Preventive care has become one of the victims of the new coronavirus, with Americans forced to skip routine physicals and screenings this spring, and many doctors seeing emergency cases only at the height of the quarantine.
As clinics and hospitals have reopened for screenings and elective procedures, patients are finding a new normal of masks, temperature checks, empty waiting rooms (on purpose) and even requests not to talk when the doctor is nearby.
When NBC investigative and consumer correspondent Vicky Nguyen recently went to the dentist, the medical staff were all wearing personal protective equipment "from head to toe."
But some people are still reluctant to go, which is worrisome for a system set up to prevent disease or catch it early — when there's the best chance to recover. It's clear the impact of the outbreak has been taking its toll.
The American Cancer Society reports "a substantial decline in cancer screening." Between March 15 and June 16, 285,000 breast, 95,000 colon and 40,000 cervical exams to detect cancer were missed, according to an analysis by Epic Health Research Network released in July.
That represents deficits of 63%, 64% and 67% respectively based on the number of screenings that would be normally expected in an average year.
Many people have turned to telemedicine for medical care, but doctors say virtual appointments often can’t fully take the place of an in-office visit.
“This COVID crisis has shined a searing spotlight on the importance of preventive health care in our country and across the world,” Dr. Gary LeRoy, president of the American Academy of Family Physicians, told TODAY.
“Telemedicine is a tool; it’s not a replacement for the patient-physician interaction.”
Here’s what to know about delaying routine medical appointments in the age of COVID-19. Bottom line: Always ask your doctor if you can safely postpone care.
Annual physical or wellness visit:
The once-a-year check-up has long been considered a standard of care, but there’s been debate over whether it’s really needed, especially for healthy adults under 50. Some health policy experts say annual physicals are a waste of time and money for many people.
But LeRoy, a family physician in Dayton, Ohio, still considered it an important visit that doesn’t only have to happen once a year.
“You want to keep your body, your most precious asset, in tune all the year long,” he said.
“We don’t want to give the public the impression that wellness visits are not essential because they are, especially for diabetics and hypertensives and people with chronic lung diseases. They really are essential monitors of the status of their overall health.”
If your annual visit was canceled, don’t assume it’s OK to skip it this year. LeRoy advised calling your doctor and asking if and when it should be rescheduled.
Even with patients who have had a telemedicine visit, he’d still rather see them in person at some point.
“You cannot practice the art of medicine virtually,” LeRoy said, noting there are many more clues he can notice and problems he can examine when the patient is in front of him, not to mention checking vital signs and taking blood tests.
Primary care physicians also often pick up on depression, he said.
Even as hospitals and clinics are offering cancer screenings again, the decision whether to go in for one while COVID-19 is still spreading requires careful consideration of the risks and benefits, the American Cancer Society advised. Talk to your doctor about whether it's best to be screened now or postpone for a later date.
“For people at average risk, a one- or two-month delay is not going to be a major problem,” said Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society. People at high risk for cancer should talk with their doctor about what steps to take, he advised.
People who experience possible cancer symptoms, like finding a lump or seeing blood in the toilet bowl, should contact their doctor now.
When it comes to routine gynecological appointments, it's unclear whether a yearly pelvic exam is necessary, the U. S. Preventative Services Task Force said in 2016. Women should talk to their doctors about whether that type of annual exam is right for them, experts advised.
But all women should receive at least one preventive well-woman care visit per year beginning in adolescence, the American College of Obstetricians and Gynecologists said.
The parts of the visit that involve screening, assessment and counseling can be done via telehealth, while the in-person physical exam can be deferred to a later date or performed on an as-needed basis, the organization noted.
The frequency of eye exams should depend on several factors including a person’s age and medical history, according to the American Academy of Ophthalmology.
School-age children should be evaluated every one to two years, while an annual exam isn’t routinely needed for healthy adults under 40. Older adults and those with risk factors for eye disease may need an eye exam once every one to two years.
Most routine care can be rescheduled, but treatment for eye emergencies should not be delayed.
Conditions that would warrant visiting your eye doctor now include:
- Having macular degeneration or diabetic retinopathy and getting regular eye injections;
- Changes in vision, including blurry, wavy or blank spots in your field of vision
- An eye injury, even if it seems minor
- Many new floaters or flashes in your vision
- Sudden vision loss
- Eye pain, headache, red eye, nausea and vomiting.
For an in-person appointment during the pandemic, your eye doctor may use a special plastic breath shield on the slit lamp machine they use to look into your eyes, the AAO noted. He or she may also ask you to wait to speak until they're a safe distance away after the eye exam is complete.
Your dermatologist will determine how often you need a skin exam to detect cancer based on risk factors such as skin type, history of sun exposure and family history.
People with a history of melanoma should have a full-body exam by a dermatologist at least once a year, the American Academy of Dermatology said.
Doctors encourage people do regular self-exams using the ABCDEs of melanoma. If they’re concerned about a specific mole and don't want to go to a doctor in person, they can point it out during a virtual appointment or send a photo. That's how a Missouri dermatologist diagnosed a patient's melanoma in June.
“Even during the pandemic, a dermatologist can examine the spot via telemedicine to determine if it needs to be tested or removed, and if so, he or she may ask you to come into their office for an in-person appointment,” said Dr. Bruce Thiers, a board-certified dermatologist in Charleston, South Carolina and AAD president, in a statement.
“This is especially important if you have a history of skin cancer, sun exposure, indoor tanning or any other risk factors.”
The American Dental Association recommends regular dental visits at intervals determined by a dentist. They can help prevent dental health problems or spot them early when treatment is likely to be simpler and more affordable, it noted.
All states have now reopened dental practices for elective procedures, according to map maintained by the organization. Added safeguards during Nguyen's visit included no spitting and the use of a special suction tool to vacuum any droplets from the air.
Dental hygienists may also use hand scaling rather than ultrasonic scaling when cleaning teeth to minimize aerosols.
If you don't want to go right now, there’s little harm in waiting one to two years between dental exams for people who have a history of few or no cavities, maintain good oral health, haven’t started new prescription medications and haven’t had significant health changes, according to Dr. Zuri Barniv, a dentist based in Sunnyvale, California, whose “Straight Up Doc” blog answers patients’ common questions.
Otherwise, it’s best to have an annual exam, he noted.