April 10, 2020 -- Coronavirus has put our lives on hold. We've postponed graduations and weddings, canceled concerts and corporate meetings. And many of us have had to put off elective surgery and screening tests.
Hospitals have delayed these services to protect healthy people from the virus and to save medical equipment and supplies for those who do have it, as doctors of all stripes have been pulled into coronavirus duty. Social distancing has forced doctors to reschedule routine checkups and other medical visits or to move them to telemedicine.
Waiting for a health service you need can be an anxiety-producing experience. It's normal to wonder how the delay could affect your health. Whether to wait, and for how long, will depend on your need for medical care.
Elective doesn't mean that you don't need the surgery. It just means you can schedule it for a later date because your life doesn't depend on it. Knee replacements and cataract surgery are examples of elective surgeries.
Some elective surgeries, like nose jobs, can easily wait. Others are a little trickier, like gallbladder surgery for gallstones.
"Once you have that, it's a time bomb. If you don't do something and the stone moves, you can get an infection. You could get a blockage in the bowel. That's an emergency," says Rafael A. Lugo, MD, owner and CEO at Lugo Surgical Group in Shenandoah, TX.
A wait won't affect the outcome of many elective procedures. But in some cases, it could change the type of surgery you need.
An injury that gets worse could turn an arthroscopic surgery into an open one with a bigger incision and a longer recovery time. A cataract can thicken with time, making it harder for the surgeon to remove, says Yuna Rapoport, MD, an eye doctor at Manhattan Eye and assistant clinical professor at Mount Sinai. "It's a more challenging surgery."
If you live with daily pain or other symptoms, even a non-emergency surgery can feel urgent. "I have difficulty reading and I can't drive," says Richard Zimmer, who's had to put both cataract surgery and hernia surgery on hold. "I had to cancel my membership at my golf club, which makes me sad because it's what I love to do."
"If you're that person who can't sleep at night, can't walk, can't help at home, can't work -- in your mind, that would be a time-sensitive situation," says Brian Cole, MD, associate chairman and professor in the Department of Orthopedics, and managing partner of Midwest Orthopaedics at Rush University Medical Center in Chicago.
Postponed Screening Tests
Mammograms, colonoscopies, and other screening tests detect cancers early, when they're easiest to treat. Although most tumors grow over a period of years, not months, there's always a risk that delayed tests could give an aggressive cancer time to spread.
That's especially worrisome to people like Lynda Williams, who's had to put off a mammogram and a genetic test for colon cancer. Colon and breast cancer both run in her family. "It makes me feel uncomfortable. It makes me wonder if something was there right now, I'd be screwed," she says. "It's not a good feeling at all."
"You do worry about not detecting a mass [lump] in the breast or a polyp in the colon because screening was delayed," says Steven Woolf, MD, MPH, professor in the Department of Family Medicine and Population Health at Virginia Commonwealth University. "By the time the cancer is detected, the cancer may have progressed."
Your doctor will weigh the risks against the benefits when deciding whether you should get screened. But if you have symptoms, waiting probably isn't an option. "Then we're not talking about screening," Woolf says. "For example, if they start seeing blood in their stools or they find a lump in their breast, they shouldn't postpone asking about that."
You also shouldn't wait to get tests for chronic diseases that could cause complications, like poorly controlled diabetes, high blood pressure, or heart disease. These conditions "can easily spin out of control if they're not managed," Woolf says.
You may be able to put off a non-essential doctor visit or test without any problems. But in an emergency, every second counts. For each minute that a stroke goes untreated, 1.9 million brain cells die. Waiting just a few extra minutes to go to the hospital could lead to long-term problems, or even death.
Yet the fear of catching COVID-19 could make you pause before you call for an ambulance. "People may be afraid to go to the emergency room," Woolf says. A stroke or heart attack is a bigger risk than coronavirus, he adds. "When minutes matter, it's best to call 911 and explain the situation. They can walk you through what to do."
What Happens Next?
After so many Americans have put off doctor visits and surgeries, what happens when social distancing finally ends? Will doctors face a huge backlog of people who need care?
Just as people start to come in for their missed appointments, there could be fewer doctors available to see them. For one thing, primary care doctors have been called in to hospitals to help with the rush of coronavirus patients. Plus, the economic toll of not seeing patients for several months could force some doctors to close their offices for good.
Whether you'll have to wait even longer to see your doctor because of these factors isn't certain. "That's one of the many lagged effects of this pandemic that we can try to predict, but we won't know until it actually happens," Woolf says.
What to Do Now
If you're anxious about waiting for a doctor visit, screening test, or surgery, talk to your doctor, says Joshua Mansour, MD, a hematologist/oncologist in Los Angeles. "Discussing the various options, bringing forward the risks versus reward, and understanding why a recommendation is made should help ease some of the anxiety regarding the new plan."
Telemedicine is one way your doctor can see you now. At one of these remote visits, you can get advice on how to manage your pain and other symptoms until you can visit the office in-person.
You might try home remedies like ice or heat to ease pain, or take pain relievers. Audrey Aronow manages her knee pain with a rub-on pain reliever and activity adjustments until she can have knee replacement surgery. "I have to do less and not stress the knee as much," she says. "I certainly don't want to risk getting that virus."