Safely Visiting the Doctor During the Pandemic

Hadley Presents

Safely Visiting the Doctor During the Pandemic

Presented by Ricky Enger

Ricky Enger: Welcome to Hadley Presents. I'm your host, Ricky Enger, inviting you to sit back, relax, and enjoy a conversation with the experts. In this episode, we discuss safely conducting a visit to the doctor during a pandemic. And our guest is ophthalmologist Dr. Lori Provencher. Welcome to the show, Lori.

Dr. Lori Provencher: Thank you. It's great to be here.

Ricky Enger: I'm so glad that you could take a little time out of your busy schedule to join us. And before we jump right in, just why don't you give a quick intro and talk a little about what you do as an ophthalmologist?

Dr. Lori Provencher: So I am a glaucoma specialist, so trained to do that, but I also do cataract surgery as well. So I see a little bit of everything, but my week is a mixture of clinic and surgery and lasers. And I see a variety of patients, all sorts of walks of life, from patients with really mild disease and no glaucoma at all, maybe just cataract, to patients that have really severe disease and are low vision in both eyes or one eye. So I have a nice mixture of people and I really enjoy what I do. So I practice in Cincinnati, and I've been doing that for about a year now.

Ricky Enger: It's interesting that the world has changed so dramatically over the last few months, but as I'm sure you know, things like glaucoma don't just go on pause while the world gets itself together again. And so people do have to go out and seek that medical care, whether it's something with their eye condition or heart condition or whatever that is. And so we want to just talk about some things that people might encounter when scheduling those necessary visits. And of course, your office will have its way of doing things and other offices may not be exactly the same. But this should hopefully give our listeners just some ideas of what to think about, maybe what to ask about before undertaking that visit to the doctor.

I guess, the first thing I'm curious about is do you have a lot of people who call the office and ask questions? Are your staff accustomed to taking calls from people that are kind of trying to plan ahead because they have no idea what it's going to be like when they get there?

Dr. Lori Provencher: Our population just in general is a high-risk population, right, for COVID-19. So we see a lot of patients in a high risk age group and patients with comorbidities. So we're expecting them to be very nervous. We want them to be nervous because that will prompt them to take good precautions. So we're expecting people to call in. We're ready for those questions. I think everyone has been inundated with information at our practice, and we're frequently briefed on updates of what's going on in the community and on a national level. And so we're primed to answer questions, we're expecting questions, and we absolutely don't mind. We want everyone to feel comfortable coming in and feel like they're ready when they decide to come in. And so part of that is answering questions, making people feel at ease, and also preparing people for the changes that we've made to mitigate the spread of COVID-19.

Ricky Enger: For a lot of people, they have a family member accompany them to the office either just so that the family member can ask questions and take notes as well and sometimes it's an issue of transportation. It makes a lot of sense for a family member to drive the patient to the doctor's office and that kind of thing. What is your approach as far as allowing family members to come in with your patients during a visit?

Dr. Lori Provencher: This has probably been one of the biggest adjustments, I think. That and masking. So most practices I would say are asking companions to stay outside of the office, either stay at home or stay in the car. If they need to drive, we ask that they have the companion stay in the car. And this is all in an effort to reduce nonessential foot traffic in the clinic. So we've all seen how crowded ophthalmology offices can get and half the time it's half of the people are patients and half are family members. So this is really for the safety of everyone. However, there are always exceptions to every rule and we're very aware of that. We do allow companions to come when patients need special assistance.

So I have not seen or heard anyone say that it was a struggle to get a companion through the door. We have a very low threshold if somebody does not feel comfortable or needs special assistance, whether it's physical or visual reasons or sometimes it's like a mental state, patients with dementia, and we have a low threshold to allow companions to come in to help those patients. And so this would absolutely include patients with low vision.

Ricky Enger: And what about in the waiting room? It's got to be a lot less crowded than before. Do you have patients stay in the waiting room while they're awaiting their visit, or do you have people wait outside and they get called inside? How does that work?

