Before the pandemic shut down military treatment facilities, family members struggled to get timely medical appointments. Continuity of care was a concern, and appointments before 7 a.m. flew off the calendar. Now with almost 18 months of appointments overdue, how are providers prepared to handle the increased demand, and what can military family members do to help?
Virtual appointments helped solve some problems, particularly when they were simply for referrals. And these appointments still can work in some instances. But have you tried conducting a well-child visit for a 4-year-old over the phone? It doesn't work.
“[There’s] nothing quite like the face-to-face doctor's appointment for many of our medical conditions and, to be honest with you, for many of our ancillary pick-ups,’’ said Dr. Brian Lein, the Defense Health Agency assistant director for health care administration.
Lein said many patients come in for one medical condition, then say, “While I'm here, can you look at ...?” That's how a lot of things are discovered.
Because of this, Lein encourages military family members to check whether they can make an in-person appointment for the things they have put off during the COVID-19 pandemic.
What Appointments Do You Make First?
Parents and military spouses usually put everyone else ahead of them. So if you have multiple kids or feel like you are healthy and don't want to "waste" an appointment on yourself, it can be a tough call.
Lein suggests asking yourself: Who really needs to be seen in person first?
“For a woman, if you're within the parameters of somebody who needs a mammogram or needs a cancer screening, obviously that can't be done on a virtual visit,” Lein said. “The first thing that we should look at is, what can we do from a virtual perspective, versus what needs to be done with a direct face-to-face, hands-on visit? And if there is an ability to do it virtually or do it remotely, we can do that, and I would prioritize that for now.”
Then look at the timeline and necessity. With some schools mandating physicals or immunizations, school-age kids returning to in-person classrooms should be seen before classes begin.
If you have a medical condition that isn't life-threatening but needs to be checked, such as diabetes or hyperthyroidism, then you need to come back in, Lein said.
“Because probably what we did is, we said, ‘All right, you're OK because it's not life-threatening and it's not something that's going to be critical. And we'll extend your medications for another six months,’” he said.
But if you're asymptomatic, were good until COVID-19 hit and haven't crossed a critical threshold -- like 50 years old to get a mammogram or colonoscopy -- you're probably OK to schedule your appointment after those who need to be seen right away, Lein said. But it's still a good idea to get an appointment on the books -- maybe in the fall when things hopefully settle down.
Are the Providers Ready for Us?
After almost 18 months, a lot of people need to see a provider. Coupled with summer PCS season and back-to-school physicals, that's a lot of demand on what is a fixed supply of providers and appointment slots. At some installations, it was hard to get an appointment before the pandemic. So how do family members convince someone to schedule an appointment even if nothing is apparently wrong?
Lein suggests using all avenues available to make appointments, including Tricare Online and calling in. Admittedly, things vary between military treatment facilities -- which is something they are trying to standardize -- but the process is improving.
“We're piloting new programs where you only have one phone call that you have to make, and that person will then make all of the appointments that are necessary for you,” Lein said. “And so that's going to be of incredible value.”
Lein said appointment spots are opening on Tricare Online three to six months out. He added it is not 100% guaranteed that all installations and facilities are opening these appointments this far out, but they are working on it. He acknowledged that it's unacceptable for patients to hear, “Well, no appointment this week; you got to call me back next week,” and they are working hard to make the response, “Here's what we've got within the next 90 days, within the next six months, in the following primary care and specialty care clinics.”
Plans on how to handle the post-pandemic demand on appointments have been in the works since November 2020, and so the managed-care support contractors -- things such as specialty care, labs and X-rays -- are prepared with additional capability to meet the demand.
What Does the Doctor Need From You?
When preparing for your first doctor's appointment post-pandemic -- or the first one you take your child to -- Lein suggests doing a little extra prep work.
“I would just make sure that you bring in anything that was done during the COVID pause,” he said.
Examples include anything that was treated by urgent care, another physician not under military care, the emergency room, etc. Lein specifically mentioned that if you received a COVID-19 vaccination from another provider or program that you make sure to bring that vaccination card to your appointment so your records can be updated.
“And I would think about and go through your body and say, ‘All right, what changed from my body from before I came in to where I am now?’” Lein said. “Focus on the areas that are concerning or keeping you up at night. Are you sleeping the same? Are you dealing with additional family stressors? Did you go and see behavioral health? Did you go and see somebody else? Were there other life issues that impacted you that you need to talk about?”
Don't forget about the social aspect of your life, either. Did your family have enough food to eat? Did your exercise habits change? Did you spend the last year sitting on your coach, working on the laptop instead of at a desk? These things can affect your health and should be noted. Take a full inventory before heading for your appointment.
And when it comes to your children, you are the expert. Parents are going to recognize changes in their children before providers are, especially now that they've been around them all day, every day for more than a year, Lein said.
“We are open and we want to see you, and I don't want anybody to take no or that, ‘We're too busy,’ for an answer because we're not,” Lein said. “We want to get our population back in, seen and cared for, to help get some of these previously undiagnosed diseases.”
“Or to reassure you that, ‘Hey, you've been doing all the right things during COVID and you've been a great mom and a great spouse and a great supporter, and continue doing what you're doing and everybody's doing fine.’”
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