When Is It Safe to See the Doctor?
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J Gen Intern Med DOI: 10.1007/s11606-020-06034-3 © Society of General Internal Medicine 2020
the COVID19 pandemic struck the United States W hen and closed all non-essential businesses, the medical world was thrust into turmoil. Suddenly, visiting your doctor was considered unsafe. Emergency room visits and hospital admissions plummeted in regions that were not COVID19 hot spots. Clinic volumes dropped and physicians grappled to navigate an upended healthcare system. Medicare shifted its policy toward telemedicine care for both COVID19 and nonCOVID19-related concerns. In response, healthcare systems drastically changed their protocols related to triaging, scheduling, documentation, and billing. In our primary care practice, telemedicine became the default visit type for both acute and chronic care issues to mitigate the COVID19 spread and shelter our high-risk patients. Yet, we must take heed of the psychological stress to patients. Every visit conversion to telemedicine has the potential to send the message: “it is not safe to visit your doctor.” Such psychologic fear may drive patients to delay care for acute complaints and uncontrolled chronic diseases, further worsening morbidity and mortality during COVD19.1 The reality is that COVID19 is here to stay. We, clinicians, must now determine the appropriate use of telemedicine for acute and chronic care management during a public health crisis. We must now partner with our public health experts to refine guidelines and procedures to ensure the safety of face-to-face visits. Inevitably, our patients will ask us, “Should I come to clinic or stay safe at home?” Telemedicine, telehealth, and related terms refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health. Studies demonstrate telemedicine’s effectiveness on chronic disease management, patient satisfaction, and economic impact.2, 3 These include hypertension monitoring, mental health evaluation and treatment, diabetes control, and dermatologic evaluation.3 The American College of Physicians supports the use of telemedicine in appropriate Received June 11, 2020 Accepted July 1, 2020
circumstances and cites its benefit in the setting of established patient-physician relationships.4 Our faculty early adopters indeed voice novel benefits of telemedicine care. Telemedicine brings the physician into the patients’ home, revealing useful information about their living environment. Medication reconciliation is smoother and more accurate when patients can show their medications over video. We can consult and educate family members without multiple people in clinic. Undoubtedly, telemedicine allows us to learn more about our patients and help them in unique ways. However, telemedicine was never intended to be the default way we provide care. Pre-COVID, telemedicine use was limited due to financial, time, and safety concerns. Most legislation on telemedicine ensures the same standard of care is provided when delivering care via telemedicine as care
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