Putting off medical care can lead to worse outcomes, providers say | Health

Movies, concerts, ball games, proms, weddings, birthday parties, air travel, work conferences, even funerals: the list of activities we’ve missed in the past 15 months seems endless.

Don’t forget medical care.

After the pandemic hit in the spring of 2020, concerned patients canceled or postponed annual physical exams, lab tests, surgical procedures and preventive screenings. Hospitals canceled elective surgeries and many caregivers switched to telehealth.

Now, two-thirds of New Hampshire residents eligible for COVID-19 vaccines have received at least one dose, and 56% are fully vaccinated, the state’s health department said.

It’s time to call your doctor, health experts say.

James Potter, executive vice president at the New Hampshire Medical Society, said care has declined across the board during the pandemic. But that’s starting to change as patients feel more comfortable entering medical offices, he said.

“Orthopedic offices are going like gangbusters right now,” Potter said. “It’s all those 50-somethings who put off orthopedic surgery they knew they needed — knees and hips.”

dr. Carolyn Claussen, a primary care physician at Willowbend Family Practice in Bedford, said when COVID-19 hit last year, “We literally canceled everything and only made telehealth visits.”

“We couldn’t do physical, routine things because you have to do a physical exam for that,” she said. “We did what we could over the phone.”

Now that hospitals were closed, “Nobody got their colonoscopies and nobody got their chest checks because we didn’t think it was safe for them to get in.”

“Personally, I think people use almost any excuse not to have their colonoscopies,” she added with a laugh.

But there’s no excuse now, and patients are starting to return, she said.

“People feel safer now that they’ve had vaccines,” she said. “So we are back on track.”

‘Missed opportunities’

Claussen is concerned about her patients whose chronic health conditions may have deteriorated because they did not come for routine checkups. Others may have developed health problems that went undiagnosed.

She is particularly concerned that people have skipped cancer screenings.

“So we miss the chance of getting cancer, number one before they get symptomatic, but also number two, we miss the chance of getting them when they are very small, when they are easier to treat, when there is a higher cure rate” , she said.

Missed cancer screenings are a major concern, agrees Mike Rollo, director of government relations for New Hampshire at the American Cancer Society’s Cancer Action Network.

A recent survey from his organization found that one in six respondents reported delays in their recommended cancer screening.

“They didn’t want to go to a clinical setting and undergo these procedures,” he said.

But that, Rollo said, could lead to a delayed diagnosis, meaning cancer has progressed by the time it’s discovered and needs to be treated more aggressively.

“Missed showings are missed opportunities,” Rollo said.

Claussen pointed out that the COVID-19 vaccine can cause swelling in the lymph nodes and axillary (armpit), which can interfere with a correct diagnosis on a mammogram. So it is recommended to wait a few weeks after the vaccination before having the procedure.

That is why Claussen advises every patient who has not been vaccinated, but who is late for a mammogram, to first schedule the mammogram.

Sometimes patients refuse screenings and say they feel fine, Claussen said. “That’s the point,” she tells them. “We’re supposed to get it before you don’t feel well.”

“If you do the colonoscopy and we find a polyp and take it out, we have prevented cancer,” she said. “That’s not just finding cancer when it’s more treatable; that is really preventing cancer.”

Are the kids okay?

Erik Shessler, a pediatrician in Dartmouth-Hitchcock Manchester, said young children may have missed important vaccinations in the past year, and health care providers are working hard to catch up.

Shessler, chairman of the New Hampshire branch of the American Academy of Pediatrics, said things are starting to “normalize.”

Calling parents to schedule the regular checkups their children have missed, he said.

“I’d say there’s quite a bit of catching up that we’re still doing,” he said. “Families come in much more comfortable, which is fantastic.”

He thinks the transition to a personal school with no outbreaks of COVID has helped calm fears.

“People were a little nervous that the sky was going to fall,” he said. “Then the sky did not fall.”

One risk of delayed immunizations in children is decreased community immunity against certain diseases, Shessler said. That could lead to an outbreak, such as the 2014-15 measles outbreak linked to Disneyland, he said.

“You’re lowering your population’s vaccination coverage and increasing the likelihood of outbreaks of these other diseases,” he said.

“I don’t want to trade one pandemic for another.”

Shessler’s other concern about delayed pediatric care was the missed opportunity to check in with the emotional and mental health of his young patients.

“The past year and a bit has been extremely tough for parents and children,” he said. “We see a lot more struggling with fear.”

He’s also concerned about developmental delays, something pediatricians look for during regular physical exams.

“Many areas of developmental delay have better outcomes the earlier they are identified,” he said.

A backlog in dental care

Some people who are delaying routine dental care during the pandemic may now have to wait for appointments.

Michael Auerbach, executive director of the New Hampshire Dental Society, said dental offices should close by March 2020 except for emergency care. They reopened that May under new infection control protocols, which meant they saw fewer patients per day, he said.

“So that created a backlog,” he said.

Most patients are now returning, and dentists are working extra hours to try and catch up, Auerbach said. “The biggest complaint we’ve heard from patients is that they just need an appointment,” he said.

Dental practices were found to be extremely safe in the past year, he said, with zero cases of COVID-19 transmission across the country.

“Oral health is part of your overall health,” Auerbach said. “So it’s very safe to go back to your dentist, and it’s important too.”

Healthcare providers say it’s time to make up for those missed appointments.

“We recognize how hard things have been, whether it’s remote schooling or not doing the usual routines that people are comfortable with,” said Shessler, the DH pediatrician.

His message to parents: “We’re here, we’re safe, we’re open and we’re ready to help.”

Rollo of the Cancer Society urged people to schedule those overdue colonoscopies and mammograms. “Preventive screenings help save lives,” he said.

The New Hampshire Medical Society is working with AARP on a campaign to encourage people to get vaccinated and resume routine medical visits, Potter said.

“Once people are vaccinated, they feel much more protected, much safer to see their doctor,” he said. “That’s what we’re really trying to work on this summer, to get that vaccination rate as high as possible.”

Advice from GP Claussen: “Call your GP.”

“Get your physical, and if you can’t get your physical for a while, at least do your routine lab work and your routine screening studies,” she said.

“We’ve been through so much with this pandemic, and I think many of us have found that family and friends are important,” she said. “You really need to take care of yourself so you can stay there to take care of your family and see your friends and get life back to normal.”

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