Safe to the doctor

The annual check-up, the appointment with a specialist: many doctor's appointments are set months in advance. And now there is this pandemic. Should I still sit in the waiting room?

It has been a good year since the corona pandemic reached Germany. The first lockdown not only emptied the streets of the city centers, but also the waiting rooms of many doctor's offices. Compared with the number of patients in the previous year, there was an average of 23 percent burglaries in the practices of general practitioners, specialists and paediatricians as well as psychotherapists from April 1 to 28, 2020. This is shown by data from the Central Institute for Statutory Health Insurance in Germany (Zi).

In April and May 2020, significantly fewer patients attended appointments in the practice with a doctor or psychotherapist than in the same period last year. Pediatricians and specialists recorded the greatest decreases. From the end of May, the numbers rose again in all areas, and patients apparently made up for visits to the doctor.

© W & B / Dr. Ulrike Möhle

Dentists in particular suffered from the pandemic

“On the one hand, many patients were afraid of an infection. On the other hand, the practice teams were also unsettled. For example, there was a lack of protective materials, ”explains Dr. Heribert Brück, cardiologist and press spokesman for the Federal Association of Resident Cardiologists (BNK). The doctor's offices needed time to adjust to the new situation.

This is also reported by Professor Dietmar Oesterreich, Vice President of the German Dental Association. Dentists were hit particularly hard by the pandemic: According to a survey by the association, there was an average drop in work of 50 percent in their practices between February and April 2020. This is hardly surprising, says Oesterreich: "The place of infection in the body and our effective area - the oral cavity - are not far apart."

Hygiene concepts have a positive effect

In the meantime, however, various studies have shown that the risk of infection in the dental practice is very low, says Oesterreich: "The already high hygiene standards were further strengthened under pandemic conditions."

This is also the case in general and specialist practices. Hygiene concepts were established and employees were equipped with protective equipment, so that the number of patients rose significantly from the end of May. According to Brück, evaluations from cardiological practices for the entire year 2020 show: "The situation has normalized again for the rest of the year from mid-April."

Even at the beginning of the second lockdown in December, there was only a small decrease in the number of patients. However, not all of the examinations in the practices have been carried out to the same extent as before the pandemic.

Take symptoms seriously

The medical societies appeal to patients to keep their doctor and dentist appointments and not to postpone them. "Otherwise there is a risk that diseases will not be discovered or that existing diseases will worsen," warns Professor Martin Scherer, President of the German Society for General and Family Medicine.

Private lecturer Dr. Sebastian Ewen, medical director of the central emergency room at the Saarland University Hospital. Together with other researchers, he found in a study that during the first lockdown nationwide around 30 percent fewer patients presented to the central emergency rooms than in the same period of the previous year. Above all, people with supposedly harmless illnesses stayed away.

"In addition, significantly fewer patients with heart attacks, strokes and pulmonary embolisms came to the emergency rooms," reports Ewen. Like other doctors, he had actually expected the opposite scenario: "Viral diseases such as Covid-19 or the flu promote vascular occlusions and can trigger events such as a heart attack."

Various studies indicate that many patients ignored their symptoms or sought medical help after a delay during the initial lockdown. An analysis by the Ulm University Hospital shows that heart attack patients often came to the clinic too late and that there were more complications than in previous years.

One in the magazine Clinical Research in Cardiology The data analysis published by the Hessian health authorities also shows that eight to twelve percent more people died from diseases of the cardiovascular system than in the previous year.

According to a nationwide study in the trade journal Stroke In the phase up to May 15, around 18.5 percent fewer stroke patients were admitted to the hospitals than in the same period of the previous year. At the same time, stroke mortality has increased.

The reason is that many patients were admitted with already severe symptoms and thus a poorer prognosis, according to the authors. The concern that this could repeat itself in the second lockdown does not seem to have been confirmed based on initial findings. “The numbers here fell a little towards the end of the year, but by no means as much as in spring,” says Ewen. This is currently still being analyzed.

