Berks County Medical Society Medical Record Summer 2020 - 9

M e d i c a l R ec o r d F e a t u r e

COVID-19 Challenges
for Primary Care

A

by D. Michael Baxter, MD

s the SARS-CoV-2 virus spread in our communities, Primary
Care offices were faced with a challenging dilemma-how to
serve their mission of continuous, first contact, comprehensive
care for preventive, acute and chronic patient needs while keeping
staff and patients safe. In addition, depending on the setting, the risks
and the resources varied. Mary Kelleher, MD, MPH, Chief Medical
Officer of the Berks Community Health Center, found the need to
respond quickly as both staff and patients became positive. Well
defined risk factors, e.g. chronic diseases, more concentrated living
arrangements and employment in service jobs that did not permit
"work from home," particularly impacted their patients. Screening
protocols, symptomatic patient isolation and reliance on community
testing was quickly implemented. The staff also moved rapidly into
the realm of telehealth which proved successful even though some
patients lacked the technology to utilize other means than a telephone
call. While adult face to face visits especially for chronic disease
management and preventive care were deferred or handled remotely,
the staff under the direction of Karen Wang, MD, did continue to
emphasize on-site preventive pediatric visits for children less than
18 months and the BCHC childhood immunization rate actually
increased. Overall the staff, and patients, learned new lessons (the
implementation of telehealth, screening protocols, appropriate testing)
and continued to serve the needs of the community.
Maria Braun, MD, a partner in the independent practice Family
Medicine Associates of Wyomissing, faced the additional set of
challenges that confronted all small businesses: How does one follow
the guidelines to "lock down" and thus close their office, serve patient
needs and yet maintain financial solvency with minimal income? Dr.
Braun's office found tele-medicine essential for maintaining contact
with patients, meeting chronic care needs and even diagnosing cases
of Herpes Zoster and acute appendicitis. However, as the health crisis
worsened so did the fiscal realities of many American businesses. In
response, Congress passed the Coronavirus Aid, Relief, and Economic
Security (CARES) Act which included the Paycheck Protection
Program (PPP) that assisted private medical practices. Although
facing unprecedented challenges, Maria feels lessons were learned and
contact and care were maintained for their appreciative patients.
Perhaps the resources available in a large group practice would
protect some primary care offices; however, according to Tom Kohl,
MD, a Family Physician in the Tower Health Medical Group,
essential changes were necessary to protect patients and staff. System
wide protocols were put in place and most patient visits were
conducted by telehealth. Although these were indispensable, Tom
found that "digital visits" with patients were challenging and that
the loss of personal touch both while examining the patient as well
as the personal contact with patients in these stressful times was
unsatisfactory. As he said, "Family Medicine is all about relationships
with patients, e.g. holding a widow's hand since the loss of her
husband. You can't do that on a computer screen."

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9
Berks County Medical Society Medical Record Summer 2020

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Summer 2020
