North Texas doctors warn patients not to put off necessary medical care during COVID-19 pandemic

Dr. David Winter was speaking online with one of his patients earlier this year when he realized the man had suffered a stroke in his home.

It took some coaxing to get his patient to come into a Baylor Scott & White hospital because he was afraid he was more likely to catch COVID-19 in a health-care facility, but in the end Winter was narrowly able to save him from permanent damage from the stroke.

“We were able to reverse his stroke and he went home well, but if he’d have waited four more hours, he would have had a permanent stroke,” said Winter, an internal medicine physician with Baylor Scott & White Health.

Health-care providers nationwide have worried since the early days of the pandemic that people may be putting off necessary medical visits because of the same fear Winter’s patient had.

One study found that outpatient visits nationwide had decreased 60% by April. The same researchers found in October that outpatient visits had increased but that there were significant differences depending on people’s age, where they live and the type of care they are seeking.

In North Texas, some health-care systems have continued to see a decrease in visits that aren’t related to COVID-19.

Emergency room visits to Baylor Scott & White hospitals still remain lower than they were before the pandemic, Winter said.

Contrary to the fears patients have, the coronavirus transmission rate in Baylor Scott & White hospitals is less than 1%.

“Of our patient-facing employees who had an exposure to a COVID-positive patient, fewer than 1% of those were found to be positive,” Julie Smith, a spokeswoman for the hospital, said in a written statement. “The majority of these exposures happened in the early days of our national response to this novel virus, with patients who were not presenting with the then-known symptoms of the virus. Over time, as our collective knowledge has increased, and guidance evolved from the Centers for Disease Control and Prevention, our protocols evolved as well, and these positives are much less frequent.”

Dr. Joe Chang, chief medical officer for Parkland Health and Hospital System, said that though it’s understandable, the perception that health-care systems present a higher risk of coronavirus infection is inaccurate.

“You’re more likely to get it at a Home Depot than you are in my clinic, and quite honestly, in anyone’s clinic,” he said. “Our employees will tell you, ‘We feel much safer at work than we do walking around the streets.’ ”

Health experts say patients may suffer more serious illnesses later if they put off necessary care during the outbreak.

Dr. Deborah Diercks, chairwoman of the department of emergency medicine at UT Southwestern, said the hospital has seen a decline in ambulance transports for chest pain and stroke symptoms throughout the pandemic.

“We have no real reason to believe that there should be a difference” in pre-COVID and pandemic ambulance use for those issues, she said. “It is kind of scary. … Maybe there’s an explanation we just don’t know about. But if this is because people are staying home and not getting the care they need for that emergent situation, it just means they’re going to have more advanced disease when we do finally see them.”

Diercks said patients should take advantage of telemedicine options, as well as consult with their doctors about what types of appointments can and can’t be put off. But generally, she said, preventive care such as cancer screenings shouldn’t wait.

North Texas health-care providers say the best thing they can do to combat their patients’ fears is educate them about the steps their facilities are taking to prevent the spread of COVID-19.

At Baylor Scott & White, UTSW and Parkland Hospital, safety measures include providers’ wearing masks and other personal protective equipment during each visit, thorough cleanings of exam and waiting rooms, social distancing in common areas, providing hand sanitizer for patients and conducting temperature screenings of the people who are arriving at the facility.

“I try to keep it really reality-based,” Dr. Elizabeth Paulk, program director of the palliative care fellowship program at Parkland Hospital, said of how she deals with patients who are hesitant about coming for treatment.

She deals with patients who have serious and advanced illnesses and said some cancer patients express fear about coming in because they are medically fragile.

“I’ve been working in this clinic since March, and I wear my mask every day, I wear my goggles every day and I have not gotten sick doing those things,” she said. “I would not ask you to come to the clinic and I would not be coming to the clinic if I didn’t think it was safe.”

Chang said visits to Parkland Hospital have rebounded and the no-show rate for its cancer clinic is also lower than it was before the COVID-19 outbreak.

He said the difference in Parkland’s visit levels is partly due to hospital staff members’ frequent communications with patients, and partly due to the people who are served by the hospital. One factor is many of the hospital’s patients have severe diseases that require immediate care.

Although some health experts worry about an increase in serious illnesses, like cancer, in the coming years because of delays in treatment, Chang said his biggest concern is that people with existing conditions will experience complications because they are avoiding visits.

“In the grand scheme of things, this pandemic has not gone on for a very long time,” he said. “We’re not talking about it’s been 10 years since anyone’s come in for a mammogram. … We’ll see many more acute problems, like people’s hypertension being out of control or their diabetes being out of control.”

Health experts stressed that though health-care systems are busier than they were before the pandemic, it’s essential that patients come in for needed care.

“We’re kind of giving people two messages,” Diercks said. “We’re like, ‘We’re full, COVID is everywhere, stay home.’ The reality is where we are, but we definitely want you to come if you’re having an acute event.”