What would you change about managing patient care in the first wave of the pandemic?
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Keep services open
This may seem controversial, but if I had known what I know now, I never would have closed down the clinic, particularly the ASC, during the first wave.
Through mask wearing, social distancing and good hygiene (hands, rooms, equipment), we have been able to keep office COVID-19 infections down to almost none and have quarantined to avoid further exposure when it has happened. We were applying the appropriate behaviors early on in the first wave when we worked with a skeleton crew and saw only urgent cases and had zero issues. Now in the second wave with many more infections in the Dallas metro area than with the first wave, we still have good control.
I surmise that we would have been in good shape infection-wise and much better financially if we had stayed open. The fly in the ointment would have been: Would many patients still have come in if we were fully opened, and would city/county/state agencies have come in and closed us down? We know of some clinics and ASCs that stayed open, and there was no retribution by health agencies. I believe that medical facilities such as we have in ophthalmology are well equipped to deal with infectious disease, and our best interest is keeping our patients and our employees healthy.
With proper guidance and advice, we can do and have done the safe thing during both the first and second waves. Closing us down, and I fear it could happen again, serves no purpose except to appease those who wish to control but do not understand what we are capable of with regard to medical safety.
Jeffrey Whitman, MD, is an OSN Cataract Surgery Board Member.
Continue to care for patients
If I could change one thing about managing patients in the first COVID-19 wave, or what I have been calling lockdown v1.0, it would be permission to take care of my patients.
I have been in practice for 30 years, all of them in private practice and roughly 22 of them as the managing partner for a group. In the face of an unprecedented (in our lifetime) infectious disease about which the smartest people in the world knew very little, the state of Ohio declared eye care, among other broadly stroked areas of medical care such as dentistry, a nonessential part of health care. Hospital systems throughout the state pulled the plug on nearly all elective surgery.
In addition, our two largest professional organizations folded like cheap suits, demanding without nuance or clarification that we close our practices and provide emergency care only.
If I could do anything differently, I would have led the efforts made weeks later by so many of my colleagues (and belatedly by the organizations’ leadership) to determine best practices in our offices and our operating rooms to keep both patients and staff safe from harm. Everything we did beginning in May we could have done in March. I would have aggressively combed our upcoming visits to better determine who was at risk for having diseases worsen, reached out to them and encouraged them to come to the office. Even throttling back to 40% of usual volume (our reopening level) would have averted considerable suffering, especially in our practice’s large dry eye population. Indeed, at the May press conference during which the Ohio stay-at-home order was lifted, both our governor and the director of health basically pleaded with those of us who had been declared nonessential to reach out to our patients and schedule their visits and surgeries as soon as possible.
Much has been made of the damage done to the financial health of practices both large and small, but it is the damage to our patients that came from a lack of access to care that matters. At least some of this can be traced to the fallacy that doctors in the community cannot be trusted to make “big decisions” in a crisis. To the contrary, no one knows their patients better than we do. Community practices of all kinds are rightly famous for their devotion to their patients, often at the expense of our own health and well-being. So, this one is a layup. If I could change one thing about patient care in the first wave of the pandemic, the decision is easy: I would have continued to provide patient care.
Darrell E. White, MD, is a Healio/OSN Board Member.
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