In many ways, Covid-19 is forcing the entire US health care delivery system in the US to mature into the 21st century, whether it is ready or not.
One enormous shift is clear: virtual care, or telemedicine, will become the new normal.
This week the federal government demolished long-standing barriers for doctors to provide telemedicine, enabling previously unthinkable conveniences like conducting an office visit with FaceTime or Skype.
This will be a completely different care experience for most people, but not necessarily worse and probably for the better.
So, what does this mean for the process of getting normal health care? People will need to navigate this brave new health care system, manage their chronic illnesses, and get answers for new problems.
Here is some advice on what to expect and how to safely access health care in the coming weeks and months.
The traditional primary care office visit is a last resort, for now
All health care facilities are now high-risk sites for either transmitting or receiving exposure to Covid-19.
This is not just about your risk of infection. Your health care provider could be the one infected because she is treating so many patients and doesn’t know it yet because the symptoms of Covid-19 don’t show up until a few days after infection.
This means that seeing a doctor, nurse or other health care provider in person needs to be reserved for when it is absolutely necessary, when an important health care decision hinges on a provider physically examining you.
If you can postpone your regular, non-urgent visit for two to three months, you should. If you need care now, call your provider’s office.
Virtual care is now the default
Though it promotes the creation of long-term healing relationships over time, the in-person office visit is not a particularly efficient or safe way to deliver health care in a time of pandemic. Covid-19 will force us all to rethink how we receive health care right now because virtual care will be the only reasonable, safe option most of the time.
Patient portals. If you have access to a patient online messaging system or portal, use that first. Many health systems offer “e-Visits” for common issues, mimicking an office visit by email.
Visit by telephone or video. If you don’t have access or can’t use a portal, then call and schedule a telephone or video visit. While telephone or video may feel constraining, a great deal of routine health care can be accomplished with a conversation between provider and patient.
Try an “e-consult.” Another type of virtual care to think about if you need to see a new specialist is an “eConsult,” in which your primary care provider contacts a specialist – remotely first – with a focused question about your health issue. The specialist then answers quickly back to them with next steps in your plan.
Now that the federal government has waived many payment restrictions on telemedicine, we anticipate that most doctors’ offices will soon offer remote visits and expand eConsults.
It is possible that telemedicine and virtual visits may become the most common form of visit as Covid-19 spreads. This goes not just for primary care offices, but for specialists, too.
Make sure you have plenty of your regularly prescribed medications
In order to maintain your health, you need to keep taking your regularly prescribed medications for your chronic conditions.
Americans visit pharmacies often to fill these meds. Nearly 85% of adults 60 and older, the group most vulnerable to Covid-19, used a prescription medication in the past month.
With Covid-19, going to a pharmacy to fill monthly prescriptions carries a new risk. There’s a simple solution to reduce everyone’s exposure at pharmacies, which is to request 60-day, or better yet, 90-day refills from your doctor for your regular medications.
And if the pharmacy can deliver it, even better. Some insurers, especially state Medicaid programs, don’t allow these extended fills. But Covid-19 has a way of dissolving policy boundaries – more insurers are now allowing longer medication fills, so check with your health plan.
As a patient, prepare to be a bit more patient
We are living through an unprecedented upheaval of societal norms. It would have been helpful if the health care system were more prepared for this moment. But in the absence of preparation, doctors and other providers are desperately running to catch up.
Physician offices are fielding huge call volumes, dealing with a host of unanticipated questions (Can I catch coronavirus by flushing a toilet? My dog is sneezing, could she have it?) and keeping up with guidelines that change hourly.
Your medical issues deserve attention, and you may need to be even more patient than usual to get response. But you may also need to be (very) politely persistent if you need an answer sooner rather than later.
Don’t forget about your general health
One of the many downstream effects of Covid-19 may be weeks or months lost in managing chronic illness or keeping up lifestyle changes. Diabetes, cancer, high blood pressure and emphysema don’t care what pandemic is circulating in our communities.
So it’s especially important to eat sensibly, exercise if you can, go outside for a walk (while staying 6 feet apart from others), stay socially connected as much as possible (reach out to that long-lost friend or family member), and keep taking your prescribed medications regularly.
When Superstorm Sandy closed the Manhattan Veterans’ Affairs facility, veterans still had worse blood pressure control two years after the facility reopened.
It may be hard to focus on less immediate problems, but if you have a chronic illness, don’t let it slide. This is clearly easier said than done, and we expect that health care teams are going to have a tough time reminding patients to follow up for regular checks.
Providers aren’t off the hook either. The true measure of a health system’s resilience is how it continues to function well during and after a shock. One of the upcoming challenges for health systems will be to continue to manage high-risk chronic illness as the pandemic occupies more and more bandwidth.
And again: Reach out with new and urgent medical problems
Remember to be in touch when new or urgent medical problems come up. And remember that mental health is as important as physical health.
Everyone will still get new aches and pains. But if you have fever, shortness of breath, severe cough, chest pain, new neurological symptoms, intense abdominal pain, or any other urgent symptoms, please call your provider team or emergency personnel right away.
With so much social isolation, disruption to normal life, and a sagging economy, mental health is also likely to be a challenge for many.
It could be an intimidating time to try to get your doctor or provider’s attention, but they need to hear from you, particularly if addiction, depression, severe anxiety, or other mental health issues come up.
Health care providers may need to triage and postpone care if a problem does not need immediate attention, but it is still important to manage new, serious physical and mental health problems when they happen.
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Responding effectively to a crisis means thinking in different ways to solve new problems.
Primary care is the bedrock of an effective health care system. In this time of Covid-19, primary care practices are rapidly evolving to deliver the care that their patients need, even in the midst of social distancing constraints.
This means that your primary care experience will likely change over the next few weeks. But don’t worry alone. Old and new technology can help us keep our distance while meeting our health needs and helping each other stay healthy and resilient in the coming months.
Dr. Barnett is an Assistant Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital
Dr. Bitton is a primary care physician and Executive Director of Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health