Getting to the doctor during a pandemic

It had been three weeks of gradually debilitating, searing pain before Johnny Staggs decided to call his local clinic for advice.

As a bariatric patient, Staggs, a 43-year-old food stamp office employee in Tennessee, had a history of dealing with hemorrhoid flare-ups, but they usually abated after a few days. He’d use over-the-counter pain medications, which alleviated the discomfort within a few hours, so there was no need to talk with his physician about it.

This time around, the medicines did nothing for his pain. It worsened to the extent where he was practically on his knees at work instead of sitting. He had to nearly stand up to watch a movie with his wife one Sunday. Housework he needed to complete went undone. He took OTC medications to get through the day, and evening versions at night since he couldn’t sleep well because of the pain.

Eventually, Staggs had to take a few days off work here and there, but ultimately he had to return once he ran out of sick leave. Even there, he was falling behind.

Since the pain started up again in early March, Staggs debated whether he should request an appointment with his clinic.

“My biggest concern was thinking, you know, you just hear in the news about how everyone’s rushing in to get tested for the coronavirus and everything,” he said. “And my thought was my issue overall seems so minor compared to if I took a spot [from] someone who had a more serious concern.”

But he also feared that leaving his pain unchecked would grow into a graver problem — or an emergency. This internal dilemma is one many may face right now as they weigh the risk-to-benefit ratio of visiting their doctor’s office.

Here’s what physicians say you should consider when you’re debating with yourself over an appointment.

Deciding whether to visit your doctor

Since states differ in which medical services are available and when varying services will be reopening, there’s no one-size-fits-all answer for whether someone should visit the doctor, said Dr. Gary LeRoy, a family physician in Ohio and president of the American Academy of Family Physicians.

If you’re thinking of scheduling an appointment or if you have one coming up, call ahead to have a clear understanding from your physician’s office about what the plan is for appointments and whether staff is available, he said.

“For chronic medical issues or for issues that really are nonurgent, we also encourage patients to call their doctors first,” said Dr. Patrice Harris, an Atlanta psychiatrist and president of the American Medical Association. “Each patient is unique, and so once they call their doctor’s office, their doctor will be able to determine if they need to come in or if they can be managed using telehealth.”

If you have a chronic health condition such as diabetes or cardiac issues, it’s more important to visit your doctor since he or she may have to examine you in ways that can’t be done via a telehealth appointment, LeRoy advised.

“If it’s a chronic thing you may say, ‘Well, I’m a diabetic; it’s just a routine diabetic six-month check-in.’ Well, there’s a lot of things that go into this routine visit that I’ll ask the patient or make routine observations about,” LeRoy said. “Or maybe we need to do labs at that six-month visit. So you can’t assume that just because it’s a routine visit that you can just put it off even longer.

“So find out what it was that your physician wanted to do that they can’t do over the telephone.”

It’s especially critical for those with chronic conditions and compromised immune systems and older adults to follow up with their doctors regarding in-person appointments, LeRoy said, since those factors make someone at high risk for more serious illness from coronavirus.

If you have serious symptoms of Covid-19, you can call your personal physician for guidance on getting to the hospital for testing.

What to know about telehealth appointments

Telehealth appointments have charges attached to them, LeRoy said, so they may not be an option for you if you’re running low on income or if you’ve lost your insurance. Insurance may cover part of the cost, and out of pocket they usually cost around $60, but your doctor’s office can explain your specific options.

Whether you can opt for a telemedicine appointment depends on the nature of your medical issue, LeRoy said. Again, if you have a chronic condition that requires labs, monitoring or injections, talk with your doctor about whether a virtual visit is suitable for you.

If you’ve noticed a change on your body, such as a concerning blemish or lump, it probably can’t be evaluated via telemedicine, LeRoy said. That’s because your doctor may have to touch it to determine whether there’s a problem.

If you’re not tech-savvy or if you live in a rural area with weak internet connection, you can ask whether your doctor is holding appointments over the phone, Harris suggested.

Some states have restrictions on services that can be offered virtually. If you’re looking to get a prescription medication refilled, ask your doctor if that refill requires an in-person visit.

Out of desperation, Staggs finally called his clinic on March 25. After waiting on hold for hours, he was told he’d be placed in a queue for a virtual appointment at 10:30 p.m. that night. But the delay went into the early morning hours and the appointment never happened, so he decided to visit the clinic later that day.

How to be safe at the doctor’s office

Some physicians’ offices have made adjustments to their waiting and examination rooms to keep everyone involved safe, LeRoy said. Medical staff have moved furniture apart for proper distancing, wiped down doors and supplies to manage surface contamination and are wearing masks and gloves (as usual) to prevent spreading.

“You should make sure that you have some sort of face covering when you go in there,” he said.

You can wear gloves, LeRoy said, but realize you can still pick up the virus and touch your face. Avoid touching your face and adjusting your glasses, and learn how to remove contaminated gloves without compromising your hands.

You should also carry hand sanitizer that you’ll rub into your hands before and after you wear gloves. If you’ve touched your credit card while wearing gloves, use the hand sanitizer to cleanse your card, too.

In a clinic he remembered as usually fast-paced, Staggs was the only patient in the office at that time. The staff was diligent in their protective measures.

“When I walked in, there was a strong smell,” he said. “You could tell that every chair had been wiped down recently.” For his paperwork, the receptionist handed him a pen after wiping it down with a Lysol wipe. Everyone was wearing a mask.

A nurse practitioner examined him, saw his pain and referred him to a specialist who was still taking patients and could see him a week later.

She wiped down the door after he left the room.

Staggs saw a gastroenterologist, who quickly realized Staggs’ problem was much worse than Staggs thought and out of his purview. So he requested that another specialist see him that same day.

After describing his pain to a colon and rectal surgeon, Staggs learned he had an anal fissure, a small tear in the tissue that lines the anus. If it wasn’t for the pandemic, the surgeon would’ve operated on him that same day. But the operation was considered an elective surgery, so the surgeon gave Staggs a cream to use for two weeks before a follow-up appointment.

Just as every other method had failed, so did the cream.

“Because that wasn’t working, he had to do a justification for surgery to get it approved from the board,” Staggs said. “And they were actually able to get me approved. My surgery was [April 22] at 7:30 in the morning. At 8:30 in the morning, I was awake from surgery, and I felt like a new person.”

The guidelines for safety are meant to accomplish three major goals, Harris said. Two are ensuring physicians maintain access to care for their patients while decreasing the risk of spread of Covid-19.

But overall, physicians don’t want their patients to feel alone, Harris added.

“We want our patients to know that we are there for them,” she said. “We also don’t want our patients to feel they have to make these decisions alone, and that they can call us so we can continue in the shared decision-making process.”