In the pediatric population, what’s different is a lot of kids can’t tell you what’s actually wrong with them. So we base a little bit more of what we do on the physical examination. For example, if there’s any respiratory concerns or any kind of ear pain, we really need to be able to take a look at the patient. When a physical exam is necessary, that’s where we really need to see kids in person. For most acute complaints, we need to do that.

If they’ve had a well visit in the last year, some people are conducting online well visits and just postponing the physical exam to a different time. Additionally, we offer a modified physical exam where with the help of a parent we can determine whether the child has any swollen lymph nodes, if the belly is tender, if they can move all around, and so on. We can assess some of those gross motor things and gross physical things over the phone or over video.

For new or sudden changes, adults really may need to be seen in person. But for ongoing chronic healthcare maintenance, telemedicine is extremely beneficial. Some physical exam findings are easy to follow via video chat. Additionally, for some of those patients, what you really need to do is get more information. And so telehealth allows for an easy way to converse with the patient in a secure setting that’s HIPAA-compliant. And it keeps patients from having to travel to and from the office, which may be a good thing for families, as sometimes transportation is an even bigger issue when they have assistive devices to get them around, e.g., wheelchairs, walkers, etc. So many patients actually prefer that kind of visit. And they can do all the elements needed to take care of the problem over a telehealth visit.

At this point, safety for not only our patients but also our team members and staff is of utmost importance. In my own office, for example:

1. We’ve screened every patient walking into our office.
   
2. We’re taking temperatures on every patient walking through our doors and their family members as well.
3. They're required to wear a mask at all times when they're in the office.
4. The cleaning process goes above and beyond what you get in other public environments. So given the fact that we’re a public environment, we’re doing more of what you would expect in a private environment. Rooms are washed down, and we’re using an aerosolized cleaner after surfaces are cleaned. The rooms are also left to dry independently for a specific amount of time before we use them again. So if there are any leftover respiratory particles, those should be taken care of.
5. All of our outpatient offices have gone to twice-per-day temperature screenings for all team members.

I can’t speak for all of BayCare, but in my own office, we are avoiding the use of waiting areas where possible. If they need to be utilized, we’re definitely practicing social distancing and using face coverings. In most cases, we have decreased the amount of entrances and exits to our facility. Obviously, they can be used to leave the building in the case of an emergency, but our entrances have been streamlined so temperature checks for everyone, including employees, can be performed.

In our offices, we have designated sick and well rooms, and we’re sticking very consistently to that. So if anyone has any illness symptoms, they’re being seen in rooms that are getting an extra special sanitation spray-down where they’re being left for an additional 10 to 15 minutes before anyone else is seen in that room.

We’ve made changes to our scheduling so that all our well appointments are in the morning and early afternoon. And at a certain time, we cut off those appointments and then start seeing patients with symptoms or concerns at the end of the day. A lot of other offices are doing this timing as well.

We’re also making sure families are aware of what we’re doing. They don’t walk in the front door by themselves. They call when they arrive at our offices. We greet them at the front door and walk them to their appointment room. Additionally, when they get into the appointment room, we have a sign that says “This room has been sanitized” so they know the room was cleaned before they came in.

All of our patient registration has to be done online before patients come in. If someone drives up and he or she hasn’t finished registration, we make the person wait and do that in his or her car so we have everything that we need to expedite the visit. As far as our staff members go, we wear masks at all times except when we’re eating and drinking. Even when we’re in our common rooms, we all practice social distancing as well. We take the care to only walk one patient in and out at a time, so they aren’t passing each other in the hallway. So we’re taking lots of precautions! 

• Everyone, staff and providers included, should wear masks.
• Patients should expect that everything will be switched over to electronic means when applicable to avoid contamination via the use of paper, pens, etc.
• They should expect all equipment that’s being reused, such as exam tables, is sterilized between patients. 

It’s important that all patients be open and honest with their providers. If they have any risk factors, extra precautions can be taken. For instance, if a patient is having new symptoms or feeling ill when coming in for treatment, we include eye coverings as well as masks to protect our providers. If we’re doing any specific lab testing that involves respiratory or nasal secretions, most likely our providers are going to have on an N95 mask, eye coverings, gown, gloves, etc. We even wear shoe coverings in our office. Patients should just be open and honest. We want to protect not only our patients but also our staff so they can be there for the next patient that’s ill.

Honestly, I think we’re in a time where COVID-19 is going to be around for a while.

At this point, we’ve already paused for about three months, and a lot of people have put off some of their health issues. So it’s important to pay attention to not only those chronic conditions but also any new symptoms. In fact, it’s even more important now that they start to follow through on a plan or get evaluated, as putting it off even longer may be detrimental to their health. So I feel like it’s time.

There are a lot of physicians who worry that even people having heart attacks are afraid to go to the emergency room. But definitely for asthmatics, people who have chronic infections, with underlying heart disease, you can’t put off those things any longer. And at this point, at my office, we’ve taken every precaution to protect those patients, so they should feel safe getting their health needs taken care of.

We’ve probably got another 12 to 18 months to go of really understanding this virus. With many illnesses that we’ve been studying, we’ve known about them for decades. We’ve known about COVID-19 for less than a year. The amount of knowledge is vast at this point, but we don’t know where that brings us. It all remains to be seen, and we’re all anxiously awaiting those answers and hoping we’ll uncover them soon. 

I think one of the other important things is to be prepared when you go in for your visit. Make sure you read whatever information is sent to you ahead of time and know what’s expected of you.

I’ll get patients that show up at my door and walk up and suddenly they realize there’s a sign there that tells them what to do. It was probably communicated to them no less than three times before they came to the office, and they didn’t pay attention.

The other thing is be patient. We’re trying to keep the environment safe, so sometimes it does take a little longer to clean the rooms and protect all of us. It takes time to put on all those layers of equipment and take them back off in a safe manner. For an office visit, you have to take your time to make sure that everybody is safe.

Also, wash your hands and wear a mask!