8 Medical Appointments to Make During Lockdown—and 2 that Can Wait

Many of the doctor's appointments on your calendar were postponed or canceled due to efforts to help slow the spread of Covid-19, and now many doctors and hospitals are opening up for business as usual. But which appointments should you reschedule STAT and which ones can wait?

Medical testing and doctor visits can make you anxious, even when there’s no global pandemic to worry about. Fears of Covid-19 may only add to this stress. But this is not a good reason to keep postponing needed exams, experts stress.

Yes, there are a lot of variables at play—from the Covid-19 rates in your community to your personal health history and whether you have any worrisome symptoms. Here’s advice from medical experts about which tests should be priorities, which you can wait for, and the factors that should influence your decisions.

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Appointments to make

Cancer screening tests have fallen by as much as 94 percent during the pandemic, according to new data from electronic medical records vendor Epic. This is concerning, says Matthew G. Heinz, MD, a hospitalist and internist at Tucson Medical Center in Arizona. “A malignancy starts microscopically and we work very hard to detect it when it is very small through blood testing and imaging because the earlier you catch cancer, the better off you will be.”

Well-visits are down, too, and that means people are missing vaccinations and other valuable care. Be sure to schedule these appointments if you’re due or at high risk.

Breast cancer screening

Do you need a mammogram or not? If you do, schedule it now, says Stephanie Bernik, MD, chief of breast surgery at Mount Sinai West in New York City. Facilities are taking extra precautions to minimize your risk for spreading or contracting Covid-19, she says. “If you are at extremely high risk for breast cancer, you should try and stay on track with your breast cancer screening,” she says. Women at high risk for breast cancer include those with genetic mutations such as BRCA1 and/or 2; a family or personal history of breast cancer is another high-risk indicator. Some women who are at low risk for breast cancer do have leeway in terms of rescheduling, as certain guidelines suggest that mammograms every two years can be sufficient. Continue doing monthly breast self-exams, she says: “If you feel something in your breast, come right in.”

Colon cancer screening

If you are at average risk of colorectal cancer, the American Cancer Society suggests starting regular screening at age 45. A colonoscopy is the gold standard, but there is concern that Covid-19 can spread during these in-office procedures, says Randell Wexler, MD, an associate professor of family medicine and vice chair for clinical affairs at The Ohio State University Wexner Medical Center in Columbus. “If you have a family history of colon cancer, symptoms, or a history of precancerous polyps, reschedule your colonoscopy now,” he says. However: “If you are at low risk for colon cancer and due for a screening, you can have a fecal immune test (FIT) instead of a colonoscopy.” This at-home test looks for hidden blood in your stool, which can be an early sign of cancer. “It must be done yearly and if we find blood, you will need to come in for follow-up testing.” With FIT, you use a brush to scrape samples from your stool, spread them on a test card and send this to a lab for analysis.

Skin cancer check

You should do regular skin self-exams to spot any signs of skin cancer, and your dermatologist will let you know how often you need to come in for a skin cancer check based on your personal risks, the American Academy of Dermatology says. “While we try to balance risks and benefits of almost all activities these days, skin cancer screening is very important,” says Jonathan Ungar, MD, director of consultative dermatology at Icahn School of Medicine at Mount Sinai in New York City. This is particularly true for people with risk factors for melanoma, the potentially fatal form of skin cancer, he says. “These include a personal or family history of melanoma; a history of sun exposure; having fair skin, freckling, or light hair; having many moles; and [compromised immune system].” If you check any of these boxes, reschedule your appointment now, he recommends.

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Diabetic eye exam

If you have diabetes, you need yearly eye exams to catch any vision-stealing conditions early. Traditionally these exams involve dilating or widening your eyes and using a specialized tool to see the back of your eye or retina, but newer techniques can allow for less touch and less risk of Covid-19, Dr. Crane says. “Retinal photography can be done in the same lab where you have blood drawn and doesn’t involve as much contact as the more traditional exam.”

Heart function tests

If you put off your electrocardiogram or exercise stress test, reschedule them sooner rather than later, says Evan Appelbaum, MD, a cardiologist at Men’s Health Boston, a Harvard-affiliated multi-specialty practice. These tests measure your heart’s activity at rest or during exercise, respectively, he says. “They can let us know your risk for heart disease and also help evaluate how well your treatments are working if you already have heart disease,” he says. “The benefit of having these tests now far outweighs the risks.”

Vaccinations

The lockdown due to the Covid-19 pandemic has meant delays in well-visit vaccinations. We don’t want to trade measles for coronavirus, says Dr. Crane. “If your well child is due for shots, they should get them,” she says. “If you have called ahead and the office is taking steps to reduce risk of Covid-19, you are safer there than everywhere else.” (Here are some vaccine myths you can ignore.)

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Your child’s camp or sports league physical

Many camps and sports leagues have amended their requirements as a result of Covid-19.

Find out what your child needs to participate this summer so you can schedule any visits accordingly and in time, Dr. Crane says.

You’re under the weather

You may need an in-person visit if you have chest pain, blood in your stool, severe headaches, or even Covid-19 symptoms, Dr. Gantzer says. The serious problem you have now is more important than any potential problems you may have in the future. “Don’t let the fear of something that may or may not happen outweigh what needs to be taken care of in the here and now.” She suggests calling your doctor’s office, explaining what is going on, and asking if you should come in or schedule a phone or video appointment.

