It is anything but “business as usual” for everyone, but especially in the healthcare sector.
In Moore County, medical facilities are running short on protective gear; some practices have closed except for emergencies; specialists are opening to take care of garden-variety illnesses and injuries; and “doc-in-a-box” medical check-ins via computer are fast gaining in acceptance and usage.
At FirstHealth of the Carolinas, the region’s main health system, and other providers, personal protective equipment such as masks and eye protection — PPE — is running short for providers. FirstHealth has actually begun reaching out to local businesses for help.
“We have great partnerships with our local business community who have offered assistance to obtain additional supplies, and the outpouring of donations and requests to assist from the community has been outstanding,” said Emily Sloan, a spokeswoman with FirstHealth.
Collection bins have been set up outside of five of the network’s fitness centers for sewn masks and other supplies that the community has donated.
In addition, FirstHealth staff are taking steps to preserve critical hospital resources where possible.
“We remain well-staffed at this time,″ Sloan said. “FirstHealth has developed an online internal system to connect those with on-going or occasional child care needs to staff or other resources that might be able to help meet those needs.″
Telemedicine Takes Off
One of the biggest transformations underway as a result of the coronavirus is how doctors are actually seeing patients. In the case of Pinehurst Surgical Clinic, Pinehurst Medical Clinic and Sandhills Pediatrics, among others, doctors have seen an exponential increase in taking care of patients via computer.
FirstHealth of the Carolinas launched a patient-friendly telemedicine app called FirstHealth On the Go last fall. It allows patients to speak with a doctor 24 hours a day, seven days a week via a phone, tablet or computer.
This week FirstHealth also launched a telephone visit resource for all FirstHealth outpatient clinics. This option will allow continued access to providers. Patients with appointments can now continue care with short telephone visits when needed.
The practice of “telemedicine” — sometimes called telehealth, e-visits or virtual care — has been around for the better part of 20 years, but its usage was sporadic and mostly used for specialists at large urban medical centers “seeing” patients in remote, rural locations. These days, physicians are seeing patients from just down the street who don’t want to — or can’t — get out with the spread of COVID-19.
Pinehurst Surgical Clinic has deployed telemedicine technology across all of its specialities while maintaining options for traditional face-to-face visits and treatment.
“We are still open and functional. If a patient feels like they need to be seen, there are no departments shutting down because of the pandemic,” said Dr. David Granthan, president of Pinehurst Surgical Clinic.
He said the clinic is working cooperatively with FirstHealth of the Carolinas and Pinehurst Medical Clinic to determine how to proceed, often speaking multiple times a week in meetings.
“This is a very fluid situation and these types of discussions with patients can change day-to-day. What is appropriate today may be inappropriate tomorrow,” Grantham said. “We are dedicated to ensure we are being responsible with our decisions. But our primary purpose in this community is to provide surgical care and will do that until the situation mandates we cannot.”
He explained the term “elective surgery” can be misleading.
“Just because it is ‘elective’ doesn’t necessarily mean it can be delayed for months on end,” Grantham said. “Depending on the condition, delaying treatment could be detrimental to the patient.
“We are not ignorant of the current situation. When we see that a patient is at higher risk and it doesn’t make sense to put them in that situation, we will tell them to postpone. If the surgery is something that can be safely put off, we will. But if it is something that is needed, we will provide that in a timely fashion.”
Routine Care Changes
For routine care at Pinehurst Surgical Clinic, patients are being contacted ahead of their scheduled appointment to discuss whether they prefer to see their doctor traditionally or via telemedicine.
“So far, that has been very successful,” he added, noting that everyone coming into the building — whether staff, patient or visitor — is screened for fever or other potential symptoms of infection. “Even I got questioned coming in the door this morning. Quite frankly, that is the way it should be. Physicians are not immune to this.”
