Over the past few weeks as the number of Coronavirus cases in my city has escalated, my definition of basic healthcare needs has evolved tremendously. Preparing for the effects of the pandemic has now turned into facing them head on. As a Female Pelvic Medicine and Reconstructive Surgeon, my priorities have drastically changed from improving the quality of life for women to preventing their exposure to COVID-19 and decreasing their mortality risks. However, for many patients the anxiety and fear surrounding the pandemic is only heightened by the limitations they are experiencing in regard to their medical care.
In healthcare, our decision making involves weighing the risk versus benefit to the patient, and helping one to identify where they fit into this picture, taking into consideration personal goals, religion, values, lifestyle, and other factors. However, this pandemic has altered the canvas on which we operate and changed the perspective of risk versus benefit. For instance, simple office visits and procedures for managing the 108 million people in the United States with high blood pressure or 34.2 million people with diabetes are now considered too risky to be seen in the office. Also seeing patients who have already been waiting weeks for their appointment with a new doctor is too risky. Some patients have even more distressing circumstances as they are awaiting biopsies to evaluate for cancer diagnoses or even awaiting cancer treatments that are now postponed, all because of the increased risk of COVID-19 exposure. Beyond facing the disappointment of a cancellation is the fear of getting lost in the chaos of rescheduling when the pandemic resolves.
Many providers around the country are canceling surgeries and asking people to stay home not only to decrease exposure, but also to have enough supplies to fight the pandemic. Though the focus on sparing ventilators, redistributing personnel, and providing personal protection equipment may seem to be taking precedence over these patients’ basic medical needs, healthcare providers are working hard to place safety first and continue to provide important medical care remotely.
The primary goal for physicians is to decrease mortality and, in times like these, addressing quality of life issues has taken a back seat, which has left many patients feeling abandoned. These feelings are valid and important to acknowledge. As if facing COVID-19 wasn’t enough, many patients have to continue to navigate their healthcare with less guidance and access to their provider. This is especially burdensome for the elderly and those going through financial hardship. During the evolution of this pandemic, healthcare providers are continuing to assess the risks of holding off on treatment versus exposure to COVID-19. For the most part, going to the clinic is limited to when the risk to one’s health begins to outweigh the benefit of staying at home.
As we see more and more offices canceling appointments, there are still ways patients can connect with a healthcare provider. There are Telehealth visits with video capability or, if this is too technologically advanced for some, a simple phone call might help get things back on track. In many cases, patients may be asked to perform home monitoring or keep diaries to assist their provider in developing a care plan while clinics are closed. In other cases, a provider may decide that the appointment can be canceled for the time being and rescheduled when it is safe to return to clinic.
Open communication between patients and providers is crucial during this time to give patients a clear understanding of the risk of delaying medical treatment and to provide peace of mind. Fortunately, the pandemic will not last forever and though the return to a normal functioning health system may be slow, basic healthcare concerns for patients will take the forefront once again and physicians will have the freedom to focus on quality of life as well as quantity.
Laura Martin, DO is an Assistant Professor of Urology in the division of Female Pelvic Medicine and Reconstructive Surgery at the University of Miami and a Public Voices Fellow of the OpEd Project.