What are the main problems you foresee once you reopen your private practice?
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Sailing in uncertain waters
In mid-March, a few days before the government ordered the nationwide shutdown, we suspended all our activities, clinical and surgical. We are now getting organized for reopening when allowed to do so, but there are still many doubts and concerns. “Normal” activity will no longer be what we were used to, and based on a realistic estimate made with our general manager, cataract and refractive surgery will be down to 25% to 30% of what we did previously. This is without taking into account patients’ response because many of them might prefer to postpone cataract surgery and give up their plans for refractive surgery for fear of the risk or because of financial problems.
We are sailing in uncertain waters. We do not know when and how reopening will be possible. It is likely to be a slow and continuously evolving set of solutions, and regulations from our government are also expected to evolve. What we know for sure is that we are going to proceed with extreme caution because we are concerned about a second wave of the infection. I am working on a prospective agenda of visits and surgery, on how to protect the patients as well as our staff, and one of the critical points is personal protective equipment. We have been facing a critical shortage of surgical masks and FFP2 masks, and there is great concern about the future, when we will need massive amounts.
We also do not know if testing will be mandatory, PCR or serologic tests, for patients who undergo surgery. In principle, they should be part of our preoperative evaluation and should be regularly performed on all our staff, but again there is a question mark on availability. We are also aware that someone who initially tests negative may be positive for the virus some days later, so we are thinking of working on alternate schedules. A team made of a doctor, an optometrist and a receptionist may be scheduled to work for half the days of a week, not coming back until the following week, while another team covers the other half. Keeping all the staff employed, however, might not be possible. If our activity is drastically reduced, we may have to face downsizing. Staggering shifts may be an answer, but we will have to see. We can only go one step at a time.
Francesc Duch Mestres, MD, is director of the department of refractive surgery at the Institut Català de Retina, Barcelona, Spain.
Working more to earn less
Before the shutdown was ordered in Italy, we had already created a protocol to enhance safety in my practice. Patients were met at the entrance of the block. Before they got into the lift, their hands were disinfected, they were given a face mask, and their temperature was measured. This protocol will be maintained when we reopen, and we are going to implement further protective measures. All our staff will be wearing single-use gowns, gloves and masks, as well as plexiglass face shields if they come in close contact with the patient for routine examinations. Breath shields will be mounted on slit lamps, and contact tonometry will be replaced with puff tests. Spreading out workspaces and times will be crucial. We will be able to see no more than two patients per hour, and they should never be waiting in the same waiting room. I expect a reduction of at least 50% of our surgical procedures. In the operating room, in addition to routine disinfection and sterilization procedures, we are going to use a soft aspiration under the drape that covers the patient’s face to remove the expired air. I am not sure about testing patients for COVID-19; I see this as a problem for our practice because many of our patients come from far away in the country.
We will have to come to terms with the fact that our income will be substantially reduced, and our lifestyle will change. I do not foresee any employee downsizing because we are going to need all our staff to carry out the many additional procedures we will have to do for patient preparation, distancing, and multiple cleaning and disinfection of rooms, equipment and surfaces throughout our working day. There will be more work for the colleagues that collaborate with me in the practice because I will no longer be able to see as many patients as I used to. We will have to work longer hours and more days in a week, for sure on Saturday morning and sometimes over the whole weekend, at least in the first months after reopening to deal with the backlog of patients we have not been able to see during these months of lockdown. There will be no holidays this summer, at least no more than a week for all of us. Inevitably, waiting lists and waiting times are going to be longer in the future, and patients will have to understand. For all of us who work in private practices, our presence at meetings will be reduced when they restart. Personally, I will cancel many of my usual commitments as a speaker because my clinic and my patients have priority. However, we will adapt. We have been forced to reduce our needs, and this is, after all, not such a bad lesson to be learned.
Massimo Camellin, MD, is medical director of SEKAL Microsurgery, Rovigo, Italy.
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