From wearing masks to waiting for appointments in the car, patients heading back to the doctor’s office will find a slew of new processes and protocols in place.
Many healthcare providers who hit pause on in-person care on account of COVID-19 are now reopening, while those that stayed open on a restricted basis are once again seeing nonurgent patients. The coronavirus isn’t contained yet, though, so new measures are being implemented to keep doctors, staff and patients safe.
In addition to doing obvious things, like doubling down on hand sanitizer, some healthcare practices are already mulling over major changes, many of which could become permanent. As a result, doctor’s offices may look different than they used to. One likely possibility includes redesigned waiting rooms so patients can seclude themselves in small, isolated nooks or pods, says Andrew Hajde, assistant director of association content at the healthcare consulting firm DoctorsManagement.
“We may see new designs that are outside the norm,” Hadje says, “and I don’t suspect we’ll go back to the same setup we have today any time soon.” The office might look different, but the care will carry on. Here are some likely scenarios we can expect.
Masks and mandatory health screenings
Expect to be prescreened for possible COVID-19, either by phone or video chat, before any doctor’s appointment, whether or not you’re sick. This will probably entail answering questions about whether you have potential COVID-19 symptoms, such as a fever, cough or lost sense of taste or smell.
When you arrive at the doctor’s office, you might be asked to wait in your car instead of the waiting room. A receptionist may take your payment over the phone, and then call to let you know when a nurse is on her way to escort you into the office. Right now, some practices are letting a small number of patients sit in the waiting room and spacing them far apart. In cities like New York, where patients are less likely to drive to the doctor, healthcare practices are staggering appointments and removing furniture from waiting rooms to facilitate social distancing.
In Olympia, Washington, family physician Dr. Jennifer Playstead asks every patient to bring a mask from home and wear it the whole time they’re in the office. If a patient doesn’t have a mask, she’ll provide one. Patients age 65 and older, and anyone else who’s high-risk, will stay in their car until an exam room is free. The nurse will open all doors on the way up to the office. Other patients can request to do the same.
Playstead also reserves her office space for patients who don’t have any symptoms that could be COVID-related. If a patient has a fever, cough or any other respiratory symptom, she sees them outside, under a treatment tent that opens up to a side entrance of the building. “We plan to continue that indefinitely until either a treatment or a vaccine is available,” she says.
Inside her waiting room, Playstead has removed most chairs to make sure patients sit six feet apart. She’s also put away magazines, books and children’s toys and added multiple bottles of hand sanitizer. “It’s a very sterile-looking environment,” she says. Patients are asked to come to their appointments alone, unless they need a friend or family member to attend because of a disability or mobility problem.
In Houston, internist Dr. Jonathan Magid has set up two entrances to his office, one for healthy patients and another for those with COVID-like symptoms. Healthy patients are seen in one part of the office and possible COVID ones in another. He’s assigned a set of staff members to each group, and the two don’t mix.
Every staff member wears a surgical mask at all times, or an N95 mask if they’re helping a COVID patient. Patients are screened over the phone when they make their appointments and then again when they arrive. At the door, they’re asked if they’ve had a fever or cough, and a nurse takes their temperature. After that, patients are immediately taken to an exam room. No one lingers in the waiting room.
“We treat everyone like they’re potentially a COVID patient,” says Magid, who, like Playstead, has instituted extensive and frequent cleanings of the office and medical equipment. Magid also requires every patient to wear a mask while they’re in his office, and he meets regularly with staff to discuss protocols and any changes that might need to be made. Taking such a careful approach gives people the confidence to go see the doctor, he says.
Magid is trying not to escalate any medical problems he can solve on his own, in order to avoid sending patients to an emergency room where potential exposure to the virus could be significant. “The ER is not a controlled environment,” he says.
At dentists’ offices around the country, many patients are being asked to gargle with a peroxide rinse to kill contaminants in their mouth before they’re treated. Some dentists are also forgoing certain equipment during cleanings, like ultrasonic scalers, the powered tools that remove plaque from teeth. While they’re important to oral health, they also could increase the number of aerosols, or tiny respiratory droplets known to be a major vector for COVID-19 infection, released into the air.
As doctors reopen practices, they’re seeking guidance from professional organizations like the American Medical Association and the American Academy of Family Physicians.
The AMA launched a physician guide for reopening medical practices, which suggests gauging whether a telemedicine appointment could replace an in-person visit. Practices should have all patients wear a cloth face covering, per guidance from the Centers for Disease Control and Prevention, and doctors should consider staggering appointments to minimize the number of the people in the office.
The AAFP suggests doctors’ offices limit exposure to frequently touched surfaces by propping open doors or using automatic sensors wherever they can. Physicians might also consider dividing their workdays between care for healthy patients and care for COVID patients, according to the organization’s practice reopening guide.
Hajde says doctors could also dedicate a few days a week to telehealth and reserve others for in-person visits. Other office design changes might include removing doors from restrooms and reconfiguring them to function more like airport bathrooms, where passengers wind their way through an open, no-touch entrance. More offices will also likely adopt automatic front-office doors, touchless, motion-activated light switches, touch-free trash cans and even voice-activated elevators.
When it comes to paying for your care, some offices are billing patients so no credit cards exchange hands. Patients may also see a push toward virtual payments using technologies like Apple Pay, to keep physical contact to a minimum. Many practices could install plexiglass at the front desk, similar to what retail businesses are doing, Hajde adds.
Some offices are also looking into replacing high-touch metal surfaces with stainless steel plated with copper or silver, where one study showed the virus lives for a shorter period of time. Patients may also find their doctor has extended appointment hours into the evening or over the weekend to make up for time lost to extensive cleaning.
At his office in Houston, Magid expects many changes to be long-lasting. “This could go on for months, years,” he says. New processes might take time to get used to, but patients will gradually adapt to the new norm — not least because their health might depend on it.