Since mid-March we have largely employed phone conversations and video visits to provide medical services to all of our members, in accordance with guidelines from the state, the CDC, and various medical organizations. These visits have overwhelmingly been effective for both patient and doctor. Our nurses are keystones in our communications.
In-person visits for urgent issues in July
State guidelines under “Phase 2” now allow patients with urgent problems as well as other situations where an in-person exam or procedure is necessary to good care to be seen in our office. We began to do so last week. We will continue this pattern — predominantly remote video visits with some urgent visits in the office — during the month of July.
Screening before in-person office visits
Before any in-office visit, the clinical staff will screen the patient by telephone to check on details of the problem, patient-reported vital signs, and especially any symptoms of or possible exposure to Covid-19. If Covid-19 is a real possibility, the member will be guided to another facility for evaluation rather than our office.
Active virus screening at start of in-person visit
On arrival at our office, every patient is screened for active infection with the SARS-CoV-2 virus, the active agent for Covid-19. We do this for your protection and ours, in recognition of the documented prevalence of completely asymptomatic carriage of the virus by a substantial portion of the population.
We use the Quidel immunofluorescent test for viral antigen, which we perform in about 15 minutes from a simple nasal swab. This is highly reliable point-of-service test and appears about as precise as the PCR testing done at larger laboratories. It employs the same reliable technology as we used to test our members for active influenza infection in the past two years. We are truly pleased to be able to offer this test in office.
There is a modest charge for the test that we will initially bill to your insurance, but the charge will be passed to your individual account if insurance coverage does not come through.
Gaining experience with safe office visits in July
We are aware that many annual checkups and standard follow-up visits have been deferred since mid-March. Most have been substituted by phone and video visits.
State “Phase 3” guidelines set to start next week will allow the gradual introduction of such “routine” checkups and follow-up visits in the office. We clearly believe that such visits are the bedrock of good preventive medicine and chronic disease management and have been central to our pattern of effective care for decades. Yet, remote visits have been quite effective so far. And we will now be able to arrange non-urgent blood tests more readily to accompany those remote visits, which will make them more complete, especially for follow-up disease monitoring.
So, for the moment we feel cautious and will wait to see how we all fare with just more in-office urgent visits during July. The sanitizing routines and patient separation issues and wearing of PPE — our staff wear at least N95 masks and face shields, more when taking any Covid-19 samples, and we test ourselves weekly for asymptomatic Covid-19 — make patient care and patient flow in the office much more complex. We believe we will routinize these procedures this month. We also will learn how other practices in the state fare with more routine in-person patient visits, and whether any unforeseen problems arise. In this arena, we feel safer not on the leading edge, but nevertheless close behind.
When will office checkup visits restart?
If July goes well, and state guidelines allow “routine” checkups and visits to be done in-office, we may begin to schedule some such visits in August, though it may be after Labor Day. We also will continue a sizeable proportion of video visits, which many of you have preferred. Certainly the member’s preference will count.
In this fashion I believe we will gradually arrive at a good, workable, and safe mix of remote and in-person visits over late summer and fall that will be sustainable in our new pandemic-shadowed reality. I will update everyone on this issue by the end of July.
A good Fourth of July weekend to you all!