Dr. Lori Provencher: Yeah. So this is going to vary practice to practice a fair amount, most likely depending on the building and patient flow and how the doctors practice. But you're totally right. Waiting rooms can be shoulder to shoulder traditionally. Like I mentioned, we're limiting companions. We, in glaucoma in particular, are adjusting our patient flow through the clinic to allow for social distancing. So one of the things we're doing is chairs are spaced farther apart than usual or they're roped off so that people can't sit next to each other. Patients might be asked to wait in an area they're not used to like a hall or a different waiting room that's currently not being utilized. We're also strategically adjusting appointment times so we can space people out, so that we're not getting these clusters of people waiting for a doctor. And then we're also using, which I think is genius and I think a lot of places are doing this, but we're using extra staff members as hall monitors, kind of traffic control hall monitors. And they're roaming the clinics looking for buildup of patients in areas where we might be breaking social distancing so we can quickly identify crowds or clusters and make adjustments to move people, adjust the flow a little bit. So we're very cognizant of that and I think that's a huge effort and a huge undertaking, but so far we've been very successful.

But you're absolutely right, the clinics are completely different. The chairs are stacked up or roped off. It's not your typical serene office environment. Things are going to feel a little different. But at the same time moving people requires cleaning, right? So every time you move somebody out of an exam room to let them say dilate or something, you have to clean the room for the next person. So it's all a balancing act of keeping everything perfectly clean, but also maintaining social distancing.

Ricky Enger: Yeah. And I think one of the things that doesn't really get talked about a lot is social distancing and how you manage that if you are blind or have low vision, because it's difficult to judge what six feet looks like. And so sometimes for people who are going out even to the store and certainly to the doctor's office and just places that they've been before, it's all new and people are concerned about how they manage to social distance safely. Have you had any instances where maybe someone was accidentally breaking social distancing, or do you have things in place that even if you aren't able to visually judge, you're still going to be able to do this safely?

Dr. Lori Provencher: This is a great point, and I think it's something that I had not actually thought about. I think having a companion in the clinic with you in this situation is crucial, because usually a companion is somebody you're already in close proximity with and they can stay right by your side and guide you, because we do have things like signs up and marks on the floor and things that aren't exactly designed for low vision. The print's not large enough, or it might not be high enough contrast. So absolutely a companion would be crucial. Again, the hall monitors or traffic control. I think everyone in an eye clinic, thankfully, is pretty cognizant of vision issues. And so if they see somebody that has low vision, although it's not always obvious, but if they see somebody that has low vision and is breaking social distancing, I don't think they would hesitate to provide a gentle reminder or to move somebody over just a little bit. But yeah, I think that's a really good point and I think it's a teamwork. So the patient needs to alert staff as soon as they walk in the door that that's a concern. No one would be frustrated or mad about that. In fact, we'd probably appreciate it. And then also relying on us. That's part of our job is to keep you safe while you're there. So with those two things together, hopefully we can keep people safely apart.

Ricky Enger: And I think that makes perfect sense to mention when you walk in that social distancing may be a problem for me, so can I have someone just watch out? Because there have been instances where other people in a place get really upset and start yelling at the person with low vision because there's a lot of anxiety, right? Everybody wants to stay safe and sometimes there's just that reactionary thing that, "Hey, get back," and the low vision person has no intention of being unsafe.

Dr. Lori Provencher: Absolutely. And we'd want to avoid anything like that. I mean, it's already stressful enough to be branching out, going outside of your home and to add a situation like that would just be, in my mind, like catastrophic and really unfair. Absolutely alert the first person you see when you walk in the door. A lot of times there's going to be somebody right there taking a temperature or asking you screening questions, so that's a great time to mention it. We are not afraid to get close to you to guide you. That's part of our job. We're going to be getting close to the patient anyways. That's a risk we're taking on as care providers. That's part of our job. And so we're doing hand washing. We're wearing masks. We're doing everything we can. Sometimes we're wearing shields or gowns if you even have symptoms or something like that and need to be seen, but we're not afraid to get close to people and to guide them if necessary.

Ricky Enger: So you mentioned that you all are wearing masks, of course, as staff. What is the examination like in terms of how people stay protected? Do the patients wear masks for the entire visit? How are exam rooms cleaned before and after? Are there hand sanitation stations? Just how does the exam itself work and keeping everyone safe?

