How to Safely Seek Healthcare During COVID-19: Expert Q&A

And welcome back to At The Forefront Live. This is another episode that will deal with COVID related subjects for our questions for our experts. As you can see, we're practicing social distancing. I'm the only person in the studio. And our experts will be joining us from remote locations today.

Today we'll discuss how you can safely seek health care during the pandemic, is it safe to go to the doctor? Should procedures be postponed? And our experts will answer all of those questions. That's coming up right now on At The Forefront Live.

[MUSIC PLAYING]

And Dr. Jeff Matthews, Surgeon in Chief here at UChicago Medicine, and Dr. Sachin Shah, our Associate Chief Medical Information Officer, joined us to take your questions today. And we want to remind our viewers that today's program is not designed to take the place of an actual visit with your physician. So let's start with each of you introducing yourselves to our viewers, and telling us a little bit about what you do here at UChicago Medicine. And Dr. Matthews, so let's start with you.

Hi. Jeff Matthews. I'm the Surgeon in Chief at the University of Chicago and Professor and Chair of the Department of Surgery at the university. I'm a pancreatic surgeon by training.

And Dr. Shah.

Hi. Good morning. I'm Dr. Shah. I'm a primary care physician boarded in internal medicine and pediatrics. And I also serve as our Associate Chief Medical Information Officer.

Perfect. So let's jump right in, because I think a lot of people have questions, we've already seen some on Facebook, about whether or not it's safe to come to the hospital. And it's interesting, I was talking with some of the folks in our emergency department just earlier in the week, and they were even mentioning to me that people are putting off potentially life saving treatments because they're afraid to come to the hospital, and that's not the message that we want people to receive. And Dr. Matthews, if we can start with you, and just have you tell us a little bit about the safety of the hospital, and, kind of, what are the guidelines for people coming to the medical center?

The hospital continues to be a very safe place. It's safer to be at the hospital than to be in many other places. It's probably safer to be at the hospital than at your grocery store, or other places. We practice social distancing at hospitals. And we have implemented a universal masking policy for patients. We have a restricted visitor policy to help with the social distancing as well. The hospital feels very safe. In fact, one of my colleagues just had to seek care in the emergency room themselves, and commented on how safe they felt during the visit.

And Dr. Shah, it's interesting, because when you walk through the halls here at UChicago Medicine, as I did this morning to get to our little studio area, I was, of course, wearing a mask, because everybody that comes in the door has to wear a mask. And people are practicing social distancing. It does feel very safe. And it is very safe, correct?

Yes, absolutely. And as Dr. Matthews alluded to, we've taken great measures, and a lot of thoughtful planning has gone into ensuring that we're taking the appropriate precautions and setting up-- readjusting the way that we are setting up our facilities and making sure that everyone is practicing the best social distancing to provide the safest care.

In fact, Dr. Matthews, one of the things that I thought was kind of interesting, we may actually be even safer than the normal right now, because of all the precautions that are taken. And this week we got some great news, which is very exciting, our 17th consecutive leapfrog A grade, which is extremely positive, and only 32 hospitals in the United States have achieved that. And that says a lot about the men and women that work here and take care of the patients. Can you tell us a little bit about what that means?

I think that is a testament to the seriousness with which we at University of Chicago Medicine take patient safety. We really have been leaders at the forefront, if you will, in the patient safety area preceding the pandemic, and for many years in a row, as indicated by that leapfrog data. And we're appreciative of that ranking. Of course, when we're talking about seeking health care during the COVID pandemic, that's a different situation.

And I would say that we continue to put patient safety at the highest priority. And all of the choices that we've made ever since we first started thinking about and standing up our response to this back in early January has been dedicated towards patient safety and doing the right thing for patients who need care, whether they have COVID or they need care for medical issues that are unrelated to COVID.

And Dr. Mathews, you said something to me yesterday that I thought was interesting. You were talking about medically necessary time sensitive procedures, what do you mean by that? And what would that cover generally at this time?

