Commentary: COVID-19 brings a new reality for medical practice

By Dr. Michael J. Bradley, DO

It is mid-March at Dover Family Physicians; the governor has declared a state of emergency. Restaurants, bars and beaches are closed, the school year is suspended, and a stay-at-home order is mandated. The phones are backed up with patients canceling their appointments, and everyone is afraid of catching COVID-19. A pandemic is upon us!

As a primary care practice that still takes care of its patients who are admitted to Bayhealth Hospital, we have been in the thick of the medical crisis. Within a few days of the state shutdown, our team of six physicians and two physician assistants, along with our great supportive staff, began to transform the way we delivered care to our patients.

Dr. Michael J. Bradley, DO

For the first week of the crisis, our office was eerily quiet and almost empty as patients did not want to come in. Zoom! Within a few days, we were able to bring telemedicine into our patients’ homes. We had daily huddles where the physicians and staff could talk about their worries and concerns, and plan the best and safest care for our patients. We were worried about our own health and afraid to bring the disease back to our families.

Even before the pandemic, primary care physicians were undervalued and underpaid. It is one reason the state legislature has formed the Primary Care Reform Committee, of which I am a member. Just like any small business, we have fixed costs that continue no matter what. During those first few weeks, our patient visits were down 50%, and we were worried that staff would have to be laid off.

We thank the state and federal governments, along with our local insurance companies, for seeing the value of telemedicine and reimbursing our care at the same level as an in-person visit. Bayhealth has been very supportive of our needs and has maintained a safe environment there for us to care for our admitted patients.

We have risen to the challenge of this pandemic. We have not had to lay off any staff, even though our schedules are less full. Our staff quickly learned how to educate our patients to access care through the Zoom platform, and now, approximately half of our visits are via telemedicine. As the old guy in the office, having started the practice in 1983, I am not allowed to see anyone with respiratory symptoms. So, I do a lot of telemedicine visits and see my healthy patients for their follow-up visits.

Some of our staff work from home now, while others are spread out a safe distance throughout the office. We also decided that the physician doing the daily rounds at the hospital would not return to the office after, reducing potential transmission of the disease. Telemedicine has allowed us to triage and care for patients with respiratory complaints without bringing them into the office. We can safely refer patients for COVID-19 testing without risking the spread into the office. Many of our elderly patients are thankful that we can do their regular medical care through telemedicine. Those patients we do see in person are brought into a clean environment to assure them of a safe visit.

And of course, we are all wearing masks and the patients too! My hands are as dry and cracked as in mid-winter, and my glasses fog up easily with my mask. We owe a big thanks to our patients who generously made us cloth masks to wear, and brought us snacks and lunches.

It is now mid-May, and we are barely surviving, but not back to our normal busy schedules. We continue to worry that our practice of nearly 37 years will no longer be able financially to emerge from this pandemic intact. We are one of the few independent practices left standing in central Delaware and are worried we will be gobbled up by a health care system. Being independent has allowed us to quickly respond to the changes we made very early in this crisis.

None of our staff or physicians has become ill. The rate of new seriously ill COVID-19 patients seems to be declining, and the governor is beginning to relax the restrictions. However, we are not out of danger. Through upcoming community testing, we can expect more asymptomatic positive cases of COVID-19. The tracing of these COVID-19-positive patients’ contacts to prevent a resurgence of the pandemic is essential. I urge you all to continue wearing a mask when around others to reduce the transmission of this deadly virus. Until a vaccine is available, we are all at risk.

Michael J. Bradley, DO, is a primary care physician at Dover Family Physicians. He is president of Medical Network Management Services of Delaware LLC (MedNet), a member of the Medical Society of Delaware Primary Care Subcommittee, and a member of the Primary Care Reform Collaborative Committee of the state Legislature.