Some healthcare can safely wait (and some can’t)

Among the many remarkable things that have happened since the COVID-19 pandemic began is that a lot of our usual medical care has simply stopped.

According to a recent study, routine testing for cervical cancer, cholesterol, and blood sugar is down nearly 70% across the country. Elective surgeries, routine physical examinations, and other screening tests have been canceled or rescheduled so that people can stay at home, avoid being around others who might be sick, and avoid unknowingly spreading the virus. Many clinics, hospitals, and doctors’ offices have been closed for weeks except for emergencies. Even if these facilities are open, there’s understandable reluctance to seek medical care where an infected person may have been just before you. So which health concerns can safely wait — and which should not?

What can wait?

It’s safe to put off some healthcare for a number of weeks or months.

• Routine screening tests. For example, a mammogram may be recommended every year or two for women at average risk of breast cancer. In that situation, it’s unlikely that having that test a few months late will affect your health. Similarly, if you’re due for a screening colonoscopy because you’ve turned 50 or your last one was 10 years ago, having it a few months late is not a risky delay. For some tests, there are alternatives you could have in the meantime. For example, there is home testing available for colon cancer screening that checks the stool for blood or abnormal DNA (findings that could indicate the presence of cancer). Each person’s situation is a bit different, so if you’re due for a screening test and can’t have it due to the pandemic, call your doctor about how to proceed.
• Routine vaccinations. Usually, it’s safe for adults to briefly put off routine vaccinations. Ask your doctor which vaccinations are time-sensitive and which can wait. For example, a shingles vaccine requires a second dose within a specific window of time after the first dose.
• Routine physical examinations. If you are feeling well and you have no pressing health concerns, delaying your exam for a few weeks or months is fine. In fact, the usefulness of routine annual physical examinations has been debated for some time, so even if you skip a year, it might not matter.
• Elective surgery. A good example is knee replacement for osteoarthritis: if you had surgery planned in April, there’s a good chance it was cancelled. That might be fine if you are able to get around and can tolerate the arthritis pain with medications. Hopefully, you can reschedule within a few weeks of the original date. But some elective surgery is more urgent than others, so review the timing with your doctor.

Thank goodness for telehealth

Video conferencing and telephone visits with doctors, nurses, and other healthcare professionals have filled the healthcare void admirably. We are realizing that a lot can be accomplished without coming into the office or hospital. Especially with the help of home equipment (such as a blood pressure cuff), you can be monitored well for hypertension, diabetes, asthma, and a host of other conditions with virtual visits. Mental health care can often be successfully provided by telehealth.

Sometimes your presence is required

Of course, some medical care simply cannot be provided by telehealth. Your doctor cannot perform procedures (such as draining an abscess) or an operation without your physical presence. A physical examination to feel a lump or search for an enlarged liver, an x-ray or other imaging test, and most blood tests require you to come in. It can be hard to evaluate a rash, look in your throat, or assess a sore joint without your being there. And if you had an abnormal test (such as a mammogram), you may be encouraged to come in for follow-up testing or evaluation. While a month or two of delay may not matter for some of these issues, for others it does.

Some healthcare cannot wait

What problems should prompt you to seek medical care even during a pandemic?

In recent months, reports from news media and healthcare providers in some parts of the US suggest that fewer people are coming to the emergency department with heart attacks, strokes, and other non-COVID health problems (see here, here, and here).

How can this be? Some problems, such as injuries from car accidents, may have become less common because people are staying in and driving less. But many conditions that land people in emergency rooms don’t go away during a pandemic. So what happened to the people having these problems?

The answer is almost surely that they are staying home and riding it out, avoiding exposure to those who might be infected with the new coronavirus, or wanting to do their part to limit emergency room overcrowding. Some may be concerned they’ll be turned away if they do show up.

But it’s risky to put off medical care for potentially serious problems, such as those on the list below. Complications of these conditions can be life-threatening, and a trip to the emergency room or urgent care is warranted.

When to seek emergency care

Call 911 or seek emergency medical care right away if you experience

• trouble breathing
• persistent chest pain or pressure, especially if you have a history of heart problems
• persistent and severe pain, such as abdominal or pelvic pain
• unexplained loss of consciousness, confusion, or a change in mental state (such as being unusually agitated or speaking incoherently)
• unexplained and persistent weakness in muscles of your arms, legs, or face that affects your ability to move or speak
• loss of vision
• an accident that impairs function, such as falling and then not being able to bear weight on your hip
• uncontrollable bleeding
• coughing up or vomiting blood
• suicidal feelings or acts.

Use your own experience as a guide. If you’ve had a serious illness in the past and now have the same worrisome symptoms, seek medical attention.

Thinking of heading to the ED?

Many emergency rooms and hospitals are crowded right now. It’s a good idea to call ahead, so the emergency providers know you’re coming and can give you advice about where to show up. If there’s time, put on a mask and wash your hands once more before leaving for the ED.

One other caveat: if you have typical symptoms of COVID-19 and your symptoms are not severe, call your doctor or local public health officials for guidance. In that situation, it may be best to avoid the emergency room; arranging testing and managing at home may be recommended.

The bottom line

The pandemic is teaching us a lot about what happens when non-urgent healthcare largely shuts down. Some of what we learn will be useful long after the pandemic is over. For example, if virtual visits are proven to be just as effective as an in-person visit, we can expect telehealth to become much more common. We may learn that we can safely take care of many chronic conditions with fewer visits. Years from now, researchers may be able to sort out what types of visits were just as good virtually and which ones were most prone to mistakes. And we might even find out that some medical care previously considered important is actually unnecessary after all.

In the meantime, here’s some advice that’s unchanged by the pandemic: if you have an emergency, seek medical care right away. And if you aren’t sure how to proceed, don’t hesitate to discuss it with your doctor.

Follow me on Twitter @RobShmerling

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