Well, to go back a little ways, when we were just on the brink of seeing the wave of the pandemic in this country, many hospitals, including ours, and then nationally, stopped what some people call elective surgery, or nonessential surgery, and we certainly were at the lead of doing that. But it's important to remember that there are many types of surgical procedures that may not be true emergencies meaning life threatening surgery needed right now, or a surgery for a life threatening condition right now, but that might be necessary to do despite the additional concerns raised by the pandemic. So we developed the concept of medically necessary time sensitive surgery and an approach to think about that that takes into account the patient's condition, the characteristics of the patient, and the risk factors they might have, either for having COVID disease or acquiring COVID disease, and looking at things like the resources that we had in the hospital as we were entering the surge phase of the COVID pandemic, where we can to have ICU beds, where we can have the teams necessary to provide care and these sorts of things.

So all of that went into an equation to help us sort out and prioritize which medically necessary time sensitive surgical procedure should be done first, and which ones could be safely postponed, and then how long could they be safely postponed.

It's interesting. It's kind of fascinating to watch the process that all of you went through to determine how to get the medical center set up correctly for the pandemic, and tremendous amount of work, tremendous amount of hours that went into that, and then, of course, treating the people that have come to us. And now the other side of the work, as we kind of get to our new normal, I guess we could call it that, is getting ready for all of the patients to come back that need help that maybe haven't been here for the past few weeks. And, again, as you ramp up for that, I can't even imagine the amount of effort that that will take, Dr. Matthews, for you to get your team ready to accept all of the folks back in here. But we're ready to do that.

We are ready. And we're doing it in a slow and thoughtful way, again, using the system that we introduced. It's now actually been widely adopted around the country and endorsed by the American College of Surgeons, among other groups, for how to prioritize which operation should be done first. We have, as you can imagine, many, many patients waiting who had put off their scheduled operations, and now we have to start to bring those back in just as thoughtful a way as we initially went about postponing or rescheduling them.

Perfect. So we're already starting to get questions from our viewers. And I want to get to as many as possible over the next 25 minutes or so. If you do have questions, just make sure you type them in the comments section. We'll try to answer as many as possible. Dr. Shah, this one is for you. Even though I'm not sick or having major problems, I want to stay on top of my health, what's the safest way to interact with my health care team during this time?

Yeah, that's a really great point. In this time period, we may sort of have the tendency to think, let's avoid the hospital, let's avoid interacting with my health care team unless I'm really sick or it's an emergency. And as you alluded to earlier, people are postponing care that they'd normally be receiving right now. And one of the really important things that's come out of this in a very fast way is the establishment of virtual visits.

There's a lot of situations where you can get a very appropriate level of care by virtually interacting with your health care provider, your doctor and the care team, and it's important to engage and continue to stay on top of your health, and that might simply be preventing worsening of conditions that are currently well controlled. And so that's really important to continue to use the health care system, stay in contact with your doctors, and we're well positioned to continue doing that right now.

Yeah, I think you can't stress that enough, that we want to take care of patients across the continuum, so we can do the virtual visits, or the telehealth, or video visits with folks that may not need to actually come into the facility, but folks who need more serious care may need surgeries, of course, we can, depending on what they need, we can certainly take care of that as well. More questions from our viewers. This one is from a viewer who is asking, how closely and often are you testing hospital staff? My husband is having an orthopedic surgery in mid-May, and we're concerned as to whether or not it's a smart idea. Is it more risky if you have to stay overnight? And I'm not sure which one of you want to take that one.

Well, since it's dealing with a surgical procedure, maybe I'll take a crack at it. If working with your doctor, with your surgeon, you've come to the decision that it is reasonable to move ahead with your operation, there's a lot of precautions that we put into the process of getting ready for your operation. We are now routinely testing patients before they have their surgery to see whether they might be an asymptomatic carrier of the COVID virus.

We are not yet routinely testing all of the health care workers, although that is coming. But we know that with the universal masking policy, and the social distancing, it's still quite safe to have your procedure. But, again, these are factors that go into the decision. And to the earlier question about video visits, that's why it's become very easy to just check in with your medical team via video visit to ask these questions, is it time for me to think about having that procedure, or is it time for you to see me in person for my medical condition?

As Dr. Shah says, a lot of the questions, and a lot of the uncertainties about timing can be sorted out in a video visit. The technology is incredibly easy. I'm actually a terrible Luddite when it comes to this, and I've learned how to use video visits, and I've been astonished at how easy it is as a provider, and in a strange way, how personal the interaction is between the patient even though we're on a screen facing each other.

