The information included in this article was current as of publication, however, information changes rapidly regarding Covid-19 and may be out of date.
To help slow the spread of COVID-19, more and more medical appointments are going virtual. But for some routine care, there’s no way to avoid seeing a doctor in person. A laptop screen can’t replace an exam room for preventive visits like checkups, Pap smears and mammograms, and dental cleanings. For now, these appointments are largely on hold. The American Academy of Family Physicians, for one, is encouraging its members to reduce or postpone non-urgent, outpatient face-to-face care.
It’s still unclear when doctors will be able to resume business as usual. But you can start planning for your post-coronavirus routine care anyway. Doctors across specialties urge patients to book appointments now for future dates, since time slots may fill up quickly once their offices reopen.
“In June, we still may be coming out of this quagmire,” says Dr. Gary LeRoy, a family doctor in Dayton, Ohio, and president of the American Academy of Family Physicians. “But go ahead and schedule. Your doctor can always reschedule your appointment again based on what’s going on in June or July.”
In the meantime, while you’re hunkering down at home, is there anything you can do to compensate for missing a preventive visit? Mostly, you should leave the clinical stuff to professionals and focus on making lifestyle choices that are generally good for you (as well as specifically recommended to you) and reaching out to healthcare providers whenever you need to, even if you can’t see them in person. Here’s what doctors say you should (and shouldn’t) do to weather this forced break from the exam room.
Wellness exams
A wellness exam is your chance to sit down with your doctor to talk about your current health, update your medical information and get a physical exam. Your doctor will typically check your blood pressure and pulse, listen to your heart, take your height and weight and calculate your BMI, or body mass index. They might also do blood work to check your cholesterol and potentially a complete blood count, which helps doctors detect various disorders, as well as other blood panels that look at vitamin deficiencies and glucose levels. Most of these tests need to be done in person.
While there’s technically no blanket recommendation for all patients to get annual wellness exams, most health insurance plans do cover them. Many doctors also highly recommend getting a yearly physical, because for some patients in overall good health, it’s the only time they see their doctor in a given year.
It’s okay to delay a wellness exam as long as you’re in regular contact with your doctor about any pressing issues. “You don’t have to have an annual exam exactly 12 months to the day,” says LeRoy. “A routine physical can wait.” Physicals are really best done in person, he adds, because even seeing how a patient walks into the exam room — maybe they’re limping or shuffling in — can tell doctors a lot about their current health.
That said, some topics often covered in a wellness exam shouldn’t wait, including getting refills on your medications. Call your doctor or send them a note through your patient portal to request medication refills before you run out.
Patients with routine care on hold should pay attention to their bodies and try to keep up with healthy habits, or even start new ones. Those with fitness-tracker watches can keep tabs on their heart rate and pulse and report anything abnormal to their doctors. LeRoy says one of his diabetic patients compiles readings of his glucose levels, blood pressure and pulse in a log and shares the data with him.
Use your time at home to eat well by learning how to cook healthy meals, fit in regular exercise and get plenty of sleep, says LeRoy. “We have a chance to emerge from this as better individuals,” he says. “Wellness is an everyday thing, not a once a year thing. Focus on your own wellness. Ride that bike instead of using it as a clothes hanger.”
It hasn’t happened yet, but LeRoy says that as the pandemic continues to evolve, it isn’t out of the question that insurance companies might tweak wellness exam requirements, allowing them to instead be done virtually in a modified way.
Well-woman visits
Depending on a woman’s age and risk factors, a yearly well-woman exam might include a pelvic exam and Pap smear, a breast exam and a prescription for a mammogram.
For routine cases — women without a history of abnormal Pap smears or breast cancer — yearly ob-gyn visits and mammograms can safely wait for a few months, says Dr. Stephanie Zeszutek, a physician in Warwick, New York, and a fellow of the American College of Obstetrics and Gynecology.
In the meantime, it might seem like a good idea for women to be extra diligent about self-breast exams. But Zeszutek cautions that self-exams haven’t proven effective in finding cancer or improving survival for women with breast cancer.
“Because lumps and bumps are very common in women’s breasts, patients doing their own exams has led to concerns about things that are normal,” she says.
Instead, patients should practice breast self-awareness, which entails being familiar with how your breasts normally look and feel. Any change, like a new lump or discharge from one or both nipples, should be reported to your doctor right away.
At this point, Zeszutek is having her patients reschedule for the end of May. If that date comes and goes with social distancing rules still in place, she says patients can shift their appointments once again. When stay-at-home orders are finally relaxed, she’ll extend her office hours if needed, and may also see patients an extra day a week until demand subsides.
Zeszutek also says patients should focus on wellness-enhancing activities for the time being. Smoking, poor diet and a lack of physical activity are not only associated with cardiovascular disease, type 2 diabetes and various types of cancer, they’re also linked to conditions frequently treated by gynecologists, including menstrual irregularities.
Dental cleanings
If you had to postpone your regular teeth cleaning, it’s more important than ever to keep up with good oral hygiene, says Dr. Jasmine Sung, a general dentist in private practice in Houston.
Over the last few weeks, Aldrich has been proactively calling her patients to get them all rescheduled. “Everyone will be backlogged,” she says. She’s currently booking most patients for June and beyond.
While they wait, some patients might be tempted to take dental cleaning into their own hands by buying a tooth scraper or other dental tools to remove plaque or tartar buildup. Aldrich cautions against that. “You can cause some serious gum damage that way,” she says. “Leave that to a dental professional.”
To prevent cavities and gingivitis, the American Dental Association recommends brushing your teeth twice a day for at least two full minutes with a fluoride toothpaste. “It’s also prudent to use Listerine or a salt water rinse to help keep your mouth clean,” Aldrich says. Make sure to also floss your teeth thoroughly every night. For patients who are prone to cavities, brush three times a day instead — once in the morning, once after lunch, and then again before you go to bed.
Aldrich often has patients come to her for second opinions, and she sometimes finds that other dentists have recommended unnecessary procedures. She worries that when the world gets back to normal, some practitioners looking to make up for lost money might overdiagnose. Patients can help prevent that from happening, though.
“Make sure you have a good relationship with your dentist,” says Aldrich. “Always trust your instincts, and if you’re unsure, there’s no harm in getting a second opinion.”