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Don’t delay key medical appointments in the pandemic — advice from Dr. Wen

Published in 18 January, 2021

(CNN)As many people postpone necessary medical care due to the pandemic, medical professionals are worried that their patients will get sick or even die from other causes.

Some 25% of Americans said that they or someone in their household had delayed medical care in the past month due to coronavirus, according to a December Kaiser Family Foundation study. An earlier report from the US Centers for Disease Control and Prevention found that 41% of Americans delayed medical care, including 12% who postponed urgent or emergency care.
We talked to CNN Medical Analyst Dr. Leana Wen, an emergency physician and visiting professor at George Washington University Milken Institute School of Public Health, to get her advice on which appointments can be postponed and which cannot, and what precautions people should be taking when going to their doctor.
CNN: Why are some people postponing their medical care? Is this a problem?
Dr. Leana Wen: I certainly understand why some people have postponed their medical appointments. In many parts of the country and around the world, there are very high levels of coronavirus spread. People may be concerned about contracting coronavirus when they go out. Also, some hospitals overwhelmed with Covid-19 patients have postponed elective surgeries and some doctors have even canceled routine appointments. Patients may not always know when the coronavirus surge is over and their appointments can resume.
This could be a problem. I’m concerned that many patients may be going without the care that they need for their ongoing medical issues so it’s important for people to check in with their doctors’ offices. Many conditions require ongoing monitoring, like high blood pressure, diabetes and heart disease. If they are not monitored as closely, they could worsen and lead to worse problems that could have been prevented. It’s not good for children to fall behind on their immunization schedules. Those who do not get cancer screenings could end up with later diagnosis and worse outcomes. Keeping up with routine medical appointments is important.
CNN: How can people go about deciding whether they could postpone an appointment?
Wen: Here are a few things to consider. Is there an alternative to going in person? Many doctors’ offices are offering telemedicine as an option. You may be able to speak with your doctor without physically going into the office. A lot could be done virtually. For example, you can monitor your blood pressure or blood sugar at home and report what you find to your doctor, and they can adjust your medications or other treatments by phone or via a telehealth visit. A lot of mental health visits can be done entirely via telemedicine.
If there are things you have to do in person, see if you can combine the visits. Perhaps you are due for a breast exam, bloodwork and a pneumonia vaccine. You can get them all done at the same time. It reduces your overall risk if you can have fewer visits.
You may live in a part of the world that’s going through a particularly difficult time with coronavirus. If that’s the case, talk to your doctor about what’s essential to do now versus important things that could wait a couple of months. For each person, that could be different. Someone who needs to get a lot of testing for a heart condition may need to get that done now, but perhaps that person could wait on getting a colonoscopy that could be done when numbers drop. Someone else may have a history of colon cancer, and the colonoscopy should not be delayed. It’s a good idea to initiate these conversations with your doctor now.
CNN: Are there medical visits or procedures that shouldn’t be postponed?
Wen: This will depend on the individual and their own medical conditions as well as their risk tolerance. In general, I would say that childhood vaccinations and other routine vaccinations like the flu vaccine should not be postponed. Treatment of conditions that could become life-threatening should also not be postponed.
I also cannot emphasize this enough: Do not delay emergency care. If you have chest pain, difficulty breathing, sudden weakness in arms or legs, and other such concerning symptoms, you should go to your local hospital’s emergency room. If you would have normally gone to the ER if it weren’t for coronavirus, go to the ER now. Hospital emergency rooms have triage protocols and also infection control protocols. Do not hesitate to go if you need emergency care. It would be tragic to have people avoid the ER because they’re scared of contracting coronavirus, only to die at home.
Remember, too, that Covid-19 causes more severe disease in individuals with underlying medical conditions. Getting those conditions treated and optimized should be a priority in and of themselves, but also not getting them treated could predispose you to even more severe effects from Covid-19. That’s another reason to continue to seek medical care even with a lot of coronavirus around.
CNN: What precautions should people take if they’re going to their doctors’ office?
Wen: You should ask in advance of going as to what procedures the doctors’ office has in place. Many places have multiple protocols in place, requiring masks and social distancing; mandating symptoms checks in advance; not allowing other visitors; and enforcing physical distancing.
Ask about what happens when you go in. How does waiting work? Ideally, the time in the waiting area while you’re in an enclosed space with others will be as short as possible. Some doctors will have you wait in your car or outside until they are ready to see you, and then usher you quickly into an exam room. Others have waiting rooms that have enforced physical distancing and good ventilation.
Make sure you are wearing a good quality mask the entire time, at least a three-ply surgical mask or an N95 or KN95 mask. Bring your own water but try not to take off your mask unless absolutely necessary. The office should have lots of hand sanitizer, but bring your own and use it after touching frequently used surfaces like doorknobs.
Also ask if the in-person visit is absolutely necessary. Can a lot be done over the phone, including speaking with the doctor? Maybe all you need to do when you show up is to get a blood draw or a procedure. Can your registration be done in advance to minimize in-person contact?
CNN: What do you say to people who would rather wait until they’re vaccinated before going to the doctor?
Wen: This might be a reasonable decision, depending on why you’re going to the doctor and how long you might need to wait until you’re vaccinated.
Let’s say that you don’t have anything urgent going on right now, and you can get almost everything taken care of through telemedicine. Maybe all you need is a routine dental cleaning and your annual cholesterol check. Let’s say also that you’re an essential worker, you are over 65, and you probably can get the vaccine in the next couple of months. If that’s the case, you should discuss with your doctor, but it might make sense to get vaccinated first and then go for your routine appointments.
If you’re not likely to be vaccinated until the late spring or early summer, that’s a bit long to put off your regular appointments. It’s probably better to go now and consolidate all the in-person tests and procedures into one visit.
In general, if you have ongoing medical conditions that require an in-person visit, and certainly if you have an urgent issue, you should go to your doctor. Follow all precautions to reduce your risk. Coronavirus is one of the reasons people could get sick and suffer ill health outcomes, but you must also watch out for your health in all other ways, too.

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