Elective surgeries could start slowly after Georgia’s coronavirus shutdown

By: - April 23, 2020 7:34 am

Dermatologist Rutledge Forney, right, advises patients over the internet more often these days and she might rely on telehealth more in the future. Contributed by Dermatology Affiliates

Dermatologist Rutledge Forney said her five metro Atlanta locations won’t reopen for in-person visits until June despite Gov. Brian Kemp’s green light to open as soon as they can operate safely.

“The governor can do anything he wants to do, but we feel that it’s very important to maintain an extensive social distancing,” she said. “I can’t keep my staff 10 feet apart if I’ve got a full clinic. … I can’t put people into personal protective equipment from head to toe, and if I can’t be 100% sure that everybody’s safe, we’re just going to do what we’re doing until June 1.”

Forney is treating patients primarily over the internet these days with a greatly reduced staff – she’s furloughed 75% of her employees. And she’s not the only one – 46% of physicians say they’ve furloughed staff who deliver patient care, including nurses and physician’s assistants, according to an April Medical Association of Georgia survey.

Association President Andrew Reisman said he understands the logic behind the governor’s order to reopen medical facilities. But cancelling so many elective appointments is a painful financial hardship for people who provide care for Georgians.

“Surgeons in my clinic… are seeing patients two half-days a week in their office, and they’re not doing any cases unless they’re emergent cases,” he said. “And in our particular hospital, most of the time, emergent cases are covered by the trauma surgeons. So their income is nil. They’re deferring paychecks.”

Reisman said he is concerned that reopening businesses could contribute to  the spread of COVID-19 if people are not careful to maintain proper hygiene and social distancing.

“At the same time, there’s also concern about keeping things shut down for long enough that practices go under,” he said. “The American Academy of Family Physicians projects that up to 60,000 primary care physician practices, family medicine practices in the United States, will probably be closed by June, and that’s going to be devastating to the health care needs of our country in general.”

Georgians who provide dental care are especially feeling the pinch as avoiding the spread of the novel coronavirus makes their job particularly hazardous.

The tools dental hygienists use create aerosol sprays that contain saliva, said  Pam Cushenan, assistant professor of the dental hygiene program at Georgia State University. The protective gear might not protect dental hygienists from COVID-19, she said.

“We can use a cloth barrier, maybe when we’re going to the grocery store, but when we’re working directly with patient care in an aerosol driven service, that would be very dangerous for the hygienist,” said Cushenan, who also runs an oral health training business.

The American Dental Association advises dentists to postpone all non-emergency procedures for now. The association says that dental emergencies “are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding [or to] alleviate severe pain or infection.”

Cushenan said some hygienists are assisting with these emergency procedures, and others are doing non-clinical jobs, but the vast majority are now without work.

“I would say 98% of the hygienists in the field at least have applied for unemployment, hoping and praying that it will actually start at some point,” she said. “Some are getting their $600 a week, and some are not, and it’s very much of hardship, because, just like the rest of the country, mortgages are still due, rent is still due, utilities are still due.”

Some fields are more conducive to telemedicine.

Forney said practicing dermatology online even revealed two potential cases of COVID-19. In some patients, the virus manifests as a rash that Forney said looks similar to cold-damaged skin – not something she often sees in April in Georgia. She referred two patients with the telltale rash to be tested for COVID-19.

Because the novel coronavirus could be behind innocuous-seeming skin conditions, care at Forney’s practices will look different when doors open in June.

Patients and staff will have their temperatures taken and wear masks. Rooms are to be deep cleaned between each patient visit. Patients will be screened with government public health questions before they arrive, they’ll have to maintain social distance in the lobby, and they’ll also be allowed to wait in the car and get a text when it’s time to come into the waiting room.

Forney said her doctors will continue to offer expanded online service even after the virus threat subsides.

“We know plenty of patients still don’t want to come into an office, whatever the guidelines are on a statewide basis,” she said. “People still have a choice.”

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Ross Williams
Ross Williams

Before joining the Georgia Recorder, Ross Williams covered local and state government for the Marietta Daily Journal.Williams' reporting took him from City Hall to homeless camps, from the offices of business executives to the living rooms of grieving parents. His work earned recognition from the Georgia Associated Press Media Editors and the Georgia Press Association, including beat reporting, business writing and non-deadline reporting. A native of Cobb County, Williams holds a bachelor’s degree in English from Atlanta's Oglethorpe University and a master’s in journalism from Northwestern University.