Time to cancel elective surgeries and other standard appointments

When Dr. Jamie Colbert recently called to check in on his parents, his mom mentioned she had a doctor’s appointment coming up soon. “I told her to cancel it,” said Colbert, a hospitalist at Newton-Wellesley Hospital and senior medical director at the not-for-profit Blue Cross Blue Shield of Massachusetts. “I told both of my parents to cancel anything elective. Going in for a checkup is a bad idea right now. If you’re healthy, don’t go near a hospital or doctor’s office right now.”

It’s unusual for a physician to urge family members to delay routine care, but with the country bracing for a coronavirus outbreak that may push our health care system to the brink, these are not usual times.

If you’re feeling well, don’t go in

In the midst of the current pandemic, the Massachusetts Department of Public Health ordered hospitals and ambulatory surgery centers to cancel elective procedures as of March 15. The state followed up on March 24 with a stay-at-home advisory telling residents that "non-essential medical care like eye exams, teeth cleaning, and elective procedures must be rescheduled."

Clinicians and public health experts are urging everyone, especially the elderly and those with chronic health conditions or compromised immune systems, to stay away from all health care facilities, including hospitals, urgent care centers and doctor’s offices, unless they have an urgent medical issue. As always, people with a medical emergency should call 911.

“Because of the risks you should really err on the side of not physically going in to use the health care system if you can,” said Dr. Mark Friedberg, an internist and senior vice president of performance measurement and improvement at Blue Cross, noting coronavirus can be carried by people who are asymptomatic and unintentionally transmitted in a doctor’s waiting room or exam room. “It’s just like interfacing with any other group of people—it’s as inadvisable as going to a restaurant or bar, which is why government officials in Massachusetts and other states have closed restaurants and bars right now.”

“We are in an unprecedented situation, and as a clinician, I am frightened about the risks to patients coming to outpatient clinics,” said Dr. Jason Wasfy, a cardiologist who manages population health at Massachusetts General Hospital, whose organization is reaching out to patients to cancel and postpone non-urgent procedures and visits.

Wasfy said clinicians are being asking to use their judgment about whether a patient needs to be seen in person. For example, he said most patients with high cholesterol will not need to be seen in person, and for those with congestive heart failure, “the added value of an in-person exam may be less than the risk of the patient coming in right now. Elderly patients with heart failure—those are exactly the patients who are dying at the highest rates from COVID-19 infection.”

Friedberg advises everyone to cancel or postpone all non-urgent appointments such as annual physical exams, well child visits, screenings and specialist visits, or convert them to telephone or video visits, if possible.

The country’s top doctor, Surgeon General Jerome Adams, has urged hospitals nationwide to cease all elective procedures to decrease the risk of spreading the virus within health care facilities, and hold health care providers and protective equipment in reserve to prepare for what will likely be a surge of coming coronavirus cases: “Hospital & healthcare systems, PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve!” he tweeted.

If you’re feeling sick, try telemedicine first

If you have an urgent medical concern that can’t be postponed, Friedberg recommends contacting your doctor about what to do. She may tell you to come in and provide instructions on how to do so safely, or she may recommend that you hold the visit by phone or video. Many doctors are setting up their own telehealth platforms, and health plans also offer these services. Insurers, including Blue Cross, are waiving all out-of-pocket costs for all medical and behavioral health telehealth treatment by phone or video right now. Blue Cross members also can call the nurse-staffed 24/7 help line at 888-247-2583.

“The whole idea is to reduce the number of people coming into the office to only those who need a physical exam,” Friedberg says. “Telephone and telemedicine first should be our mantra. Whenever you can, don’t see your doctor in person—see them virtually.”

Mass General is quickly mobilizing online tools and telephone and video platforms, Wasfy said.

“We have preexisting video platforms; they’re being ramped up quickly given the circumstances. These types of alternatives to in-person visits are critically important,” he said. “We want people to get the care they need in the way that’s best for them. The medical community is bracing for an extraordinarily serious situation—we want to use every tool we have to confront it.”

The biggest benefit of staying away from the health care system right now, Friedberg says, may be to people you don’t even know: “By not coming in, you’re helping the most vulnerable people, such as those in active cancer treatment and dialysis who have to come in. In many cases, they don't have a choice. But you do. By avoiding non-urgent, in-person care, you’re doing something altruistic and admirable.”

^{PHOTO OF Dr. JASON WASFY FROM MASSACHUSETTS GENERAL HOSPITAL & PHOTO OF Dr. MARK FRIEDBERG BY MIKE GRIMMETT}