The COVID-19 pandemic has radically altered daily life around the world. Physician practices are experiencing major changes as well. These vary widely by specialty. Yet several common themes run through all practices. Non-essential appointments and procedures are being postponed. Consultations are being done by phone when possible. Protections are being instituted against infected patients.
St. Louis Metropolitan Medicine reached out to several SLMMS members to find out how their practices are being impacted. These comments are as of Monday, March 16 through Wednesday, March 18.
Family practice physician Mark Pelikan, DO, says his practice at Esse Health “is developing protocols for phone triage to determine which patients really need to come to the office to be treated.” Many patients are canceling; follow-up appointments for chronic conditions are being postponed, he added. Esse also has a service through which patients can receive text updates on COVID-19.
He noted that patients with COVID-19 symptoms are having difficulty getting tested because they don’t meet the screening criteria set by the public health departments. “We are left without knowing what to do except isolate,” Dr. Pelikan said.
Internal medicine and geriatric physician Mark Gunby, DO, with BJC Medical Group, said besides many cancellations, “We are restructuring office schedules to see well patients in the morning and ill patients in the afternoon. We also are limiting to one the number of family members or caregivers who can accompany the patient.”
He continued, “BJC has set up a nurse triage call system along with e-visits and video visits to help handle potentially infected patients’ questions regarding the risk of COVID-19 and the appropriate testing if needed. This provides a uniform approach to these at-risk individuals, making sure they get the appropriate answers to their questions and testing if needed. We will likely be using more telemedicine visits for Medicare patients as we get further instruction.” (CMS on March 17 announced it was expanding Medicare coverage of telemedicine.)
In ob-gyn, birthing is obviously not going to stop, but the hospital environment is changing. Robert A. Brennan, Jr., MD, hospitalist ob-gyn at SSM Health St. Clare Hospital, said, “We are wearing a mask for each patient encounter. We have limited the number of visitors to two. And there is no entry through the ER. We also have increased hand washing. There is a nurse screening everyone at the entrance.”
In child psychiatry, Pearl Serota, MD, described what she is experiencing: “We are screening patients for symptoms and travel history. We are keeping people seated at a distance. In the waiting room, we’ve removed toys and children’s books. We are asking only one parent to accompany the patient. We also are looking at telehealth options.”
Psychiatrist Luis Giuffra, MD, has had many cancellations. But he also is making greater use of telepsychiatry visits.
At the Mercy Hospital South acute rehabilitation unit, rehabilitation medicine physician Jennifer Page, MD, gives this update: “We have changed our 49 rooms to all-private, thereby cutting our census in half to decrease the risk of infection. We have limited access to our therapy department and have closed the dining rooms to visitors. Visitors are limited to participating caregiver or immediate family member.”
She added, “We are all in this together.”
At the office of dermatologist M. Laurin Council, MD, part of Washington University Physicians, she said patients are being aggressively screened prior to coming in, then again at check-in. She added, “We also are postponing long-term follow-ups and cosmetic appointments. We are communicating with patients electronically instead of in-person when possible. We are minimizing waiting room time by rooming patients quickly and we generally keep a distance from each other. As this situation evolves, we are very likely to tighten our protocols further.”
Independent dermatologist Erin Gardner, MD, said his office basically shut down on March 19, “for what will be likely the rest of March. Many staff are afraid to report to work, in part because of concerns for their own health. Many dermatology visits are for non-urgent services, so rescheduling is often a reasonable approach.”
Also in dermatology, George Hruza, MD, said his office is following policies including social distancing of at least six feet, no visitors accompanying patients, screening patients on the phone and at the front door for potential COVID-19 exposure, and frequent cleaning of high-touch surfaces.
In nephrology, kidney dialysis must continue. Nephrologist Inderjit Singh, MD, said “Our dialysis units have instituted a mandatory policy for all patients and staff including nurses, technical staff, dieticians and social workers to wear masks and appropriate personal protective equipment while inside the unit. No visitors are allowed in the waiting area of the dialysis unit at any time. We also emphasize to patients that there is NO evidence as of yet that the COVID-19 virus directly affects kidney function.”
He noted they are exploring telemedicine options both in the office and dialysis units.
Plastic surgeon Edmond Cabbabe, MD, said his practice has seen a severe slowdown, due to most plastic surgeries being done on an elective basis.
In radiology, David Pohl, MD, of SSM Health St. Joseph Hospital-West, shared his observances: “We are seeing increased demands from the ER for imaging. The critical question being addressed at this point is room cleaning between suspected or positive cases. We are considering a general ban on all routine or follow-up evaluations.”
He added, “We are preparing our home computers so we would be able to do at least preliminary review and readings from our homes if several members of our group must undergo quarantine.”
Nuclear medicine radiologist Christopher Swingle, DO, with West County Radiology at Mercy Hospital St. Louis has seen less impact due to the nature of his cases. “There’s been a bit of a decrease in elective scans, but PET/CT numbers have stayed about the same. Cancer patients are less likely to want to defer staging and restringing exams,” Dr. Swingle said.
Regarding staffing, he shared, “My group is encouraging anybody who thinks they have been exposed to work from home. In a radiology practice, we are largely prepared to do that. I think there’s a good collective sense that we are all in this together and colleagues have been very good about schedule flexibility.”
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