BALANCING BETWEEN HEALTH & ECONOMY IN A COVID-19 PANDEMIC SITUATION: PERSPECTIVE OF AN OPHTHALMIC PRIVATE PRACTITIONER
DR SWATI AGARWAL,
KOLKATA
NAMASHKAR!!
Now
that we have learnt and understood the importance of flattening the curve of
COVID-19 pandemic, we also need to acknowledge that there might be multiple
spikes of SARS CoV2. Health of oneself, our staff and our patients should be
our first priority.
Escalating
costs & basic running expenditure and at the same time dwindling number of patients
are adding to the economic burden of an ophthalmologist. The patients which we
postpone now – are going to become acute in near future if the lockdown
extends.
Friends, it seems we are learning and unlearning between ‘Time is Money’
and ‘Health is Wealth’!
We need to adapt to changing situations. The process for this adaptation
will depend upon the following variables:
1. Practice Type: Solo or
Group; Corporate hospital or an academic based Institute.
2. Place of surgery is
self-owned, neutral surgical center, or hospital.
3. State of practice:
-Recommendations &/or Mandates from the
local/state/central governments
-Guidance from the state or medical societies
-Whether any hotspots or COVID clusters in the neighborhood
of the practicing area
4. We work as a team and the willingness
of our team to adapt on a daily basis to the changing situations and scenarios
is important.
Action is needed now and after lockdown & crisis period:
1. Request vendors for
delayed payment of EMIs, request landlords to waive off full or part of the rent.
Call on Force Majeure clause if needed.
2. Arrange for Personal
Protective Equipment (PPE) for all the staff and doctors
3. Staff can be counseled to
work more after the COVID 19 period, maybe even a few hours on Sundays. They
can be asked to use their leave period now. The salary deduction may be
contemplated depending upon the staff level. Salary should not be deducted for a
staff with low pay and more liabilities at home. Scenario changes depending
upon how long the staff has been associated with you and their dedication
towards the center.
4. Make the best use of your
EMR, software, social media platforms in keeping the patients communicated.
Inform them about taking prior appointment bookings, mode of payment, wearing
masks and bringing nil to only 1 attendant when they come for visit. This will
also save communication time with patients.
5. Triaging patients over the phone has importance in reducing OPD rush:
a. Postpone nonessential
appointments. This also depends upon the needs of the patient, example
refraction may be essential for someone with higher refractive error, broken
specs, or even lower refractive error with active needs.
b. Planning spaced outpatient visits. Patients may be asked to wait in their vehicle outside and
enter the clinic only when they receive a call from reception as to when their turn
is about to come.
Segregate
patients on the basis of age and infective status, for example, elderly,
diabetics, refractive error patients can be called at a particular time or slot
of the day whereas infective patients like those suffering from conjunctivitis can
be called in another slot.
c. Virtual visits or
e-consultation can be done by various online platforms available or even a
WhatsApp or facetime audiovisual communication. This will reduce the number of
visits or reviews per patient. It will specifically be more beneficial for
patients residing in remote areas, elderly patients with comorbidities, and
patients with fever and cough who cannot attend OPD in person. Keep the patient name, age, video for records
and use your own judgment for reviewing or referring these patients.
6. Be medicolegally vigilant.
Do not hold down your defenses in the process of extending a helping hand. Get
a consent both from patients availing teleconsultation and from patients opting
to attend the clinic during a COVID crisis.
7. Try your best in
preventing any cross infection
a. Use of surgical masks, cap,
waterproof gowns, visors, gloves by the doctors and staff. Frequent cleaning of
hand with soap and water or 70% alcohol-based sanitizers. Staff should change
into uniform after entering the clinic.
b. Chemoprophylaxis with HCQs
for the doctors and health care staff should be considered based on individual
judgment and suitability.
Only essential
staff should be called. If any staff develops cough &/or fever, he should
be sent into quarantine.
c. Patients may be asked to
open shoes at entrance or use shoe covers. Floor, door handles, tables should
be cleaned with diluted household bleach solution/ 1%Na Hypochlorite, multiple
times of the day. The center should be kept well ventilated with as much of natural
light as possible. AC filters should also be frequently cleaned. Closed bins
should be used for disposal. UV irradiation &/or formalin fumigation of the
center may be done frequently.
d. Patients should be asked
to give proper history over the phone regarding any h/o fever, cough, contact with
COVID patient. They should maintain health etiquettes like washing hands-on
entering the clinic or using hand sanitizer at the entrance. They should wear masks and
speak only what is required.
e. Minimum waiting time for
patients should be emphasized. Avoid multiple room visits d multiple reviews of
the patients. NCT is a NO. Avoid and postpone investigations that require
contact with the patient or longer time at the clinic. Disposable applanation
tonometer if available should be used or tips should be cleaned with 1% Na
Hypochlorite or alcohol solution. Trial frames and OPD lenses like
+90D/+78D/+20D should be cleaned in between every patient. Mount screens
between the patient and doctor on the slit lamp.
Speak as
little as possible and give in writing to the patient. Maintain a distance of
>1m with all patients and staff. Reduce your OPD time.
f. Discourage patients to try
multiple optical frames. The ones which have been tried should be cleaned
before placing them back on shelves.
g. Discourage cash as a mode
of payment. Instead, plastic money in the form of Paytm, G-Pay, Netbanking,
cards should be encouraged. Else patients should be asked to give the proper amount
of bill without the hassles of change.
Most
of us have postponed our nonessential surgeries for now till an indefinite period.
But gradually the patients will lose patience. Postponing surgeries for a
longer time will only add to the financial stress of the practitioner. In an
ideal situation, any patient being taken up for surgery should undergo a COVID
PCR testing and an HRCT. Till now there have been no directives from the
government of any mandatory preop COVID testing. Given the limitation of
finances in a developing country like India, patients can be taken up for
surgery if the surgery is urgent/essential or the patient has been waiting for
surgery for a long period of time. Paramedics, OT staff should be educated and
trained accordingly. HIV kits may be used and the surgeries may be spaced out,
keeping only a few per day.
Since
we all are having some extra time now, try to make the best use of that. Work
on your website, google page, profile. Update yourself with the latest in
academics. Update all your accounts, patient details, billing, etc. Analyze
your performance over the last few years. Etc
Friends, this COVID crisis is in an Unpredictable and Volatile
situation now. Be Mentally and Financially Prepared for similar such events in the future.
As the famous saying goes, Lets Be prepared for the worst, but Hope for
the Best!