Dr. Lori Provencher: We have patients, every single patient, every single person in the building has a mask on. I would recommend people put their mask on from the moment they leave their car to the moment they get back to their car and to wear it properly. So it's very tempting when you're there at an eye doctor's office for several hours and you're breathing in a mask to want to pull it down over your nose or pull it down when somebody's out of the room and you're by yourself. But again, that's all exchange of air and potentially infectious particles or aerosols, so really trying to resist that temptation. You're going to have a mask on the whole time and we're going to be like a hawk watching you to make sure you keep it on because it's for your safety and our safety. All providers will have a mask on.

The exam itself might feel a little different. I, for me in particular, have reduced the amount of contact my technicians have with patients. For example, they will check vision and get a little history and do some basic exam components that don't require close proximity. But for an eye pressure, in the past, the technician would often check the eye pressure and then I would either utilize that pressure. If I had any concerns, I'd recheck it. But for now, I'm asking that they don't check eye pressure because I'm just going to check it once and be done. So that minimizes the amount of time that the technician is close to you to protect each of you. For me, I'm at the microscope. I actually wear two masks. I have an N95 on and I wear another mask over that. That way I can kind of keep my N95 clean because there is still an issue getting new N95s over and over again. And then there is a breath shield. So we traditionally have small breath shields on the slit lamps. It's just this like clear plastic piece of material that protects droplets. But now we have larger ones that we've put on since the coronavirus issue, and that is just yet another barrier between the patient and the doctor.

So essentially you're going to have two to three masks between the two of you, plus a breath shield. And then I'm doing frequent hand washing, frequent hand sanitizer between every patient in and out of every room. We clean down the entire exam room between patients. And so the flow is a little different. The examination itself though should feel similar. We're not going to skip out on any parts that are necessary or anything like that. You're there and we want to get you the exam you deserve and need while you're there. But occasionally we have, especially when things were very serious and you're still locked down to some degree, we were delaying any non-essential testing.

So things like a visual field or a picture of your retina or optic nerve where you're sitting in a machine. If it wasn't absolutely crucial, we were delaying that because it's just another source of exchange. But now I think we've got enough of a method down with cleaning and moving patients and we feel that at this point we need to continue the regular screening and care for patients that we're... I am at least not really delaying testing anymore at this point.

Ricky Enger: So what happens if a patient comes in without a mask perhaps because they just haven't been able to get one anywhere? Does your office have any disposable masks available for people coming in?

Dr. Lori Provencher: That's a great question, and this is something we ran into in the beginning when we were reopening our doors. Patients are all alerted ahead of time by phone that they need a mask, so they do have time to hopefully get one. But I recognize that's not possible for every single person. And so we do have some very inexpensive masks for sale in the front of our building where patients can purchase a mask. As far as like pulling your shirt up over your nose or something like that, we're just not accepting that because it's just... You have to draw a line somewhere because you're protecting the other people in the building. So it should provide comfort to those who do come with a mask that everyone else is following the same rules.

Ricky Enger: And what about paperwork? That's one of the things that has traditionally been difficult for someone coming in with low vision and they don't have a companion with them to fill out the paperwork. Sometimes it's inaccessible, so the print is small, and writing in those little boxes is a problem. Are you making that available to people ahead of time, either electronically or by mail, just to eliminate that one extra step that they might have to get a staff member to assist or whatever at the clinic itself?

Dr. Lori Provencher: Yes, we are doing this, and there are multiple practices that are under the platform that I work for. So we've had calls about this and multiple doctors putting their heads together on how we can do this best. So it's going to vary across states and practices, but overall, I'd say there are multiple mechanisms to get paperwork done ahead of time. So some practices might be calling you in advance and not just doing like your typical things like, has your insurance changed or is your address the same, but things like actually getting the history that we normally get the morning of your exam from you in person like, has your vision changed, are you having pain, are you taking your eyedrops, those sorts of questions.

And that minimizes the time you're in front of a technician. We've done this for a while, but we're still sending paperwork to the home to be completed in advance. So I mean, the print is still going to be small, unfortunately, but if patients have like a home magnification system they use, then that could be utilized thankfully and you can use your own pen that's not covered in everybody else's germs. And then we do actually have a software we've implemented and it's a mobile-based software. So histories and updates can be done in advance over the phone. So if you are curious about that, I think it's a very reasonable question to call in advance of your appointment and ask what can I do to get everything done in advance that is possible. And even if that's just snail mail sending it to your home, I think that's still a worthwhile effort.