Consequences for cancer therapies

An analysis in Oncology Research and Treatment. Accordingly, there were fewer inpatient cancer treatments during and after the first lockdown than in the same period in 2019. This is based on data from 75 facilities in the Helios Clinic Group. The decrease in inpatient admissions for cancer diagnosis or therapy was on average 10 to 20 percent.

Oncologists and hematologists in private practice, on the other hand, recorded an increase in the number of patients who received cancer therapy between April and June. "Based on these data, we suspect that we were able to accommodate some of these patients," says Professor Wolfgang Knauf, Chairman of the Professional Association of Resident Hematologists and Oncologists in Germany. Overall, there were no break-ins in outpatient therapy for cancer patients.

It is different with preventive and early diagnosis examinations: Breast cancer screening, for example, was suspended for two months. "This is a safety investigation on a mostly healthy person," says Knauf. Postponing this for two months is not so problematic. Because the medical practices are now well equipped and patients there do not have to fear infection, experts appeal to visit them again regularly. Knauf: "The earlier you recognize a malignant tumor, the better the chances of recovery."

In the practices of resident cardiologists, the decline in patient numbers was limited to the period from mid-March to mid-April 2020. After that, they returned to normal. The downward swings are holidays

© W & B / Dr. Ulrike Möhle

Video consultation hours are becoming more popular

When personal contact between doctors and patients was limited, video consultation hours boomed. Between the beginning of March and the end of June there were over a million doctor visits via video chat, compared to a few thousand in the previous year.

General practitioners and psychotherapists used this option most frequently. "As a result, medical care for people with mental illnesses could be absorbed quickly," says Dr. Christa Roth-Sackenheim, board member of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology.

"Sometimes patients even tell me more intimate things than when I am sitting across from them." Older, less internet-savvy patients were more likely to use phone calls. One drawback: group therapies are currently not allowed to take place via video.

Meanwhile, most patients would rather come back to the practice, says Roth-Sackenheim: "Many want face-to-face contact." For many mentally ill people, the pandemic is very stressful - especially for people who are difficult to deal with stress.

In psychiatric clinics, it took about three months to adapt to pandemic conditions, according to Roth-Sackenheim. In some cases, there were stops in recording. “The clinics are now well equipped and have developed effective hygiene concepts.” During the second lockdown, they would have admitted around half of the usual number of patients.

Further analyzes must shed light on the exact consequences for the care of different patient groups. However, the pandemic brought something positive with it: hospitals and medical practices are now better equipped for future crises.

Keep your appointments as close as possible

For fear of contagion with the coronavirus, many patients avoided doctor's offices during the first lockdown. The practice teams first had to adjust to the new situation.

Hygiene concepts have now been effectively implemented. The medical societies appeal to patients to attend treatment and preventive appointments. This is important so that diseases can be recognized and optimally treated.

Contribute to organized processes

Many practices have now set up appointment consultation hours instead of open consultation hours. This is to prevent too many people from meeting each other. Patients should call ahead and arrive on time about five minutes before the appointment.

Observe the hygiene rules

Patients should adhere to the well-known hygiene rules: when entering the practice, disinfect their hands, sneeze into the crook of the elbows, keep their distance from others and wear mouth and nose protection.

Everyday masks are often not enough. In many federal states, a medical face mask is compulsory in medical practices. (As of February 1). These include surgical masks, KN95 and FFP2 masks. In Bavaria, FFP2 masks must be worn. Please note the current regional regulations.

This is what you can expect in practice

Practices such as clinics have taken many precautions to minimize the risk of infection. For example, disinfectant dispensers are set up at the entrance, and the reception area is separated by a pane of glass. The practice rooms are regularly ventilated and surfaces disinfected. Wearing mouth and nose protection is compulsory.

Distance rules also apply. Markings are drawn on the floors, the waiting rooms are not fully occupied. If it is easily possible for patients to attend the appointment alone, they should forego accompanying persons.

Call the practice first if you have cold symptoms

Anyone who has a doctor's appointment but suddenly feels cold symptoms should call the practice beforehand. The next steps are discussed over the phone. For example, whether a corona test is necessary or how treatment can still take place.

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