We've all gotten used to this now. And we can have that conversation. There's no blanket rules about it. It's really in the context of what is your condition, what is the procedure that's being thought about, what's the situation in your hospital, in your region, whether you're here in Chicago, or whether you're in a different city, or you're in a suburb, or a rural hospital, all those things factor in to deciding whether the time is right to think about moving forward.

And it's interesting to note, too, one of the things that UChicago Medicine, I think, has done quite well, the big building that we use, which is The Center for Care and Discovery, the CCD, that building was built a few years ago, and we have negative pressure rooms that are used-- negative pressure floors, actually-- for our COVID cohort units. And what that means is basically it's a negative pressure in the room, and that air is taken out of the room, it's filtered, and then is exhaust from the hospital, which makes it even safer for the people in the hospital, and keeps, I believe, and you, too, can certainly talk more about this than I can, but it makes it even safer for the patients throughout the rest of the hospital. And, also, the COVID patients are in one specific area, so it's a very, very safe place to be. And I just can't stress that enough.

More questions from our viewers. This is one. I'm going to have a procedure at a hospital in New York, and was told I would not be tested automatically when I got there, should I be? How can I know for sure that I'll be safe when I go into that hospital? Hey, Dr. Shah, you want to try that one?

Yeah. I think the guidelines on these have evolved, and some of this has been based on the capabilities, the actual testing capabilities of each facility. But here at University of Chicago, we have the capability, we have the capacity to do the testing, and our policy is now that we are testing everyone before they have procedures done before they go to the operating room, including those patients that may be asymptomatic. Now, does that change how we approach patients? Not necessarily.

Everyone is going to still take the same precautions, because we know that there is a significant portion of patients who may not have symptoms and still be positive and be able to transmit the virus to others. And so we're taking all of those full precautions. But the testing is being done as part of our policy before any OR procedure, or even outpatient procedures.

Another question from a viewer. What if I have autoimmune disease, and my annual visit to UChicago Medicine is next month, along with tests? Do I wait a couple of months? I feel fine. Hey, Dr. Matthews, that might get back with your video visit comment a few moments ago.

One of the things that we've learned during COVID is that there is no substitute for the conversation between a patient and their physician. And these video visits really facilitate that. It's easy to send these video virtual visits, and be able to have your family members in the room, and chat altogether, and have all the questions answered. It's very difficult to make generalizations. And this is exactly why a virtual visit before you come to the hospital is a good idea, to figure out whether conditions on the ground, as it were, is exactly appropriate to make that trip to the hospital, have that conversation with your doctor.

To the earlier question about the New York hospitals, it's going to vary from state to state, from region to region, testing availability, and how many patients are in the hospital at one time that have COVID, how well the hospital's able to do with isolating the patients who have COVID disease from patients who don't, all those factors go into the decision. It's individual.

Great. And here's one specifically aimed at you, Dr. Matthews. It says, I'm scheduled to have cataract surgery in May. Dr. Matthews, where does this type of surgery fit in the priority of surgery, and how long might it be postponed?

Surgery-- I'm not an ophthalmologist, so I would expect that the patient should talk to their ophthalmologist. But, in general, cataract surgery would be closer to what we would imagine as truly elective surgery. There's really nothing urgent about it. There are eye procedures, say, for a patient who has glaucoma that may be more urgent and time sensitive, but cataract surgery, in general, is less time sensitive than many other types of procedures. So that's the type of procedure that would certainly be postponable. In the state of Illinois, Governor Pritzker has set a directive that a facility shouldn't be doing elective surgery until after May 11th, but even after May 11th that is the type of operation that may be less time sensitive and easier to reschedule.

Another question from a viewer, I have multiple myeloma, I have an appointment next month for blood work at the lab, will they be taking appointments at the lab, or will it just be us sitting around in a crowded room and waiting? And that's a tough one to answer. But, Dr. Shah, I think you can probably take a shot at that one, if you will.

Yeah. The lab, like a lot of other places, we have changed the configuration, taken away chairs in the waiting room to make it as easy as possible to socially distance. We're trying very hard not to even have very many patients wait in the waiting room. We'll take them directly back. We'll ask them to-- if there's a scheduled time for an appointment, you come at that time, and we'll get you back as soon as possible right away, so that you're not staying in the waiting room.