Appointments that can wait

Cervical cancer screening

One cancer test you may not need to reschedule right away is your Pap test, says Heather E. Gantzer, MD, a spokesperson for the American College of Physicians and an internist at Park Nicollet Clinic & Specialty Center in Saint Louis Park, Minnesota. You are probably not all that late for these important tests since doctors’ offices were closed for non-essential visits for only a few months, she says. The National Cervical Cancer Coalition suggests getting Pap tests at age 21; if the results are normal, you can wait three years until your next one. At age 30, you can undergo a Pap test every three years, co-testing with a Pap and human papillomavirus or (HPV) test every five years or an HPV test alone, every five years. Some types of HPV are linked to cervical cancer. “Not every person needs a Pap test every year,” Dr. Gantzer says. Make sure to stay on top of your schedule. When in doubt, call your doctor and ask what tests you are due or overdue for, she adds. (Here are the 29 things doctors wish you knew about cervical cancer.)

Your routine dental cleaning

If you had to postpone your regular dental cleaning and you have no pressing concerns, it’s OK to wait it out, says Saul Pressner, MD, a dentist in New York City. “I recommend focusing at first on necessary treatments,” he says. “I believe patients are interested more in health and proper function presently, and postponing discretionary and cosmetic procedures, until they feel more comfortable that things have stabilized with the pandemic.”

You may be on the clock, Dr. Wexler warns. “We don’t know what the fall season is going to look like and if Covid-19 does have a secondary peak, it will occur during flu and strep season.” Those sicknesses could add complicating factors to anything you may need, so it’s best to get those basic things done now.

At-home solutions

Try telemedicine for yearly well-visits

Certain medical appointments can be conducted with video conferencing or over the phone, which reduces risk of Covid-19 without letting other concerns slip through the cracks. “Call your doctor’s office and say ‘I usually come for an annual visit and I am late. Should I come in-person or schedule a phone or video visit?'” Dr. Gantzer says.

Annual well-visits help your doctor stay on top of your health and get ahead of and manage many diseases, including diabetes, but most of this information is gathered via counseling and asking pertinent questions, she says. “We check vaccine schedules, ask about alcohol use, substance abuse, and depression,” she explains. If you are overdue for yours, it can be done over the phone or video, and then she can order follow up lab work such as routine blood work, including cholesterol and blood sugar, and shots when needed, she adds. If your doctor notices any red flags, an in-person visit can be scheduled.

Consider taking your own blood pressure

High blood pressure is a leading cause of heart attack and stroke, but it is silent, meaning that it doesn’t cause any symptoms until it is too late. Measuring your blood pressure is an important part of yearly wellness exams, but it can be done at home too, Dr. Gantzer says. “Blood pressure can’t be ignored or fall off the radar,” she says. “Get a blood pressure cuff and check it at least once a year, and make sure to bring your cuff and your readings when you see your doctor face to face.” Blood pressure readings of less than 120 millimeters of mercury (mm Hg) for the systolic blood (upper) pressure and 80 mm Hg for diastolic (lower) pressure are within the normal range, the American Heart Association notes. The association offers up some guidance on choosing an upper-arm home blood pressure monitor, including how to measure your arm to make sure it fits.

If you have high blood pressure, check with your doctor to find out how often you should test your blood pressure at home and when you should be concerned about the readings, Dr. Wexler adds.

Even weight can be assessed virtually as part of your annual wellness visit. “We can enter the patient’s weight from their home scale, or, there are Bluetooth scales that will transmit the weight directly to the clinic’s electronic medical record,” says Sarah Crane, MD, an internist at the Mayo Clinic in Rochester, Minnesota.

That said, if you have a chronic disease such as diabetes or a heart condition, certain exams require a face-to-face-visit and should not be postponed if you are overdue.

Sources

Denise Mann, MS
Denise Mann is a freelance health writer whose articles regularly appear in WebMD, HealthDay, and other consumer health portals. She has received numerous awards, including the Arthritis Foundation's Northeast Region Prize for Online Journalism; the Excellence in Women's Health Research Journalism Award; the Journalistic Achievement Award from the American Society for Aesthetic Plastic Surgery; National Newsmaker of the Year by the Community Anti-Drug Coalitions of America; the Gold Award for Best Service Journalism from the Magazine Association of the Southeast; a Bronze Award from The American Society of Healthcare Publication Editors (for a cover story she wrote in Plastic Surgery Practice magazine); and an honorable mention in the International Osteoporosis Foundation Journalism Awards. She was part of the writing team awarded a 2008 Sigma Delta Chi award for her part in a WebMD series on autism. Her first foray into health reporting was with the Medical Tribune News Service, where her articles appeared regularly in such newspapers as the Detroit Free Press, Chicago Sun-Times, Dallas Morning News, and Los Angeles Daily News. Mann received a graduate degree from the Medill School of Journalism at Northwestern University in Evanston, Ill., and her undergraduate degree from Lehigh University in Bethlehem, Pa. She lives in New York with her husband David; sons Teddy and Evan; and their miniature schnauzer, Perri Winkle Blu.