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

·7 min read

Jun. 6—Movies, concerts, ballgames, proms, weddings, birthday parties, air travel, work conferences, even funerals: The list of activities we missed over the past 15 months seems endless.

Don't forget medical care.

After the pandemic hit in the spring of 2020, worried patients canceled or postponed annual physicals, lab tests, surgical procedures and preventive screenings. Hospitals canceled elective surgeries, and many physical and mental health providers switched to telehealth.

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

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

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

"Orthopedic offices are going like gangbusters right now," Potter said. "It's all those individuals 50-plus who put off orthopedic surgery that they knew they needed — knees and hips."

Dr. Carolyn Claussen, a family practitioner at Willowbend Family Practice in Bedford, said that when COVID-19 hit last year, "We literally canceled everything, and only did telehealth visits."

"We couldn't do physicals, routine stuff because you need to actually do a physical exam as part of that," she said. "We did what we could over the phone."

With hospitals shut down, "No one was getting their colonoscopies, and no one was getting their breast checks, because we didn't think it was safe for them to come in."

"I personally think people use almost any excuse to not do their colonoscopies," she added, laughing.

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

"People are feeling safer now that they've gotten vaccines," she said. "So we are getting back on track."

Claussen worries about her patients whose chronic health conditions may have worsened because they didn't come in for routine monitoring. Others may have developed health issues that went undiagnosed.

She is especially concerned that people skipped cancer screenings.

"So we're missing the opportunity to catch cancers, number one before they become symptomatic, but also number two, we're missing the opportunity to get them when they're really small, when they're more easily treatable, when there's a higher cure rate," she said.

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

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

"They didn't want to go into a clinical setting and have these procedures," he said.

But that, Rollo said, could lead to delayed diagnosis, which can mean cancer has progressed by the time it's discovered and has to be treated more aggressively.

"Missed screenings are missed opportunities," Rollo said.

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

That's why Claussen advises any patient who hasn't been vaccinated but who is overdue for a mammogram to schedule the mammogram first.

Sometimes patients balk at screenings, saying they feel fine, Claussen said. "That's the point," she tells them. "We're supposed to get it before it makes you not feel fine."

"If you do the colonoscopy and we find a polyp and take it out, we've prevented a cancer," she said. "That's not just finding a cancer when it's more treatable; that's truly preventing a cancer."

Are the kids all right?

Erik Shessler, a pediatrician at Dartmouth-Hitchcock Manchester, said young children may have missed important immunizations over the past year, and providers are working hard to get them caught up.

Shessler, president of the New Hampshire chapter of the American Academy of Pediatrics, said things are beginning to "normalize."

Parents are calling to schedule the regular check-ups their children missed, he said.

"I would say that there is a fair amount of catch-up that we're still doing," he said. "Families are much more comfortable coming in, which is fantastic."

He thinks the transition back to in-person school without any outbreaks of COVID has helped calm fears.

"People were a little bit nervous that the sky was going to fall," he said. "Then the sky didn't fall."

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

"You decrease your population's rate of vaccination and increase the chances for flares of these other illnesses," he said.

"I don't want to trade one pandemic for another."

Shessler's other concern about delayed pediatric care has been the missed opportunity to check in with his young patients' emotional and mental health.

"The past year and a bit has been extremely trying for parents and children," he said. "We're seeing a lot more struggling with anxiety."

He also worries about developmental delays, something pediatricians look for during regular physical exams.

"A lot of areas of developmental delays have better outcomes the earlier they can get identified," he said.

A dental care backlog

Some people who put off 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 had to close in March 2020 except for emergency care. They reopened that May under new infection control protocols that meant seeing 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 to catch up, Auerbach said. "The number one complaint we've heard from patients is they just need an appointment," he said.

Dental offices turned out to be extremely safe over the past year, he said, with zero cases of transmission of COVID-19 reported nationwide.

"Oral health is part of your overall health," Auerbach said. "So it is very safe to go back to your dentist, and it's also important."

Health-care providers say it's time to catch up on those missed appointments.

"We recognize how difficult things have been, whether it's with remote school, whether it's with not being able to do the usual routines people are comfortable with," said Shessler, the D-H pediatrician.

His message to parents: "We're here, we're safe, we're open and we're ready to help out."

The Cancer Society's Rollo urged people to schedule those overdue colonoscopies and mammograms. "Preventative screenings help to 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 kind of feel much more protected, much more safe in going to visit their doctor," he said. "That's what we're really trying to work on this summer, to get those immunization rates up as high as we can."

Family practitioner Claussen's advice: "Call your doctor."

"Get your physical, and if you can't get your physical for a while, at least get your routine lab work and your routine screening studies," she said.

"We have been through so much with this pandemic, and I think a lot of us have found that family and friends are important," she said. "You really have to take care of yourself so you can continue to be there to take care of your family and see your friends and get life back to normal."


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