Elective Medicine and the ‘New’ Normal

Even as the private practice is preparing to reopen, the coronavirus threat continues to demand precautions for aesthetic physicians trying to get through the pandemic healthy, financially secure and with hope for when quarantine and social distancing are no longer needed.

But the question for now remains: When the COVID-19 restrictions lift, what will your practice look like?

Members of the American Society of Plastic Surgeons (ASPS) recently released a statement clearly outlining an action plan of how to reopen the practice safely when there comes the call to open the doors.

Understanding Local Statistics

While the decision to reopen lies with leaders of local or state governments, ASPS recommends researching the persistence of COVID-19 in your local communities. While some areas are seeing a decrease in cases overall, including associated deaths and admittance to the ICU, other areas are not. Knowing the numbers could mean the difference between being able to reopen safely or not.

In a recent interview, St. Louis, Mo., facial plastic surgeon Laxmeesh Mike Nayak, M.D., says while it’s important to follow direction provided by national societies, it’s equally important to have discussions with other local multi-specialty practices.

“At least we’ll know where we stand relative to one another, and maybe open each other’s eyes a little bit,” he says.

It is also necessary to look at the availability of testing in your area, along with the type of test being used, according to the statement.

RNA/PCR and isothermal nucleic acid amplification tests “demonstrate the presence of viral participles, which are present in both symptomatic and asymptomatic individuals who are infected with the virus, and throughout the period of time when an individual sheds virus,” according to the statement, and have reported sensitivities to be as low as 60% to 70%.

In comparison, Serology tests (IgM/IgG) only report whether COVID-19 antibodies are detected, via a finger prick. The tests, allowed by the U.S. Food and Drug Administration (FDA) under emergency, have not been formally evaluated, so quality and reliability are unknown.

These factors should be considered when welcoming back patients due to the rate of people unable to be tested, even when they do show consistent symptoms.

Amy Foreman Taub, M.D., Glencoe, Ill., founder and medical director of Advanced Dermatology, says that when the doors do open, it’s all about putting plans and protocols in place for the safety of both patients and staff.

Social Distancing

Contact between staff members and patients in the practice is an inevitable. To help, Dr. Taub has created a process to minimize waiting room traffic and is tracking who on her staff is helping specific patients.

“… it will be difficult to distance ourselves in patient encounters,” she says. “We have been checking people in by cellphone as they wait in their car and may continue to do this. We are also limiting certain staff per hallway and office (2 offices, 4 hallways) so that if anyone gets ill, we can quarantine those in that hallway/office.”

Dr. Nayak says he’s also going to have his patients wait for their appointments in their cars, instituting a text message check-in process.

“We will be instituting a text message check in, [having them] wait in the car,” he says. The practice will then send a text message summon to come inside where they will answer a health questionnaire, wash their hands, have their temperature checked, then escorted directly to a room.

Unlike Dr. Taub, he notes that he has a luxury of space in his practice that works for social distancing.

“We are blessed with 24,000 [square feet] of office space,” Dr. Nayak says. “We will occupy each 4000 [square foot] segment with no more than 10 people — counting patients and staff — at a time.”

To help with this, Drs. Nayak and Taub are also seeing fewer patients per day.

PPE

Along with social distancing measures, both physicians note that their staff will be wearing masks, along with other personal protective equipment (PPE) and adding physical barriers when possible.

“We have purchased plastic shields for the reception and exit desks to shield our staff from secretions,” Dr. Taub says. “We have also gotten cotton masks with a pocket and are putting cutouts of the blue paper we wrap our instruments in before sterilizing them in the autoclave over a procedure mask, in an effort to be able to reuse the procedure masks we have. They will each receive two so that they can launder it in hot water overnight.”

They also urge patients to wear masks if possible.

“We are going to require masks...” she says. “If they don’t have a mask, we are discussing whether to give them one of our cotton ones since we can launder them.”

Minimizing the Spread

Both staff and patients will have their temperatures checked upon entering the office, along with being asked about any potential exposure to someone diagnosed with the virus, Drs. Taub and Nayak say.

“If we can get a reliable test that can have a result within a few minutes, we will purchase those and perform them on every patient and staff member,” Dr. Taub adds.

It is recommended that patients come to their appointments alone, according to ASPS, unless they are accompanying a minor to an appointment, to minimize potential spread.

Once a patient leaves the exam room, Dr. Taub has added a block of time to sanitize, specifically, “a 10-minute block after each patient to allow for additional deep cleaning measures.”

Above all, Catherine Maley, aesthetic practice management and marketing expert, says to be clear with patients on what to expect before they come in for an appointment.

“Tell them exactly what to do: cancel if you don’t feel well, leave [the] kids at home, bring a mask, text us when you are in the parking lot and wait for us to respond, you will be tested when you enter the building. Spell it out.” she says.

Virtual Consultations

Now that virtual consultations have become the standard of current and post-COVID care,

Maley suggests using the tool as a way to communicate with patients for pre- and post-op care, noting that patients may actually prefer it that way.

However, she says, make sure that the process for consultations is the same online as it is in person.

“Now that the door has opened, you’ll have patients demand it because they prefer to communicate this way or they’re busy and this saves them time,” Maley says. “Be sure your processes are the same virtually as they are in person, so you are more likely to convert that consult all in one session.”

“For example, the coordinator calls ahead to pre-qualify them and pre-frame the physician as the best choice, the surgeon meets with the patient to talk clinically and then the coordinator gets back on to fill in the details and close.”

Dr. Taub says she’s hoping to implement virtual consultations in this way for her own practice.

“We are working on this as we speak,” she says. “We do think that [virtual consultations] will be an important aspect that will continue into the future. Also, it may be very good for ability to check in with patients after procedures to ensure safety as well as optimal healing.”

The fee for these virtual consultations vary based on location and local governmental guidance. Regardless, Maley says that during the pandemic, she suggests not charging, at least for now.

“I think they should be free consults for now while we are still in the thick of this and patients are getting used to it,” she says. “However, once things go back to “normal,” then start charging a fee to avoid no-shows.”

While reopening the practice in this way may be less than ideal, Dr. Taub explains that right now, safety is paramount.

“It isn’t ideal,” she says. “Of course, we like to have personal interactions with all of our staff and patients, and it reduces being able to read facial expressions with masks. However, we have to put the safety of our patients and staff ahead of what is ideal.”