CHARLOTTE, N.C. — Medical procedures invariably cause patients stress. COVID-19 just amplifies that.
"Normally, there's a level of anxiety with any procedure. Even if it's routine for (the doctor), it's the one time you're getting this done," said Dr. Vipul Shah, a Charlotte eye surgeon. "You doing this (during the pandemic) adds that much more anxiety. So our comfort needs to transfer to them."
After about two months of low activity in response to the pandemic, medical practices are starting to open up again. If you need cataract surgery or a colonoscopy or a knee replacement, medical providers are scheduling you again.
However, it won't be as you once experienced a doctor's appointment: You will likely have a medical screening and have your temperature checked before entering a medical office. Depending on the practice, you will either be required or at least strongly requested to wear a face mask.
If you schedule a procedure, you will likely be required to have a COVID-19 test days before, and to self-quarantine until your operation is performed.
Doctors know that all adds to a patient's apprehension. The doctors are adjusting, too, by wearing more personal protective equipment (PPE) and doing some appointments by video calls, rather than in-person visits.
But in the end, it's on the medical pros to manage patients' worries:
"People have fear of a procedure," said Shah, with Charlotte Eye, Ear, Nose and Throat Associates (CEENTA). "Now, there is an added burden of care."
In mid-March, when COVID-19 began spreading widely in the United States, medical providers had to re-evaluate everything about daily business.
There was concern hospitals could be overrun with patients testing positive. The demand for PPE quickly exceeded supply.
Typically, elective procedures were shut down. Also, doctors adapted to new ways to continue treating patients.
A prime example: Over one recent four-week period, OrthoCarolina did 7,000 doctor's visits by telephone or video conference for patients who were at high risk of complications from the virus or just were anxious about coming in.
"Prior to that, we had done zero" appointments by remote means, said Dr. Bruce Cohen, OrthoCarolina's chief executive officer and a practicing specialist in foot and ankle injuries.
Cohen said his physicians typically resisted alternatives to in-person visits in the past, but the success they've had with them, combined with the ongoing pandemic, will make that more common going forward.
Not every patient can be treated successfully in a remote manner. An orthopedist might have to rotate a joint to test flexibility or an ear-nose-and-throat doctor might have to be in-person to determine if ear pain really is in the ear or radiating from an inflamed throat.
Who needed to be seen, and how, became a series of judgments from March to May. Lately, coinciding with N.C. Gov. Roy Cooper's easing of stay-at-home restrictions, medical practices have had more latitude to bring in patients whose ailments weren't deemed urgent a month ago.
"With patients who didn't need to come in, we tried to delay them coming in," said Dr. Michael Sicard, who treats sinus, ear and allergy conditions at CEENTA. "We've all kind of had a learning curve: On the patient side, on our side and on the scheduling side.
"As physicians, (it's evaluating) what can we do, and how do we do it safely? Our office life has changed. We've all gotten a lot more comfortable wearing masks, not just in the O.R. (operating room)."
Busy, not flooded
With all but emergency treatment shut down for about two months, there was concern the pent-up demand could flood medical practices once protocols loosened. However, it appears the mix of some patients' urgency to be treated and others' reluctance to schedule appointments has struck a workable balance.
All four physicians interviewed for this story said they're busy, but not overwhelmed, as schedules flow back toward pre-pandemic norms.
"We thought that all the backlog of people (needing procedures) would just dump into the system, and we'd be working seven days a week," said Cohen. "What we found is a lot of patients were still scared (of the virus). A lot of my patients wanted to wait until June or July, and see how this settled."
The counter-balance to that, Cohen said, was some patients who saw this as the ideal time to recover from a surgery, since they and their spouses were already staying home; convalescence would be easier with a caregiver already working from home.
Dr. Sidney Fletcher, chief clinical officer for Novant Health, said patients need to understand things will look different when they return to hospitals and doctor's offices for treatment. But it's a good different.
"With the restart (of general care), we really needed an opportunity to create time and space (for) all the protocols and procedures we needed in place," Fletcher said. "Not only to have all the enhanced safety measures in place for patients, but (so they could see) all the physical things that looked different and felt different."
As Cohen summed up, "We just need to stress to people it is safe.
"There's no way of protecting any of us completely from getting this thing. But I think the procedures we're using – both in the office and especially for surgery (are there). We're taking really, really significant precautions."
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