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Remember the exam room?

We have started scheduling comprehensive visits (“checkups”) for members in our office. We had deferred all checkups since mid-March at the start of the pandemic, meaning there are several months of previously scheduled checkups that did not occur. The state prohibited such visits, and most of you had little interest in coming into our office for an extended visit under uncertain safety conditions.

We agreed. We substituted remote interval visits, which in fact largely did the trick of keeping up preventive care and chronic care maintenance. While Zoom or FaceTime are a bit better, plain old telephone discussions usually do quite well.

And last month (when DPH allowed) we also reinstituted in-office visits for urgent problems where we felt we needed the direct contact and physical examination to give you proper care. Such visits have largely been successful and uneventful for all. We continue to offer them as needed, along with virtual follow-up and urgent visits.

Safe environment for in-person care

In our judgment, periodic long (and unrushed) appointments for comprehensive evaluation of each person’s medical needs and present condition are the foundation of good preventive and illness care. Orchard Health Care’s mission is to enable and implement that type of care environment for you and for us.

At the same time, the pandemic SARS-CoV-2 virus imposes unheralded strictures on how we can use our office safely. Spending extended time in any small closed space with anyone presents a theoretical enhanced risk of disease transmission. And proper environmental hygiene requires surface sanitization of any room after use for patient care including at least 30 minutes with no occupants in order to allow multiple air turnovers by the HVAC system.

As you know, our office suite has one exam room for each doctor’s consultation room, and the nurses each have their own office/exam room. The logistics are daunting. Following is what we will do.

How we manage in-person visits

Everyone who will be seen in the office is remotely prescreened for symptoms of and exposure risks for Covid-19 by one of the clinical staff, usually the prior day, possibly Friday for Monday visits.

Patients for checkups will be expected to get any requested lab tests done in advance of their visit. Appropriate lab slips will be provided to the laboratory or the patient well before the appointment. If you have symptoms of or high-risk for Covid-19 infections we now would normally reschedule your visit and discuss what to do instead.

Every patient who comes into the office after remote screening receives a nasal swab for active Covid-19 virus using the Quidel antigen test. We have described this before in these blogs. The test is highly accurate with rare false negatives and almost no false positives in laboratory evaluations. It is used widely for regular screening of nursing home staff, for example. All OHC staff and doctors are screened weekly. The result is ready in about 15 minutes. This is an added measure of safety for you and for us. There is a modest fee for the test.

Scheduling of in-person visits

All in-person visits (whether checkups or urgent visits) are scheduled at set times. These are 8:30 a.m., 10 a.m., 11:30 a.m., 1:30p.m. and 3:00 p.m. from Monday through Friday.

Dr. Kanner’s in-office visits for checkups will be scheduled on Tuesday and Wednesday mornings and extended to Thursday mornings if needed. He will be available for urgent in-office visits on Monday afternoon as well Tues-Wed-Thu mornings. Virtual visits may also be scheduled at other times.

Dr. Sobel’s in-office checkups will be scheduled Tuesday, Wednesday and Thursday afternoons, and Friday mornings. She will also be available for urgent visits on Monday mornings. Virtual visits may be scheduled at other times.

Checkups in two parts

Both Dr. Kanner and Dr. Sobel will plan an extended conference with each patient (preferably by video conference on Zoom or FaceTime) the day prior to their scheduled comprehensive checkup visit. The purpose of this “Part 1”  is to review all existing issues and treatment plans, learn of new patient concerns, and review lab data, consultants’ reports and other outside testing.

In other words, we will try to cover all the detailed discussions we would normally have with each patient as the initial (and largest) part of any comprehensive checkup visit. But we can do this effectively and more safely by the remote video conference, and thereby substantially reduce the close one-on-one contact time in our office that would otherwise be required.

On the scheduled day for “Part 2” of the comprehensive checkup visit, we can then have a targeted and much more compact meeting in our office (in the exam room) to do a physical exam, take an EKG if needed, and review final new treatment plans. We hope to accomplishment the in-office portion in about a half hour. That two-part sequence should enable each person to have had a thorough and unrushed comprehensive visit as the renewed basis for upcoming health care over the next 6-12 months.

The benefits of two-part checkups

The minimized true in-person time, together with prior SARS-CoV-2 screening, not to mention all our PPE’s and sanitizing, should keep us all safe from Covid-19 infection in our office while providing the thorough and thoughtful medical care that we all want.

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