Tele-medicine and tent clinics help doctors do their jobs

A tent has been set up in Pasadora Place to allow doctors to screen patients with respiratory symptoms.
A tent has been set up in Pasadora Place to allow doctors to screen patients with respiratory symptoms.

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The doctor will Skype you now…

Doctors across the Cayman Islands are changing the way they do business in an effort to keep themselves and their patients safe.

Some have closed their doors for anything except emergency situations.

Others are consulting with patients over WhatsApp or Skype.

Several practices have set up tents outside their offices to segregate patients with respiratory symptoms from those with everyday ailments.

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At Pasadora Place on Friday, 20 March, the glass-panelled doors of various medical centres were plastered with printed notices advising visitors of the new protocols.

Dr. Joseph Marzouca said he aimed to keep his practice open as long as possible. He is asking patients with coughs, colds or breathing difficulties to report to a tented consultation room outside the office.

If they have travelled overseas or have symptoms consistent with COVID-19, he refers them to the Health Services Authority. Other patients are seen inside the clinic by doctors in protective wear.

Marzouca said staff had been working non-stop over the past few weeks and the practice may need to reduce hours.

‘Doctors are human, too’

Marzouca said he understood why some clinics were closing their doors.

“Doctors are human, too, and if they feel it is a difficult situation, they may want to close up,” he said.

“It might well be a good thing that a few doctors stay home. If we all go out there at once and everybody gets sick, that could be a bigger problem,” he added.

At Cayman Clinic on Crewe Road, patients are being directed to call a triage number.

The phones are manned by Dr. Heidi Fahy, who is in isolation herself, at home, after returning from a trip to the UK on Sunday, 15 March.

She screens the calls and decides which can be dealt with over the phone, via WhatsApp, and which require an in-clinic appointment with a doctor.

“We are discouraging routine appointments and trying to manage as much as we can on the phone,” she said.

Cayman Clinic’s Dr. Heidi Fahy works from home, in self-isolation, with patients over her computer.

By isolating herself from her colleagues and patients beyond the required 14 days after travel, Fahy said she could stay healthy and serve as a ‘reserve doctor’ so the practice continues to have capacity if any of its other doctors get sick or need to be isolated.

Extra precautions

Dr. Virginia Hobday, also of Cayman Clinic, said patients were being seen by appointment only to avoid congregation in the waiting room. When there is a backlog, she said, patients had been willing to wait in their cars.

She is taking extra precautions to keep herself safe and working by isolating from family members.

“I don’t eat with them, we don’t share the same bedroom or bathroom, we see each other outside,” she said.

Tele-medicine is helping doctors serve as many people as possible, but it comes with financial implications.

Some doctors say that insurers have not been willing to cover consults over Skype or WhatsApp that are not directly related to COVID-19.

That’s a problem for many practices, said Dr. Philip Buys of International Medical Group.

“We are doing tele-consults to ensure we are not exposed and to ensure we are not creating high-risk environments for our patients, so it is COVID-related even when it is not,” he said.

Buys, who is 60, said a lot of doctors on the island fell into the ‘at-risk’ age group for COVID-19 but, more crucially, so do many of their patients. He said it was important that health professionals did not become vectors for the virus.

“It is not about what it means for me; it is what it means for the people that come to see me,” he said.

Annikki Brown, chair of the Standing Health Insurance Committee of the Cayman Islands Insurance Association, said doctors were covered for some phone consults unrelated to COVID-19 through the Standard Health Insurance Contract.

“We are mindful of protecting our vulnerable in Cayman who have underlying conditions by preventing them from having to go to the doctor’s office for renewals of their prescriptions,” she said.

There are various conditions attached to the use of tele-medicine, and if and how much doctors can bill for their time. Brown said these had been sent out to all medical practices in the Cayman Islands.

She added that telemedicine should not be used as a “business continuity plan” for doctors, however.

Emergencies only

Dr. Eugene Foley has closed his eye clinic on Smith Road for routine appointments, though the emergency service continues.

“We shut down for routine cases and we have cancelled all non-urgent elective surgeries from last week Friday (13 March),” he said.

“A lot of our patients are elderly, and it would be a disaster for them if they were exposed to the virus.”

He said he would be dealing with emergencies on a case-by-case basis, but the large majority of procedures and surgeries in the schedule could be safely postponed. Essential sight-saving eye injections will continue uninterrupted under conditions carefully managed to reduce risk to patient and practitioner.

Foley said social distancing must be observed as completely as possible by everyone in Cayman and hr is not sure that is yet happening. He believes tele-medicine can help doctors avoid face-to-face contact and allow elderly patients to get the care they need without risking social interaction at a time when it could put them in grave danger.   

He also cautioned everyone to be more careful in daily life to prevent avoidable accidents and illnesses that might land people unnecessarily in emergency departments. Since the closure of schools, he said, there had been a noticeable increase in leisure-related issues that have needed emergency treatment.

Other practices made announcements on their Facebook pages or web pages of reduced hours or appointment procedures.

Seven Mile Medical Clinic is only seeing emergency patients, but remains open for telephone consultations. Royale Medical and Wellness Centre remains open but recommends anyone with a cough, fever or shortness of breath to call before coming in. The centre is also operating a round-the-clock tele-medicine service.

Dentists and vets also impacted

Dentists are also closing their doors for all but emergency cases. A spokesman for Strand Dental said elective appointments and check-ups were being cancelled.

Many vets remain open but with protocols in place to segregate humans in the waiting room. There is no current evidence that dogs and cats can spread the virus.

Jennie Boyers, manager at Island Vets, said the practice was taking precautions and cancelling routine surgeries, but remained open and available on the phone for emergencies.

Full coverage: Coronavirus

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