It was early spring, about the time the novel coronavirus was spreading like wildfire in the US Northeast. Fear was keeping some ill people at home, unwilling to risk a visit to a doctor, especially if the health problem appeared to be mild.
That's what happened to a patient of obstetrician-gynecologist Dr. Maria Sophocles, who directs Women's Healthcare of Princeton, New Jersey.
"I have a 61-year-old female who noticed spotting in March just as Covid was exploding in New Jersey," Sophocles said via email. "It was a small amount and it was brownish so she figured it was nothing and forgot about it."
The spotting reappeared in the fall. This time, the woman made an appointment and came into the office to be examined. An ultrasound found an abnormally thick lining in her uterus, which required a bioposy.
"The tissue came back with endometrial cancer," Sophocles said. "Had she come in March we could have diagnosed her 7 months sooner!"
A drop in patient visits
A national survey by Kaiser Family Foundation, released Wednesday, found that 54% of obstetrician-gynecologists surveyed had seen a decrease in patient visits since the epidemic hit in March -- most of those doctors believed it was due to fewer patients seeking care.
While the survey showed telehealth visits rose in some areas during that same period, many doctors felt it was more difficult to provide "reproductive preventive care and manage chronic gynecological conditions" during the Covid-19 pandemic -- and were concerned about the impact on their patients' health.
"At least six in ten OBGYNs reported being very or somewhat worried about delays in contraceptive care, prenatal care, follow-up care for abnormal pap smears, STI treatment, and obtaining an abortion," said the survey, which collected responses from early July to the first of September from a nationally representative sample of 855 office-based OB-GYNs.
A rise in telehealth in some areas
Before March of this year, 86% of the OB-GYNs surveyed said they did not conduct telehealth visits as part of their practice. By June, the survey found that number had completely flipped, with 84% of the doctors now conducting telehealth visits.
But the use of virtual care was not evenly distributed. Age, gender and geographical location appeared to play a role in the adoption of telehealth services. Older doctors, male OBGYNs and doctors in rural areas were least likely to move to virtual visits when compared to their younger, more urban counterparts.
"About 1 in 4 OBGYNs practicing in rural areas, small practices and in states without Medicaid expansion reported no telehealth use," the survey found.
Nor was the adoption of telehealth smooth and without complaint among those who did go virtual, the doctors said.
"Almost all reported some sort of challenge related to delivering care via telehealth, including limitations in conducting a physical exam, patients having difficulty using telehealth, and the inability to conduct diagnostic testing," the survey found.
Sophocles, a specialist in menopause and sexual dysfunction, sees that in her practice as well.
"Telemedicine has been a wonderful way to safely and conveniently conduct consultations but as a gynecologist there are certain conditions which require an exam," she said.
"I can often help with a telemedicine visit, but if there is a breast mass or bleeding after intercourse or abnormally heavy periods or bleeding in a postmenopausal patient or a miscarriage -- those issues must be dealt with in person," she added.
The survey found almost all OB-GYNs reported using in-person visits for certain contraceptive services and testing for sexually transmitted diseases.
"Half reported prescribing hormonal contraceptive pills via telehealth, but very few are utilizing telehealth for sexually transmitted infection (STI) testing, or for providing instruction on self-administered contraceptive injections or intrauterine device (IUD) removal," the survey said.
What to do
It's important that a woman stay up to date with screenings, tests, vaccines and other necessary care, especially if pregnant, according to the American College of Obstetricians and Gynecologists.
Women can go ahead with these appointments, "with appropriate safety measures in place at the health care office," the association states.
Before your appointment, ask the doctor's staff about the precautions they are taking, including masks, social distancing or limiting the number of people at the clinic or office.
"It is important to wear a cloth face covering or mask, stay at least 6 feet away from other people when possible, and keep your hands clean. Talk with your ob-gyn if you have questions about how to stay safe," the statement said.
Other precautions include:
- Notice when you touch something -- the office pen, a chair -- and then wash your hands with soap and water for at least 20 seconds or use hand sanitizer with 60% alcohol before or after touching any surfaces in public areas, such as in the waiting area.
- Be especially careful about frequently touched surfaces, such as doorknobs, elevator buttons and touch pads during your visit.
- Keep your hands away from your face, including your eyes, nose and mouth.
- Keep your mask on at all times. If you cough or sneeze, do it into the mask.
- Minimize your time in the office -- ask if the staff can bill you or use touchless mobile pay options.
- Try to get three-month prescription refills to reduce the need for return visits to the doctor -- or the pharmacy.