Reflections On Providing Podiatric Care During The COVID-19 Pandemic

From a personal standpoint, the coronavirus has been very stressful on many levels. Professionally, it is challenging to provide the care patients need and balance the safety guidelines put forth by the government. Also, running a practice with a close-knit office team means properly handling everyone’s stressors. Making sure they are protected is my utmost concern. Our doctors and team are like my family. It can be stressful on everybody. There are the obvious financial concerns from an extreme drop in patient flow and office visits. We know that there will be hard times but it is for the greater good. 

There are grave concerns for ourselves, our families, friends and colleagues, doing our jobs nobly while risking our own health. Personally, focusing on protecting one’s family as best as possible while still doing one’s job is extremely stressful. We come home from work and immediately get into the shower in the hope that we won’t spread the virus. The required social distancing creates unknown stress for a lot of us and every time we turn on the television or Internet, there is nothing but bad news.

This is unlike anything we have experienced. We as physicians need to grab the flag and march forward, providing care based on the oath we took years ago. I am proud and happy to do so, but it is a great amount of stress.

We made adjustments in our office for the past couple of weeks, rescheduling any non-emergent appointments. We are still seeing our postoperative patients, diabetic foot ulcerations, infections and fractures. We are attempting to keep as many patients out of the hospital and emergency room as we can. I think that is our responsibility and role as physicians and surgeons in private practice. 

What Unique Challenges Have Emerged With The COVID-19 Crisis?

One of the more unique challenges is properly maintaining appropriate separation while rendering care and maintaining the safety of my team and the other physicians in my practice. Making sure our communication is effective, trying to navigate multiple offices and nursing homes, and executing surgical requirements is a tall order. Also, as a hand-shaker and an Italian, social distancing is extremely tough for me.

Patients remain in their cars to avoid sitting in our waiting room. Patient scheduling is extremely spaced out to limit contact. My team is wearing personal protective equipment and we are checking the temperatures of each patient. I have run into issues in finding masks as well as cleaning products. I almost bought cleaning wipes that would normally sell for less than $2 for $19 a bottle. Fortunately, my staff has appropriately stocked hand sanitizer. Patient volume is down drastically so we do not require as many products in our office at this time. Prior to patient appointments, we go through the recommended questionnaire in regard to symptoms, exposure and travel. Patients are required to bring their own masks and I wear a mask and eye protection. 

A fair amount of my patients do not require telemedicine. We are rescheduling patients who require routine care. I think it is important from a practice standpoint to reschedule, not just cancel these appointments, in order to avoid losing these patients to follow-up.

That said, I cannot express how happy I am that insurance companies made the decision to allow telemedicine service coverage. It is very helpful for a lot of patients for both diagnosis and treatment. Being able to electronically prescribe medications and utilize video evaluation to properly diagnose as best as we can are very helpful. I think the patients appreciate it. Usually after finishing my 15-minute visit, there is a five-minute chat about life, the coronavirus and how people are doing personally. I have really gotten to know my patients even better.

Final Thoughts

People are scared. It is a new world that we live in now. When patients with more urgent lower extremity issues come in, they want to receive care but these patients also just want to talk. There are a lot of medical questions, some of which I can answer and some that I cannot. However, I think the most important thing is not only administering care but also being a caring physician, and listening to people’s problems.

Dr. Pagano is in private practice in Plymouth Meeting, Pa. He is the course director of Pediatric Foot and Ankle Orthopedics at the Temple University School of Podiatric Medicine. Dr. Pagano is the Vice-President of the American College of Foot and Ankle Pediatrics, and the on-air expert for Spenco Medical on QVC.