Ricky Enger: Do you feel like people have been a little slower to come back and get necessary treatment or have people kind of recognized that, hey, my pressure might be high. I really need to go in? Have you had a slowdown of patients, or does it seem fairly steady in what you expect?

Dr. Lori Provencher: Yeah, it's been an interesting mixture. Some patients have been very nervous to come back in and it probably depends on what information they're consuming and what their individual risk is and how bad their eye disease is. Some have been very nervous to come back in. Some have been very nervous to have surgery and have been willing to delay even pretty necessary surgery, while others have been really anxious to get back in and get their eyes checked and get their pressures checked and those sorts of things. So it's been a mixture, and it's hard as the doctor because you don't want anyone to feel like they're not getting the care they need. But we also have the unique view that we kind of know who really needs to come in and who could wait a little bit longer. So when we were shut down, we had to do a lot of triage and deciding who could wait and who really needed to be seen. But even then, the people that really needed to be seen, it was up to them and how comfortable they felt coming in. It varies. It's very much personality-dependent as well.

Ricky Enger: It's comforting and not really a surprise, but it still is comforting to know that medical professionals really are taking a lot into account and taking their own safety, as well as patient safety into account. And sometimes it's just that fear of the unknown that keeps people from coming in and maybe just having some of that information to allay some of those fears and just have an idea of what to expect. That can be really helpful, I think. Is there anything that... I mean, we've covered a lot. Are there any things that you maybe feel are important to touch on that we didn't cover?

Dr. Lori Provencher: We're all nervous too. You know? We're confronted with this every day. It has become a little more normal for us on the healthcare side of things because we're seeing it every day in the office. We're doing all these measures and getting used to this new normal as everyone's calling it. We're nervous too and we want to take good care of you. I think the worst thing would be for a medical provider to get it and then to spread it to other people. And so it's not just wanting to protect ourselves, but it's wanting to protect every single person we come in contact with every day. We're all in this together.

And I think it's exciting to see how the profession has really pulled together to get back out there and provide care for people. Because, I mean, it goes without saying the vision is so important, taking good care of yourself, your whole body, and your eyes is just... It's a tough balancing act in this new situation we're in. I want people to feel comfortable to reach out to their eye doctors. I think across the board what I've seen on national forums and all the education that I've seen that's been put out there is we all really care and we want to be able to continue to provide care for people in this pandemic.

Ricky Enger: Is there a place that people can go? You practice in Ohio and things are a little different everywhere, but maybe there are some guidelines that medical professionals are generally following across the board. Is there a place that someone could go to look for that kind of information?

Dr. Lori Provencher: Absolutely. So I mentioned ophthalmology on a national level making efforts to combat the situation. And if you go to aao.org, that's the American Academy of Ophthalmology, and they have a large banner right at the top of the website, it's in purple, called COVID-19 Resources. And under that sub website, there is a whole list of different resources including what the Academy of Ophthalmology is recommending ophthalmologists follow when they reopen their practices. So you'll get a sense of what guidelines we are being advised to use, and you can compare your practice to those guidelines and decide if you feel like things are up to snuff and you're comfortable going in.

And then there's also a link lower down on the page that provides a list of state society COVID-19 resources. So it'll link you to each individual state and their situation and what sort of guidelines they're providing for ophthalmologists. So there's a lot of information on that website, but I think it's useful because, as you mentioned, things are a little different everywhere you go in this country right now and they're constantly evolving. So keeping up to date and just kind of a check and balance, right? So you're checking what your doctor in their practice is doing compared to the national standard.

Ricky Enger: Thank you so much for that. We'll have those links in our show notes, so you can check out those resources as well. Dr. Provencher, I want to thank you so much for joining us. This has been such valuable information and I know that our listeners are going to benefit from this. So I just want to tell you I appreciate you for your time and thank you for sharing this valuable info.

Dr. Lori Provencher: No problem. Thank you for having me. This is such an important topic, so it's an honor to be invited to join.

Ricky Enger: Thanks for listening, everyone. Got something to say? Share your thoughts about this episode of Hadley Presents or make suggestions for future episodes. We'd love to hear from you. Send us an email at [email protected], that's [email protected], or leave us a message at 847-784-2870. Thanks for listening.