[villagerjack]

With the constant barrage of messaging about the Corona Virus i.e. Washing hands frequently, do not touch your face, do not shake hands and social distancing at a recommended 3-6 feet I must admit to being a little nervous at a dermatologists office yesterday where patients, including me were getting minor surgery. The surgery for most includes a minor but invasive procedure and waiting in the office with an open wound while a lab test is performed to see if the cancer has been entirely removed.

The reason for my belated concern ....I just never thought about it until I got home.....was that there were so many patients that the small room holding the post op patients, at times we did not have adequate seating and all the patients are seated inches away from each other with open wounds. Indeed the larger waiting room has seats so close you have to be careful not to rub knees your fellow patient. Curious that while there were signs in the office for washing and shaking hands etc., there were no signs for social distancing.

I do not mean this post to be critical of any single doctor...and I will not mention the doctors name.... since this could be commonplace among a lot of doctors but I am surprised at the lack of messaging from the medical community with regards to the social distancing efforts either being employed or suggested at Doctors offices.

If possible, please view this as a constructive effort for educational comments and if you have an appointment with a doctor, are you concerned about the social distancing at doctors offices?

[OrangeBlossomBaby]

This is why anyone who shows symptoms, or is worried that they might have been exposed to the virus, SELF-ISOLATE for 14 days and do NOT go to the doctor's office.

If you have an appointment, and think you might have been exposed to someone who is actively sick with COVID-19, call the office and let them know. They'll probably reschedule you.

If you have symptoms and are short of breath or in other medical distress, call 911. Do NOT go to your doctor's office.

[villagerjack]

I understand you can have the virus and not show any symptoms so do you think doctors have some responsibility to arrange appointments better so fewer patients are waiting in their office?

[blueash]

Originally Posted by villagerjack

I understand you can have the virus and not show any symptoms so do you think doctors have some responsibility to arrange appointments better so fewer patients are waiting in their office?

Actually that's a great question. It is not reasonable to deny medical care to people who need or want it. But it is reasonable to ask how can the operation of the office and design of patient flow lessen, not eliminate, possible contagion.

If I were a person with a diminished immune system [or just a very cautious person] I'd ask if I could check in by phone, wait in my car until it is my turn for care, and return to my car rather than any secondary waiting areas between steps in my visit. I'll be happy to fill in the paperwork in the exam room. Please don't bring it in on a clipboard which has passed thru 50 other hands that day. Just the paper, and I'll use my own pen. Or better yet, I'll verbally tell you that my name, insurance and contacts are all the same as last time.

The flip side of this is to hope that patients understand that these next few weeks may be overwhelming for primary care offices. The ill and the worried well and the phones will be swarming. I am understanding of all those instructions to "Call your doctor" for every concern. But how is the doctor's office supposed to handle all those calls?

Who in an adult practice do you think is trained in how to obtain a viral naso-pharyngeal swab correctly for the patient while protecting themselves? Do you think your GP has a haz-mat suit like you see on TV? Most office nurses and certainly most medical assistants have never seen a viral culture sample being collected. But that's who the system is expecting to do the work for those not seriously ill enough to have the overwhelmed public health department involved.

At this time your doctor cannot just send an order to Quest to have them do the Covid test. Quest and others do NOT collect the sample. But they will run the sample if someone else collects it. But your private doctor doesn't have the correct equipment to collect the sample, nor anyone trained in how to collect it.

The Sumter Co Health Dept has fewer than a dozen nurses and many of those are administrative not lab procedure trained. If the worst predictions are accurate the health care system will overwhelmed, completely. Both the outpatient and inpatient management will be easily criticized for its many inevitable failures. Lack of staff, lack of supplies, lack of beds, lack of respirators, lack of patience, but no lack of patients.

That is why the policies of containment and more importantly mitigation are critical now. I could be that if nothing is done everything will be fine. And maybe that is the most likely outcome. But the experience in Wuhan and Korea and Italy suggest that Covid can be a rapidly spreading killer. And once it has spread there is no going back to have a re-do.

Now off the soap box.

[retiredguy123]

Originally Posted by villagerjack

I understand you can have the virus and not show any symptoms so do you think doctors have some responsibility to arrange appointments better so fewer patients are waiting in their office?

I think that should be done all the time, virus or not.

[Carla B]

Thank you, Blue Ash, for an enlightening post on how the system can be overwhelmed. Even in normal times, it doesn't seem to do much good "to call your doctor." My experience has been that 1) if a live person answers, they'll tell you that no appointments are available and to go to urgent care, 2) you get a recording and are directed to leave your name and number and someone will call you back in a day or so, or 3) there is no answer at all.

[villagerjack]

Originally Posted by blueash

Actually that's a great question. It is not reasonable to deny medical care to people who need or want it. But it is reasonable to ask how can the operation of the office and design of patient flow lessen, not eliminate, possible contagion.

If I were a person with a diminished immune system [or just a very cautious person] I'd ask if I could check in by phone, wait in my car until it is my turn for care, and return to my car rather than any secondary waiting areas between steps in my visit. I'll be happy to fill in the paperwork in the exam room. Please don't bring it in on a clipboard which has passed thru 50 other hands that day. Just the paper, and I'll use my own pen. Or better yet, I'll verbally tell you that my name, insurance and contacts are all the same as last time.

The flip side of this is to hope that patients understand that these next few weeks may be overwhelming for primary care offices. The ill and the worried well and the phones will be swarming. I am understanding of all those instructions to "Call your doctor" for every concern. But how is the doctor's office supposed to handle all those calls?

Who in an adult practice do you think is trained in how to obtain a viral naso-pharyngeal swab correctly for the patient while protecting themselves? Do you think your GP has a haz-mat suit like you see on TV? Most office nurses and certainly most medical assistants have never seen a viral culture sample being collected. But that's who the system is expecting to do the work for those not seriously ill enough to have the overwhelmed public health department involved.

At this time your doctor cannot just send an order to Quest to have them do the Covid test. Quest and others do NOT collect the sample. But they will run the sample if someone else collects it. But your private doctor doesn't have the correct equipment to collect the sample, nor anyone trained in how to collect it.

The Sumter Co Health Dept has fewer than a dozen nurses and many of those are administrative not lab procedure trained. If the worst predictions are accurate the health care system will overwhelmed, completely. Both the outpatient and inpatient management will be easily criticized for its many inevitable failures. Lack of staff, lack of supplies, lack of beds, lack of respirators, lack of patience, but no lack of patients.

That is why the policies of containment and more importantly mitigation are critical now. I could be that if nothing is done everything will be fine. And maybe that is the most likely outcome. But the experience in Wuhan and Korea and Italy suggest that Covid can be a rapidly spreading killer. And once it has spread there is no going back to have a re-do.

Now off the soap box.

That is a Great response. Thank you and you can get back on your soapbox anytime you want.

[villagerjack]

Originally Posted by retiredguy123

I think that should be done all the time, virus or not.

Overbooking is very commonplace.

BTW I go to the Villages healthcare office at Lake Sumter and the waiting room is more like a hotel with adequate spacing between patients all day every day not just when there is possible contamination from a virus.

Appointments are always on time.