As virus restrictions ease, MDs and hospitals urge patients to resume care

kffpostponedcarepoll-300x178Doctors, clinics, urgent care facilities, and hospitals are laboring to get out an important message tied to the Covid-19 pandemic: Patients should not delay seeking their needed medical services, especially urgent or emergency treatment, due to fears of getting infected with the novel coronavirus.

It made sense to postpone many types of medical services as states sought to reduce the virus’ wildfire spread and to prevent the U.S. medical system from potentially getting overwhelmed with Covid-19 cases, experts say.

But public health restrictions are easing, and medical practices and facilities have set up ways to minimize the possibility of coronavirus infection, such that patients may want to reconsider their highest anxiety.

As the New York Times reported:

“Under orders from their states, many hospitals canceled elective surgeries like hip replacements as Covid-19 cases soared. Now most are gradually allowing the resumption of elective surgeries. But for these, as well as for more time-sensitive procedures like cardiac catheterizations, cancer surgery and blood tests or CT scans to monitor serious chronic conditions, doctors now find themselves spending hours on the phone trying to coax terrified patients to come in. In a review of its claim and pre-authorization data for seven acute conditions, including heart attacks, appendicitis and aortic aneurysms, the insurance company Cigna Corporation found declines ranging from 11% for acute coronary syndromes to 35% for atrial fibrillation in the rate of hospitalizations over a recent two-month period. In a study published Tuesday in The New England Journal of Medicine, Kaiser Permanente reported a drop of nearly 50% in heart attack admissions in its Northern California hospitals.

“At the University of Rochester Medical Center in Rochester, N.Y., emergency room visits dropped by 50%, and many of the patients who do come have waited too long to seek treatment. They ‘are presenting late with strokes and heart attacks,’ said Dr. Michael Apostolakos, the system’s chief medical officer. ‘Or they’re not showing up until they can barely breathe from heart failure.’ In Newark, emergency medical services teams made 239 on-scene death pronouncements in April, a fourfold increase from April 2019. Fewer than half of those additional deaths could be attributed directly to Covid-19, said Dr. Shereef Elnahal, president and chief executive of Newark’s University Hospital.”

Kaiser Family Foundation poll found that 48% of Americans said they or a family member has skipped or delayed medical care because of the pandemic, and 11% of them said the person’s condition worsened as a result of the delayed care.

Cognitive biases always mess with all our decision making, and the New York Times explained why patients have reacted so sharply to infection fears in delaying care:

“Declining crucial, potentially lifesaving treatment might seem irrational. Mental health experts explain that anxiety affects the part of the brain involved in thinking and planning for the future. It arises when that part, the prefrontal cortex, doesn’t have enough information to accurately predict what lies ahead, causing the brain to spin scenarios of dread. Enter panic. ‘If you have anxiety and then you exacerbate that by watching the news and reading social media, that’s where you get panicked,’ said Dr. Jud Brewer, a psychiatrist and behavioral neuroscientist at Brown University. ‘And the rational, thinking parts of the brain stop functioning well when we’re panicked.’ Panic, in turn, can lead to impulsive behavior and dangerous decisions, Dr. Brewer and others said. ‘People are saying: “So I’m having a heart attack. I’m going to stay home. I’m not going to die in that hospital,’” said Dr. Marlene Millen, a primary care physician at the University of California, San Diego. ‘I’ve actually heard that a few times.’”

Patients should know about measures that medical facilities are taking to protect them from coronavirus infection, the Washington Post reported, quoting experts including Mark Wakefield, associate chief medical officer of MU [the University of Missouri] Health Care system:

“Returning patients and visitors across the country will see changes that are here to stay. Screening for infection symptoms before appointments. New barriers, social distancing, and restricted visitation. Appointments spread out over longer hours to spread the traffic. Fewer forms to touch. Drive-ups for shots. Waiting in your car to see the doctor. More use of technology to keep space between patients and health-care providers. Before the virus hit, MU Health Care was using telehealth for virtual patient visits about 200 times a month. Now, Wakefield said, ‘We’ve done more than a thousand a day for many days.’”

Some patients have gotten upset when medical service providers, notably dentists like those in a Texas practice named “Swish,” have tagged them with fees — not covered by their insurance — for infection control measures, as the independent, nonpartisan Kaiser Health News service reported via NBC News:

“Swish Dental is one of a growing number of dental practices nationwide that in the past month have begun charging patients infection control fees of $10 to $20. Swish and others say they need the extra money to cover the cost of masks, face shields, gowns and air purifiers to help keep their offices free of the coronavirus. The price of equipment has risen dramatically because of unprecedented demand from health care workers. Dentists say they struggle to pay the extra costs, particularly after most states shut down dental offices in March and April for all but emergency care to reserve protective equipment for hospital use. They are also seeing fewer patients than before the pandemic because some fear going back to the dentist and, at the same time, dentists need to space out appointments to keep their waiting rooms uncrowded.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the high value in their staying healthy and away from the U.S. health care system. Until medical science comes up with a way to prevent or better treat it, the coronavirus will continue to pose the possibility of swamping our health resources. In their better times, they already had notable problems with infections acquired in hospitalsnursing homes, and other medical care giving facilities, as well as major challenges with medical error and misdiagnoses. That said, the system and the providers in it need our support.

They seem to have withstood the first, major assault of Covid-19, with almost 2 million infections and more than 100,000 deaths in this country. But the system long has had an excessive reliance on a profit-gouging, fee-for-service business model, requiring a steady stream of patients. Medical practices as well as clinics and hospitals have seen their finances upended by the pandemic and the country will be in terrible shape if providers are forced out of business and invaluable care gets lost.

The virus, of course, has not disappeared, and it won’t, as if by magic. So, all of us need to exercise mature, common sense, and good judgment about slowly easing back to normality. Too many of us have lost work and our own finances may be in bad shape. But for those who still can access medical services, needed treatments should not be avoided out of unfounded fears.

Talk with your doctors. If you feel like they are pressuring you because they just need the business, you may need new caregivers. But solid practitioners should give you the reasoned, informed medical counsel and care needed, including word about treatments that should not be delayed.

This is especially important if you have serious or chronic illness or injury and have required sustained medical attention. Don’t neglect your specialty care, too, if you’ve needed help with everything from your eyes and ears to your heart, lungs, kidneys, all the way to your feet and toes. Your kids, of course, grow and change fast — and seeing your pediatrician regularly can be key. It’s unclear what the plans in the months ahead will be schools, colleges, and universities. But if your caregivers have availability and it was part of your budget anyhow, it might be good in the next bit to get them their check-ups, and, yes, those all-important vaccinations appropriate for their age.

The Covid-19 pandemic has pounded home for all of us the importance of our health, including how preventive and regular health care matters. Here’s hoping that the terrible days we’ve already experienced will help rid our health care system of costly and wasteful care (which abounds, as skeptics note), allow for improvements and innovations, and allow us and our health system to look to better days.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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