Medical Care During COVID-19
Katherine Koh, MD, MSc

Katherine Koh, MD, MSc is a practicing psychiatrist at Massachusetts General Hospital and the Boston Health Care for the Homeless Program. She specializes in clinical care for homeless patients who live on the street and conducts research on the health of homeless populations. She is a graduate of the MGH/McLean Residency Program, where she served as MGH Chief Resident as well as Chief Resident for Community Psychiatry. She earned her medical degree from Harvard Medical School, received a Master’s of Science in Evidence-Based Social Intervention from Oxford University, and earned her Bachelor’s from Harvard College.

Q. My level of concern about COVID-19 is so high I am afraid to go to a variety of doctors. What can you suggest for moderating this concern and being able to make it to the doctor? Can I take a supportive person with me?

A: If you feel comfortable that your condition can be managed well with telemedicine, this option can provide you with excellent medical care in the time of COVID. If you have to visit the doctor in person, make sure to carefully follow the rules required by the physician’s office. Policies may differ regarding bringing a supportive person, so find out before the visit what is allowed and explain why you would benefit from bringing one.

Q. Which doctors’ appointments should I keep or cancel during COVID-19? What factors should these decisions be based on?

A: Any doctor’s appointment that can be completed safely through telemedicine should be kept. If an in-person visit is needed, one should consider the following:

  • How serious or bothersome are the current symptoms?
  • Do you feel the visit can be safely deferred to a later time?
  • Does the doctor feel the visit can be safely deferred to later time?
  • How thorough are the infection control practices at the doctor’s office?

Q. What helpful tips do you have for staying safe at a doctor’s visit? At a pharmacy?

A: Make sure to carefully follow the rules of the physician’s office before and during the doctor’s visit, such as completing symptom screening and temperature checks, wearing a mask, sitting at a 6-foot distance from other patients in the waiting room, and wearing eye protection if preferred to reduce risk. Figure out a safe way to get to the doctor’s office: Can somebody drive you and wait in the car so you can avoid a long bus ride?

Pharmacies that provide medications through mail order covered by insurance are the safest option, and you should feel empowered to call any pharmacy to find out what options exist to maximize safety. If necessary, sending a representative to pick up medications for you is also an option.

Q. I am afraid to go to the dentist for a routine visit. How can I insure that my dentist is following the best safety procedures? Am I better off being the first person in the morning to receive treatment? Is this one of the highest risks doctor’s appointments that I can make?

A: You should call the dentist’s office to inquire about their infection control practices. Questions could include whether the office does symptom and temperature checks for patients and staff, the status of mask, eye, and face shield policies, the configuration of the waiting room, and sterilization procedures for instruments. While the dentist must work in close proximity to the patient, steps to help reduce the risk, such as the dentist’s use of protective equipment including a face shield, may mean that the benefits outweigh the risks. Although some people think of an office as cleaner in the morning, this is not necessarily the case and there is not any data to support that morning appointments are safer.

Q. Can I postpone my mammogram or other recommended preventive screenings by 6 or more months? What safety precautions are being offered at major Boston hospitals? Am I safer going to a satellite office in, say Waltham, where there is less traffic?

A: Mammograms and other screening procedures should not be postponed if at all possible. A recent study in a major medical journal, the Journal of the American Medical Association, noted that 1/3 of excess mortality now being documented in the time of COVID is due to non-COVID deaths perhaps attributable to delay in diagnoses, which highlights the importance of following through with recommended screenings (1). At major Boston hospitals, all guests entering the hospital are required to wear a mask and use hand sanitizer. Many offices are limiting the number of people in the waiting room at any given time, so going to a less busy clinic is not necessarily less risky.

Q. Eye exams seem very risky at this time. What is being done to minimize risk of these procedures? Can routine eye exams be postponed till next summer?

A: Like other preventive visits, eye exams should not be postponed if at all possible. Certain eye diseases like glaucoma have no symptoms, and other conditions like diabetes, hypertension and macular degeneration can be discovered by looking inside the eye. Many ophthalmology offices require screening questions, histories taken over the phone, temperature checks, hand sanitizer, and mask usage. Exam rooms are sterilized and the slit lamp (used to look inside the eye) often has a plexiglass shield to separate the doctor and the patient.

Q. What is a good decision-making process for deciding whether to request a telemedicine appointment versus an inpatient appointment?

A: If you do not feel comfortable that your appointment can be done safely in person, telemedicine is the optimal choice. Factors that should be weighed include the importance of the physical examination for your symptoms, the need to obtain lab or imaging tests, the preference for face-to-face contact, the risk status associated with one’s physical health conditions, and the infection control practices of the office.

Q. I need some help with substance abuse. Are inpatient treatment, outpatient treatment, and sober homes safe treatment options during COVID-19?

A: Most inpatient, outpatient, and sober homes have implemented infection control practices that optimize safety during COVID-19. If possible, one should call in advance to confirm what these procedures are.

Katherine Koh, MD, MSc
MGH Psychiatry
Boston Health Care for the Homeless Program

 

References

  1. Woolf, S. H., Chapman, D. A., Sabo, R. T., Weinberger, D. M., & Hill, L. (2020). Excess deaths from COVID-19 and other causes, March-April 2020. JAMA, 324(5), 510-513.
Medical Care During COVID-19