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Should Docs Stop Providing Routine Care in the Era of COVID-19?

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What your doctor is reading on Medscape.com:

MARCH 20, 2020 — As the COVID-19 crisis deepens and pressure on the medical system increases, clinicians and facilities are having to prioritize care.

To help, medical societies and hospitals are working with providers to determine what care must go on and what can be delayed, rescheduled, canceled, or performed remotely to protect providers and patients and to make way for a predicted surge of COVID-19 patients.

Some decisions are easier to make than others, experts from a variety of specialties and settings told Medscape Medical News.

Leonard Feldman, MD, a hospitalist and associate professor of medicine at Johns Hopkins Medicine in Baltimore, Maryland, told Medscape Medical News that adult wellness visits should be canceled for the time being.

Likewise, if there’s no pressing reason to order lab tests, this is the time to put those off, he said.

“If you have a brittle diabetic, maybe we’re going to have them come in to get their hemoglobin A1, but the HbA1c is a reflection of 3 months, and you don’t want to get it any earlier than you absolutely need to,” he said. “It will be a very small subset of diabetic patients we will be encouraging to get lab testing.”

He adds that this is not the time to bring in relatively healthy patients for a routine blood pressure check. A much better solution is to urge patients to get a home monitor and transmit readings, he explained.


Don’t Delay Child Vaccines

Vaccines for children should be given on schedule, he said, especially for those younger than 2 years and for 4-year-olds (who will be due for their second measles-mumps-rubella shot).

But vaccines for adults, such as shingles and pneumococcal vaccines, can wait, he said. “We don’t need to be prioritizing them in the middle of a pandemic.”

A routine pulmonary function test for chronic obstructive pulmonary disease (COPD) or any routine test that puts droplets into the air should not be conducted at this time, he said. Likewise, manometry to check esophageal function should wait, he said, if a patient won’t develop significant morbidity if the test is not performed.



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