I'd like to thank Paul Orloff for allowing us to use this as a forum to share concerns, solutions and advice as physicians and business owners in the face of the pandemic. In concert with NYSOS Im hoping we get to share a lot of information. If you have some free time look through the website and buy the book!!
First Id like to share some questions that we can all comment on -also and Ill add a few links for which I thank Aspasia Draga and Robin Pelligrino
This Covid 19 is becoming an issue
I hear plenty of info but no real hard and fast data
I don't have hospital parent giving me guidelines or rules I'm forced to follow -so how are we handling this???
a- have you restricted access- ie are you not seeing routine care
b- do you screen all patients walking in? if so how?
c- how do you clean rooms between patients? what happens when you run out of chlorox or other wipes?
d- do you wear a mask? even better do you have or can get masks???
If we are ordered to shut down (the webinar below addresses this question but not fully)
1- do you still pay staff? it could be a month!
would you have them use up vacation and sick time?
Salaried employees with no revenue it becomes an even bigger issue
2- will you still see emergencies?
3- Most importantly will you remove all sharp objects from your house to prevent your significant other from killing once you are at home constantly?
any other questions you'd like to hear?
two helpful links below- the second an arts and crafts project that will help distract you
https://www.youtube.com/watch?v=X6IsfWdFtHY&t=36s A 30 minute webinar as to how to handle office staff/closure and legal aspects associated with covid
https://www.youtube.com/watch?v=wvnx_KIUE9A a quick easy slit lamp shield
Thanks to all
Peter Menger MD- be smart-practice safe ophthalmology!
If telemedicine is of any interest, the new standard is Zoom. It is free, powerful but simple to set up and most of its features you don't need. Like having the patient in front of you on a full screen. No pressures or AC evaluation, but it is the best hand we are being dealt.
We are doing the same. One doctor in the office per day with minimal staff. We see emergencies and urgent patients only. Have done facetime telemedicine since we don't have any other viable options. Love your idea of keeping hospital ID in case of lockdown
sorry email plmmd@aol.com (yes aol -Im old- if im sequestered I promise to be an adult and engage outlook)
Update for today
-reduced to minimal staff only seeing emergencies
-working on telephone and facetime telemedicine- not optimal but certainly better than nothing
-having my webmaster place a banner on my webpage that will update patients as to office status - telling patients this when calling and putting it on the phone message
-cancelling all routine appointments but when doing so they are logged - seems once you cx an appointment on our software it disappears- need to know who to call once we're back on line
-hard to decide what to do with flashes and floaters - any retina groups staying open
-i heard theres a call to register physicians (retired or active) to be mobilized if this get much worse- anyone know the link?
-also bring you hospital ID home (dont leave it clipped to your white coat at work)it may be needed to move around the city if theres a lockdown and you need to get to the office or hospital
-finally - i treid to post to this blog directly from my iphone I cant seem to get it to work. On a laptop it does once you create a log in. I know people tell me they posted but I dont see them. If youd like to add to this email me and Ill put it up.
-keep safe!
I dont know if anyone is following this blog, please comment and let colleagues know your plan.
Not all asc's have closed some remain operational - Surprisingly enough patients were anxious to proceed with their elective surgeries that were scheduled for tomorrow, its very fluid and the center administration decided cancelling anyone over the age of 70 or with comorbidity.
I am only seeing post ops and emergencies and routine care has been restricted. Also trying to manage patients over the phone though suboptimal. Does anyone have a telemedicine ophthalmology option?
My next issue will be the inevitable economics of prolonged office closure, here i'd like to get feedback.
Found this in my closet to wear over my scrubs today. 35 years hold!
Finding it difficult to do any eyecare w q tips alone- gloves it is. Im findng the patients who come in for routine visists are quite cavalier (if there not here for an emergency) and this makes them the people we need be most cautious with.
Just heard from Eric Donnenfeld he informed me OCLI and its ASC have closed for all but emergent care
Seems people having difficulty commenting - send me your comments plmmd@aol.com and I'll post
Aspasia Draga writes
My practice consists of four MDs
Screening on the phone has already been implemented for exposure or illness.
Hand sanitizing and screening again when pts arrive.
Breath shields for the slit lamps have been made and we have ordered acrylic ones. Probably will wear masks this week.
We have reduced our volume/ schedule so that the waiting room can comply with social distancing. there will be one doctor and limited staff to cover per day of the week.
Ambi center has not cancelled cases but we have contacted and offered elderly patients to postpone.
We will await if we are mandated to cancel elective cases
Anxious to hear all of your ideas
Stay safe and healthy Soula
I've had feedback in regard to sending people to the ER and the attendant risk of sending them to a greater risk environment as well as overburdening an already stressed system. I fully understand this but know my staff and facility don't have the capacity to handle potential high risk patients, I don't even have an n95 mask nor can I get one. Given telemedicine/ophthalmology seems an option but picking out a foreign body or pulling a lash needs to be hands on. Please let me know if Is there a telemedicine option or a practice capable of managing patients outside the ER. Im sure there will be compassionate liability issues but a facetime call with a close up of a red eye could be an issue, if misdiagnosed.
In regard to cancelling elective surgery - I have a number of cases in two days and the free standing ASC I use has as yet not restricted elective cases. I've been in contact this morning with the owners and the CDC has not advised them they will be used as Covid site as yet. They were told to continue operations.
I understand ENT associates ( a major 39+ office group) has stopped elective surgery system wide.
I have no information on telemedicine
Thanks for the useful information, Peter. Are you via NYSOS or anyone else working on a possible tele- Ophthalmology platform if this crisis or challenge is prolonged?
Also as my office is not physically equipped to handle Covid patients Im thinking I need to refer anyone who has cold/fever and conjunctivitis (or any other eye emergency) to a Northwell facility or general ER