And I think another important point is you brought the point up that in the hospital itself we've designated certain floors, entire floors, that are negative pressure for patients that we know that have COVID and are under investigation. The same is true for the ambulatory center for the outpatient building. We have a designated space where patients that we know who have the COVID, who have tested positive, or who have symptoms concerning for them, they are seen in a completely separate space, that's done to really minimize the potential risk of exposure to other patients and staff.

And I think that's a wonderful point to bring up, because I know we're even doing that also in our emergency department. We question the folks as they come in, and they basically triage the people as they get to the door, and have different spots for people who potentially have COVID versus people who do not. So every effort is being made to keep the patients very, very safe here. And, again, I like what you said earlier, Dr. Mathews, this is one of the safest places you can probably be right now, and it's probably safer than if you're maybe even going out shopping. So another question from a viewer, and this is about virtual visits, the virtual visits are great, how do follow-up tests work, for example, a need for a blood sample? And either one of you can take that one, please.

Yeah, I can take a stab at this one.

Great.

So we are evolving a lot in the way that we're learning how to manage these. To Dr. Matthew's point, earlier, and as we've been emphasizing, there's a lot that you can accomplish with virtual visits directly. As a primary care physician, I've been seeing a lot of my patients the last several weeks on video visits. And there's something very satisfying about that personal contact, and seeing the faces of my patients, and being able to reconnect. And you're right, there's times when there will be some follow up required.

For now, we are, much the same way as we're doing with everything else, we're prioritizing what's needed right now, what's essential right now, whether it's a test, whether it's an x-ray, whether it's a CT scan, blood work, and in many cases, we can actually put it off, or for a little while, it's completely appropriate to postpone it for a couple months. If there's something that does have urgency, that there's an immediate need, like I said, our radiology department is ready to safely deliver the tests that are necessary, the lab stations are ready to safely do that. We have infusion centers. And it's really been thoughtfully laid out and reconfigured to make sure that the patients who need the care are given that care safely.

So a quick follow up to the virtual visits, or the video visits, Dr. Shah, how does somebody go about scheduling something like that? And what kind of things do they need to prepare for to make sure that it works?

Yeah. So a great question. We're going to be ready, our call center, the main number, the appointment line is taking appointments and scheduling video visits, they have been for the last couple of weeks. Starting tomorrow, our primary care practices, and our women's care practices will be taking appointments online, so you can, as a patient, you can directly schedule an appointment by going onto My Chart, which is our patient portal. And within about two weeks, by the middle of May we'll be offering direct scheduling for most of our ambulatory practices, for our outpatient practices, to schedule appointments.

Ways to really make the most out of these visits, you want to find a good quiet space, you want to find some private space where you won't be interrupted. All you really need is a smartphone. You can use a computer. Laptops work great, because they have webcams built in, or a desktop computer with a webcam, a tablet works perfectly well as well. And you want to make sure that you have things, the questions that you have in mind already, just write them out in advance, keep your medications with you, so that you can review your medication list, make sure you and your doctor are on the same page.

And as someone alluded, as Dr. Matthews alluded to earlier, you can invite, with video visits, you can invite family members, loved ones, caregivers, to join in, video conference in, even if they're not in the same place as you, which is a nice advantage of this. So it's quite easy. And it can be a very helpful visit to have.

And John now put up the address there, the web address, which is, of course, UChicagoMedicine.org on the screen, and 888-824-0200 is our phone number. We'll put that up throughout the show as well. But we're trying to make it as easy as possible. There's an instructional video on the website as well that gives you some clues as to what to look for. Dr. Matthews, another question from a viewer, are mammograms, colonoscopies, considered to be essential?

That's a great question. And we are working through the answers to those questions. Really, as we speak, the medical community is trying to figure out what's the time sensitivity of screening procedures. In general, most screening procedures, if you were supposed to have an annual procedure done, and it happened to fall during this period of time, those things can be safely postponed. It may be a month, it may be two months, those can generally be safely postponed. But it's important that we get back into a regular schedule on that.

Again, the answer to the specific viewer's question depends upon where they are, what city, and what community, how affected has the community been by COVID, how overwhelmed or not are the medical systems and hospitals there, what are the existing state rules about that. In Illinois today, we're not really thinking about screening mammography, or screening colonoscopies being done right now because the governor still has a stay at home order, and that would be considered less time sensitive than other types of procedures. So I think in the state of Illinois, those things are being pushed off towards the June and beyond time frame. But we will start to catch up with that.

