Lancaster Physician Fall 2020 - 21

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"I'd like to
cancel my
physical/
routine
appointment.
I don't want
to come to the
doctor's office
and run the risk
of catching
that virus."
This request is still heard by my staff,
although less than in the spring, as patients
realize that the pandemic is not going away
anytime soon. Questions I commonly hear
these days are "Doc, is it safe for me to...
travel to see my family?"
send my kids to school?"
spend a weekend with friends?"
My answer is always, "It depends," and we
try to work through the risks and benefits.
The same is true for the question, "Is it safe
to visit my doctor's office?" So, what are the
benefits and risks?
The benefits for an acute problem are
clear-the opportunities to have the problem
evaluated with diagnostic testing, treatment
initiated, and reassurance provided. For
routine checkups and physicals, the benefits are much more long-term. Appropriate
management of chronic problems, such
as high blood pressure and diabetes, may
not make one feel better NOW, but is an
investment in the future to lower the risk
of heart attacks, strokes, or the multiple
complications of diabetes. The pandemic has

taken a lot away from our normal lives, but it
has not found a way to slow the progression
of complications from chronic diseases that
require management. We do not want a
"second pandemic" from complications of
conditions that have been neglected out of
fear of the virus.
What is the risk of a doctor visit? Actually,
these days, it is considerably less than a trip
to the grocery or hardware store and far less
than going to a restaurant or movie theater.
Screening questions and temperature checks
before entry, masks throughout, relatively
empty and spaced seating in waiting rooms,
and scrupulous cleaning of exam rooms
make most doctors' offices places where the
coronavirus is absent and not able to infect
those visiting.
But low risk does not mean no risk! With
the coronavirus wandering haphazardly
around Lancaster County, infiltrating all but
our own little cocoons, any venture outside
our own home is putting us at risk. How
can we maximize the benefit of medical care
while minimizing risk?
Looking first at the management of chronic conditions, the simplest approach is to
"see" the doctor without leaving your own
home through a virtual or "telemed" visit.
Technology has made that possible, and with
Medicare and most insurance companies
paying for these services, virtual visits can
provide a safe way to manage chronic conditions. (Be aware that Medicare has agreed
to pay for virtual visits only on a temporary
basis, with no assurance of coverage when
the pandemic eases.) Privacy issues prevent
us from using common platforms such
as Zoom but, with a little guidance, the
platform utilized by your physician can be
installed and easy to use. Telephone visits
without the visual component are useful
but not as satisfying.
Self-monitoring at home can go a long
way to help the doctor manage chronic
conditions. Periodic measurements of
the HbA1c (which averages blood sugar
readings over three months) and regular
blood sugar self-checks provide guidance
on management of diabetes. Home blood

LANCASTER

21

PHYSICIAN

pressure measurements can determine
success of current treatments and indicate
when changes are needed. Regular weight
checks provide clues to fluid retention in
those dealing with heart failure. All of those
measurements can be done at home or with
a quick visit to the lab and then discussed
during a virtual or telephone visit.
What are the benefits of an annual physical? Is there any point in coming to the
office when you are feeling fine and any
chronic conditions are comfortably managed? Although there are clearly times when
lab results show abnormalities of concern
or a physical exam reveals a new finding of
significance, such as a new heart murmur,
a worrisome skin lesion, or a lump that isn't
supposed to be there, I think the real benefit
of an annual visit is the chance to develop
the relationship between doctor and patient.
The time set aside for the physical provides
an opportunity to get to know each other
and to foster the sense of trust so critical
in ongoing care. It also provides the time
to discuss lifestyle changes that can impact
future health and to update immunizations.
How to assess the need for an office or
virtual visit for a new issue is more difficult.
Often, the underlying concern is, "Doc,
should I be concerned about this new
symptom, or is it safe to let my body heal
itself?" Our bodies are simply amazing in
their ability to heal, and there is a lot we
can consciously do that helps or hinders that
restorative process. Physicians are trained to
be on the alert for red flags, such as symptoms
that could be signs of something serious that
warrant further investigation. A consultation
often needs to be in-person at the office if a
physical exam is needed for assessment, but
sometimes it can be carried out virtually.
To follow are some suggestions on how
people can decide whether a visit with their
provider is advisable.
Most colds are self-limited and usually do not need a visit. Fortunately,
regular mask-wearing and hand-washing
Continued on page 22
Lancaster Physician Fall 2020

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