MINNESOTA HEALTH CARE ROUNDTABLE
SCOTT: Will this ever end? Is it really as bad as “they” say? Is your faciliuty
safe for my condition? DEEPTI: For us too. “Doctor when will this be over” is the most common
question from my patients. Unfortunately I have no clear answer for this. A lot of them delay care, essential screening tests and elective surgeries in anticipation that this will all be over soon. We have to explain to them that what with the numerous ebbs and surges we cannot tell when there will be is an end date and that they hould continue to seek care as usual.
and Washington State, which allowed “elective procedures” to take place in settings that didn’t draw from vital PPE or decrease hospital capacity to treat COVID patients. RUTH: There are risk variations depending on what the procedure might be- we need to establish priority – what should be first? There is no need for premature panic. It is important to maintain both the safety of the general public and risk mitigation in serious illness. SCOTT: We must make clear that free-standing
JESSE: We have recently begun an outreach
program in working directly with the Minnesota Department of Health. We assist people with disabilities to learn how they can receive COVID testing throughout the Metro area. People ask questions about what they can do to protect themselves, to mask-up, to practice social distancing and have the information they need in order to receive testing. RUTH: We have not received questions from
patients. Most of the questions we have dealt with were from physicians, primarily retirees asking how they could help and if they needed waivers for exam requirements. VICTOR: Some of my patients did well, with
In absence of clear regulations it is important for us to be concerned with potential abuses.
work-from-home conditions reducing their stress, stabilizing their routines, and improving their own capacity for self-care. Others found themselves coping through overeating, stressed by an overexposure to news and social media, and unable to exercise outside their house. As time has gone on, some adapted and others did not, falling into depression and loneliness. Without an end in sight, patients are asking me when they will be able to hug and touch loved ones, to trust the space between them and those with which they make family, community, or business. What lessons should be learned from the Governor’s executive orders around the ban on elective surgeries?
KIT: The prohibition wasn’t limited to “surgeries” and also included
“procedures” like imaging. Additionally, everyone had a different definition of “elective” since the order was written in such a broad and vague manner. As the order dragged on, it became more and more difficult for providers to discern what procedure was “elective” and what was emergent. For example, a patient experiencing chronic cramping and pain was referred to us by a gastroenterologist. This imaging could have been dismissed as an “elective procedure”, but we proceeded with the scan which revealed an abnormality in the colon. Subsequent emergency surgery indicated early stage colon cancer. The patient’s cancer was removed, which spared her from chemotherapy and a colostomy. Had we waited to see the patient until the order was lifted, she could have had metastatic disease and a far more dismal prognosis. Unfortunately, we have a number of examples of delayed care that have resulted in long-term negative health outcomes and families that are suffering the consequences. In the future we should look to other states, like Texas
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APRIL 2021 MINNESOTA PHYSICIAN
—Ruth Martinez
surgery centers do not pose a threat to inpatient care or ICU beds. We must recognize the critical role they can play in an overwhelmed health care system. We must establish clinically based and mutually accepted definitions of “elective”. There are differences between what is urgent or emergent versus elective with medical necessity, versus purely for screening or cosmetic reasons. Also, “elective” refers to timing and scheduling of a procedure, but it does not mean the procedure isn’t needed. Finally we must identify interim steps between “survival” shutdown mode and “all clear” that can be activated during future executive orders. Interim steps would recognize that there are dangers to postponing all procedures within a broad category. Deferring care for one to two weeks might be acceptable for some patients, but a continued postponement can ultimately be harmful when those same patients are deferred longer.
DEEPTI: At the time the initial executive order was released it seemed to be the right call, the problem is all “elective” surgeries cease to be elective after a period of time-someone dealing with knee pain and needing an elective knee replacement cannot suffer for months just because elective surgeries are cancelled. Similarly surgeries for work up of cancer etc., which are elective in nature, can only be delayed for finite periods or else they can lead to catastrophic consequences.
What are the biggest issues you see around the COVID vaccine? JESSE: We need to continually provide health promotion with
information about the importance of well-being, clear information about why vaccination is important and assure that information is accessible to all. In addition, we must think about preparing and responding to the needs of communities and populations over the arc of the pandemic. We have to also think about continuity of services, supports, resources and responsiveness to high-risk populations over a longer view of time, that follows the arc of the pandemic, beyond 2021. SCOTT: There are many issues. Distribution/vaccination based upon
categories of need (elderly, congregate facilities, health care workers….). Maintianing adequate supply for the all populations, the costs of purchase, distribution, vaccination. Dealing with deniers and how to document when a sufficient percentage of a population has been vaccinated to move towards pre-COVID activity are some of these issues.