And if there is a specific reason why a screening exam should be done sooner rather than later, that's a good reason to have that conversation with your doctor. And here at University of Chicago Medicine, we have the ability to do those on a limited basis for patients who have a particular reason why it needs to be done now. We probably are not thinking about doing those in general [AUDIO OUT].

So, Dr. Matthews, what kind of procedures have your team been doing? What kind of things have you been seeing?

We have been focused almost primarily on things that are medically more urgent and more time sensitive than not. And as I mentioned earlier, Tim, we created very early on in this pandemic a system, one of my colleagues, Dr. Vivek Prachand, developed, in collaboration with our team here, a system to prioritize medically necessary time sensitive surgery. And so the types of procedures that we have been doing throughout the pandemic, far fewer than we would normally be doing, maybe only about 15% of the typical amount of operations that we are doing, are things that absolutely need to be done.

There may be a specific reason why a cancer operation needs to happen now, or perhaps somebody has a cardiovascular disease, like an aneurysm that's growing, that needs to be performed now. So those types of procedures have been what we've been doing, whereas the less time sensitive things have been postponed.

Yeah. So, obviously, the most important message that we're trying to get out here is, if you really do need something done, of course, consult with your physician, but we're certainly open for business to take care of those things, because we don't want people to suffer, and we don't want people to not do well, obviously. And this is actually a comment from a viewer, but this is a nice one, we like this. They said they've had three telehealth, or video appointments, and they were all terrific. So it's nice that these are going well.

And you gentlemen both have mentioned that you've done these, and they've worked well. I guess another advantage is, if you're a patient, you don't have to wait, you're at home, in the comfort of your own home doing this, and maybe that-- I don't know-- Dr. Shah, if you can comment on this-- but maybe that makes people a little more comfortable even during the appointment.

Yeah, I think it certainly does. And I can say, as a primary care provider, it's also nice to get a little bit of a snapshot into people's homes. And they've been able to involve family members more. And certainly, during this time, we really want to minimize how much people leave their homes. The safest place to be overall is home, if it's at all possible. And so it does help us in a lot of ways to minimize the trips that people have to make to leave their home and still get the kind of medical care that they need.

Fantastic. Gentlemen, we're about out of time. I want to give you each an opportunity to kind of leave our patients with a parting thought. And Dr. Shah, we'll start with you. And, Dr. Matthews, we'll have you wrap us up.

Sure. I think this is a really challenging time for everyone, but we've evolved very rapidly. And I think our approach to health care has been no exception to that. I think there's a lot of positives that can come out of this. And I think even as we do return to a sense of normalcy, it will look very different, and medicine will look very different. And so I think one of the benefits will be the ability to interact with your health care teams in new and innovative ways that can be very productive and very helpful to help prevent the need to use the hospital, and the need to use the emergency departments.

Dr. Matthews, any closing thoughts?

No, I would say, thank you for hosting this, Tim. It's a pleasure to be here. I would just say that this has been an unprecedented time for all of us, including us here in the hospital, and all of the health care workers. We're really grateful to our team, our surgical residents, our medical residents, our emergency room team, the whole staff that's been here at UChicago Medicine throughout.

For our viewers, it is important to continue to get medical care beyond the care that's needed for COVID itself. And while some of those types of care could be safely postponed, eventually we need to make sure that people can get what they need. And now is the time to be reengaging with your physician, reengaging with your health care team to find out what the next steps are, what's the right timing, what should be done in the interim, and how do we continue to move forward to provide the care that you need for you, and for your family.

That's really, really wonderful advice and well put. That is all the time we have for the program. We'll have another At The Forefront Live tomorrow at 11 o'clock central where our physicians will discuss what may be the new normal, how we can be as safe as possible as restrictions begin to be lifted, and how quickly we can safely interact with our friends, our family, and our co-workers. That's Friday at 11:00 AM central time. Please remember to check out our Facebook page also for future programs and helpful health information.

Also, if you want more information about UChicago Medicine, take a look at our website at UChicagoMedicine.org. You need an appointment? Give us a call at 888-824-0200. And you can schedule that video visit also by going to the website and learning more about it. Thanks, again, for being with us. Hope you have a great week.