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Once Virginia starts reopening, should you see your doctor in person?

virginia reopening optToday, most of Virginia starts reopening.

From today until at least the end of the month, restaurants, bars, breweries, wineries, places of worship, indoor shooting ranges, and brick-and-mortar retail stores such as book sellers will be allowed to operate at 50% capacity, subject to certain restrictions. Others, such as schools, beaches, and sleep-away camps, will stay closed.

And, most important from a health standpoint, the ban on so-called “elective” procedures (i.e., those that don’t involve life-or-death threats) is being lifted.

This doesn’t mean that seniors who’ve been putting off routine or chronic care should all rush right down to their doctors’ offices. People over 65 are still the age group most vulnerable to COVID-19, and most of the deaths occur with patients over 80.

So the question is: When should you (or an elder you’re caring for) see the doctor in person? Consult by telemedicine? Or call 911 for an ambulance to the emergency room?

It depends on what the specific problem is:

Honest-to-goodness, life-threatening emergencies – Out of fear of coronavirus infection, many patients with heart attacks, appendicitis, and mild strokes, among other life-threatening conditions, have been risking their lives by showing up at emergency rooms much later than they should have. If you or someone you’re caring for has chest pain, trouble breathing, a drooping face, arm weakness, difficulty speaking, acute injury or trauma, or is in immense pain, call 911 right away. Do not pass go. Do not collect $200.

Urgent non-emergencies – Abnormal changes in your condition – unexplained swelling in an arm or leg, a strange lump, a sudden weight gain shortness of breath, chest pain, or a temperature– may not be cause for alarm, but they could very well be cause for concern. So can changes in a chronic condition, such as hypertension, diabetes, heart or kidney disease. “With an acute illness on top of chronic, it’s really hard to evaluate in an appropriate manner through telehealth,” Dr. Jacqueline Fincher, president of the American College of Physicians, advises. It’s better to call – not email or contact through a patient portal – your doctor, who can triage by phone and then tell you whether or not to come in.

Ongoing treatments – “Some things just don’t work well for telehealth,” says Dr. Colin Delany, chairman of the Cleveland Clinic’s Digestive Disease and Surgery Institute. “Anything needing a physical examination, or a formal assessment before treating, needs to be done in person.” That could include small, growing skin cancers, allergy shots, biologic asthma treatments, and regularly scheduled cancer treatments or dialysis.

Managing chronic conditions – Telehealth lends itself very well to managing diabetes, hypertension, Crohn’s, and colitis – especially if patients have glucometers, blood pressure cuffs, and scales at home. (Check to see if your Medicare plan covers these.) Throughout the pandemic, psychiatrists have been seeing patients virtually.

Routine care you can postpone – Non-urgent dental appointments and routine cancer screenings (unless you have symptoms).

If you’re not sure – A telehealth session that lets your doctor see what you’re talking about (e.g., a swelling or skin rash) helps the doctor triage your condition and determine if it calls for an in-person visit.

If you have questions – Medical practices and hospitals have changed their check-in procedures to help prevent infection, so calling ahead to learn what to expect makes good sense. So does calling if you have any general healthcare questions. And if you have any questions about coping with the Coronavirus outbreak, or your retirement years in general, please feel free to call or email us. Just as we always have, we’ll be happy to give you honest, objective answers.