Originally Posted by
datlas
I noticed a very interesting trend in office visits comparing my office and a sister office a few towns over.
My office is in a college town/county seat, and most patients are college educated/white collar. The sister office is in a post-industrial town (the steel mills are all shut down) and more blue-collar.
Our patients are generally NOT wanting to come in for regular visits, more than half are cancelled. And the patients who are sick don't want to come in and want us to diagnose/treat over the phone. We are seeing VERY few patients in the office.
The sister practice is still quite busy, patients are coming in for physicals/routine office visits and sick visits too. I am guessing that it's a demographic issue. It's good for the sister office economically, but maybe not so good for their population as a whole.
I am trying to convince the majority of my patients to do telehealth visits whenever possible. If in-person necessary (like say a physical) I am willing to see those patients now but also fine to postpone routine annual physicals a few months. I am leaving that decision up to the patients (for now).
We are trying to limit our cases to urgent and emergency things only, but our clients can’t distinguish.
Yesterday I saw a blind Pug as an “urgent” case. The dog had lost her vision over about 6 weeks until she went completely blind around 3 weeks ago. From her neurologic exam, the problem could have either been with the retinas (in which case she needs an ophthalmologist) or the optic nerves (in which case she needs to see me).
Questioning the owner further, she already saw an ophthalmologist who “did some test where they put her in a dark room and flashed laser beams into her eyes and then the machine spit out a graph.” Not laser beams but that would be an ERG, the test which would tell us whether it’s a retinal problem or not. What did the test show? “I don’t know”. What did the ophthalmologist tell you? “I don’t remember.”
Jeez so I call the ophthalmologist who is excellent and I know personally and who not only would never fail to explain a diagnosis to a client but who would always also provide a written summary. She’s in surgery but gets on speaker phone to talk to me- flatline ERG, definite retinal disease, weird diagnosis that she spent 3 hours discussing with the owner, zero idea how this owner got the idea that there’s an urgent need to see a neurologist.
On Monday I saw an “urgent” probable diabetic neuropathy in a 19 year old cat who I kid you not has had nothing more than a single spot blood glucose in a year and a half, and that was 450 mg/dL six weeks ago. Go back to the prescriber of your insulin and get a glucose curve please.
So this will be our problem in trying to limit our caseload at all. We can’t tell over the phone- sudden blindness from neurologic causes would indeed be a life threatening emergency, whereas already-diagnosed ophthalmologic blindness is not. Incoordinated gait and trouble walking would be an urgent problem, but we’re not likely to do much with that in a poorly regulated diabetic until someone at least makes a stab at figuring that out and correcting it.
The vet school at Univ of Wisconsin has shut their hospital down completely because someone who works there was dx with COVID19.