1 Question, 5 Answers is a column where we ask different types of healthcare pros to weigh in on the same issue.
During the height of the COVID-19 pandemic, going to a doctor’s appointment was an odd, sometimes fraught experience. First, it meant doing a fair amount of research. Was the visit really necessary? Did it have to be done in-person or could it be done virtually? Typically, for an in-person visit, you would have to wear a mask, undergo a temperature check at the door and fill out a health questionnaire.
But as mask requirements lift and the number of vaccinated Americans increases, will doctor’s appointments go back to the way they once were or will they permanently change? We asked five different types of healthcare providers. Here’s what they told us.
Lauren Streicher, MD
Medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause
Chicago, IL
On virtual visits: I think the number one thing is the transition to telehealth. One of the misconceptions out there is that telehealth just became something people wanted to do because of COVID. The truth of the matter is that we always wanted to do telehealth, and we weren’t able to, because insurance didn’t cover it. That’s why we were always having women come in, even for things that could very clearly be done over the phone. But now because of COVID, insurance companies have started covering these visits. We’re all hoping that this coverage will continue. I really see that as the biggest potential permanent change that’s going to happen for us.
On safety precautions: I think the masks will probably stay in place for the time being because quite frankly, not everyone has been vaccinated and that’s a problem. I feel very strongly about that because when I got COVID, I was hospitalized. I had no underlying conditions, and this idea that only people who are old are potentially at risk of having a fatal COVID illness is simply not true.
Michael Barnett, MD
Assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health and primary care physician at Brigham and Women’s Hospital
Boston
On virtual visits: Telemedicine will become a standard tool for providing primary care, replacing somewhere in the range of 10 percent of visits, on average. Patients with any symptoms of a respiratory infection (like a cold) will be required to wear masks and follow stricter infection control practices like going to a reserved room in the clinic, perhaps indefinitely. This is a big change because acute respiratory infections are among the most common reasons why anyone visits the doctor. PCPs are going to transfer more care for chronic illness outside of the office via telemedicine or just plain old phone calls. They have learned how to do it during the pandemic and it’s clearly a more sensical way to manage chronic illness.
On vaccines: I highly doubt adult internal medicine practices will require adult patients to be vaccinated. A large proportion of our population has incomplete vaccine status for lots of vaccines and we can’t exclude them, not just because of how many patients there are, but also because of the equity implications. For pediatrics practices, the question [of whether to mandate vaccination for patients] is more complex; this is a controversy they have been dealing with for many years and I don’t think the COVID vaccine will change the underlying debate much.
Joshua Zeichner, MD
Director of cosmetic and clinical research in the department of dermatology at The Mount Sinai Hospital
New York City
On safety precautions: COVID-19 has certainly brought hygiene protocols to the top of everyone’s minds. Even as we move past the pandemic, it is likely that many of the safety changes that have been brought to the office will not change. Face masks are likely here to stay in scenarios where there is close contact with patients. Having temperature checks and health screening questionnaires prior to well visits will probably continue to some degree. The air filtration systems installed in many offices will continue to be used. Hand washing is always important. However, COVID-19 brought hand sanitizing to a new level, which is likely to stay not only in medical offices, but also public spaces including restaurants and stores.
Christopher Roberts, DDS
Adjunct professor of dentistry at the University of Michigan, currently on the Board of Trustees of the American Association of Orthodontists
Findlay, OH
On safety precautions: After the pandemic, I have no doubt there will be permanent changes to the way dentists practice. Let me give you some history. In the late 1980’s, blood-borne pathogens, such as HIV, caused a major change in the way dentists practiced. Before this time, gloves were rarely worn for most routine dental procedures. We are now going through this same type of change with airborne pathogens, such as COVID-19. But exactly which changes we have seen in the past year will remain permanent is hard to say definitively.
I doubt routine temperature checks and limiting social distances will remain as permanent procedures once the pandemic is over. Dentists use “universal precautions,” which means we treat all blood and certain body fluids as if they are infectious. I think there will be continued protocols for containing the spread of viruses in dentistry but that all patients will be treated the same, whether they are vaccinated or not.
I expect dentists and every member of their staff who has clinical contact with patients to be required to routinely wear masks or face shields while treating patients. Since viruses are spread through aerosols. I believe anytime a dental healthcare worker creates an aerosol, such as when using a dental drill or an air/water syringe, a mask or face shield will be mandatory.
Matt Lundquist, LCSW, M.S.Ed
Founder and clinical director of Tribeca Therapy
New York City
Our psychotherapy practice has been gradually reopening for in-person sessions, with about two thirds of our sessions still online. For now we’re only seeing vaccinated patients as well as those who are ineligible either because of age (we work with some children), or a medical issue that would make vaccination unsafe. Nonetheless, we ask everyone who enters our office, including our staff, to wear masks in the public spaces in our office (stairs, waiting room, hallways). We anticipate that as case numbers continue to drop we will likely drop this requirement.
The biggest legacy I see in our practice is the ability to offer remote work. We anticipate a return to a majority of our sessions being in person, but we also anticipate that we will be doing many more video sessions indefinitely. The advantages are quite significant: Sessions can happen during travel for work or pleasure, increasing consistency of treatment. Individuals who are sick can stay at home so as not to infect others while still doing therapy, if they feel well enough for a video call. We also see some advantages for our therapists in the flexibility of allowing for them to do some remote work to accommodate travel or childcare demands.
Responses have been condensed and lightly edited.