot. What you hear may depend on whether your primary care provider has a solo practice, sees you in a neighborhood clinic or in a large hospital. Not all offices have reopened. Some are only seeing patients without COVID-19 symptoms, while others have strict protocols for separating patients with COVID-19 and those at risk for the virus from those coming in for routine care.

“We’re all doing it differently,” says Dr. Kate Atkinson who runs two family medicine clinics in Amherst and Northampton.

She’s opening up for physicals and some basic procedures but seeing a lot of patients via telemedicine. Many smaller practices like Atkinson’s are not seeing any patients with symptoms of COVID-19 because the personal protective equipment that requires is too expensive.

Related:

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.

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