“In the midst of a pandemic, anything we can do to keep people safe so they are not sharing infection is appropriate,” said Dr. Christoph Diasio of Sandhills Pediatrics. “As a retirement area with a large elderly population, we have an extra obligation to do this.”
North Carolina has moved “incredibly aggressively,” he noted, to broaden access by temporarily removing some of the barriers to such services. Those steps included relaxing some federal privacy regulations on using HIPAA-compliant secure transmission lines and expanding payment policies.
“The bottom line is that things are changing, but everyone is responding to what is happening today. We have to balance patient care with infection control,” Diasio said. “The novel in the name (COVID-19) means it is new. No one has a natural immunity.”
The pandemic is also challenging because around 80 percent of those exposed to the virus will have mild symptoms.
“That is precisely why it is easy to spread. People may not know they are sick, or just think they have a runny nose. But a few will get super sick. There is a big variable in the presentation of it,” Diasio said. “People should stay home and try to limit their circle to their own family.”
If you have coronavirus symptoms, but do not require emergency medical care, you should consult your primary care provider by telephone or through telemedicine first. They may recommend you stay home, self-isolate and take care of your medical needs. At this time, there is no treatment for COVID-19 and most cases will not require advanced care.
Telemedicine works particularly well for mental health therapy, visible medical conditions like a rash, and patients may also be more relaxed getting the care they need at home.
“If we are trying to keep people apart, this is a way to do that. For our teen patients, using this technology is like a duck to water: this is their natural state,” Diasio said. “But it’s hard to look in a patient’s ear canal. There are limitations.”
For patients that must come in for care, Sandhills Pediatrics has taken a divide-and conquer approach, separating its clinics. One side serves sick patients and one side helps well patients, with dedicated medical staff in each area.
“If we can keep 10 to 20 percent of people at home using telemedicine, we are making a difference,” he said.
Pinehurst Medical Clinic has also adopted new policies to help minimize the spread of COVID-19, including strict visitor rules and multiple avenues for remote visit access by telephone or through the FollowMyHealth patient portal.
“PMC has a strong history of being a responsible member of the communities we serve and a vital healthcare resource,” said Nichole Cox, Pinehurst Medical’s business development manager. “PMC appreciates the patience and support from all of our patients, staff, and community during these ever-changing times.”
To schedule a visit, patients are encouraged to call their primary care physician for further instructions or go to the PMC website for step-by-step guidance on how to start a FollowMyHealth patient portal visit.
Other Specialties Adapting
If you had an appointment to get your teeth cleaned scheduled this month, you’ve likely heard from your dentist that your visit has been called off. That’s because the North Carolina State Board of Dental Examiners recommended dental elective procedures be postponed for at least the next two weeks.
“Anything that would create an aerosol, like drilling a tooth and general dental cleanings. We’re trying to talk people into not coming,” said Dr. Clement Monroe of Drs. Monroe & Monroe in Pinehurst.
His clinic will be closed through April 5 for all but emergency patients. Other dental offices throughout the area have made similar decisions and announcements.
“We are, of course, trying to take care of patients to keep them out of the hospital and identify true dental emergencies. But if the situation can be handled with an antibiotic to keep you out of the office, that is what we are trying to do,” Monroe added.
“Our worry is the health of the community and making sure the disease isn’t transmitted further. That is the challenge we are in.”
Carolina Eye Associates has also scaled back its operations to only “urgent or emergent patients” until further notice, at all 13 of its locations in North and South Carolina.
In a statement issued Friday, Carolina Eye said it would follow guidelines established by the Centers for Disease Control, American Academy of Ophthalmology, and the Center for Medicare and Medicaid Services to cease any non-urgent patient care as well as all elective surgeries.
“Safety is the number one priority at Carolina Eye Associates. This decision is in the best interest of our patients, doctors, and staff.”
Similarly, optometrist clinics including Family Eye Care of the Carolina have also temporarily closed their offices until appointments can be safely rescheduled.
Contact Laura Douglass at (910) 693-2474 or email email@example.com