Elective Procedures During COVID-19: How to Talk to Patients

Americans aren’t accustomed to waiting for what they want, and that includes elective medical procedures. The coronavirus pandemic, however, is throwing up a hurdle to many patients’ plans for those procedures.

In some cases, their choices are being made for them; as of March 26, the governors of 27 states had issued executive orders to temporarily suspend non-emergency procedures in their states. In other cases, patients are weighing the benefits and drawbacks of continuing with their treatment plans. Physicians can play a valuable role in helping patients make a difficult decision or come to terms with a situation they can’t control.

We spoke with Roberto Ochoa, M.D., Director of Hematology, Oncology, and Palliative Care at the Chen Senior Medical Center in Hialeah, Fla., about how he handles these important, but delicate, conversations.

If a patient still has the option of an elective procedure, how would you counsel that person in making a decision?

There are four big points I’d make.

First, I’d ask them to consider the personal side of things. In hospitals right now, there are almost certainly going to be people with the COVID virus, and therefore you’d increase your chance of being exposed to it. In a patient population like ours, people over 60 with underlying health problems, that means exposing yourself to a virus that has a fair chance of killing you.

Second, I’d appeal to their good citizenship. In many places, we need to give space to our hospitals to deal with people who have COVID — especially in a place like New York, where they’re at or above capacity in managing people with COVID already. Leaving non-emergency procedures for later on, when capacity is back to normal, is a big help.

Third, I’d address the possibility of complications. All procedures, even the safest ones, carry risks of complications. Sometimes you have to stay in the hospital for days afterward — and if that happens now, you’re going to be in a hospital that could be packed to capacity with people with COVID. The risk of getting an infection while you’re in the hospital is low, but it’s higher than normal at this time.

Finally, I’d explain that, after their procedure, they’d probably be recovering alone. Most hospitals have a complete no-visitors policy right now. It’s not like usual, when you can have a spouse or child or friends or loved ones next to you before and after your procedure. You’ll be by yourself, maybe for a long time, and that’s a hard thing for most people.

How would you approach patients who are unhappy their procedure must be delayed?

First, I’d let them know that I hear them, I understand their concern, and I know why they don’t want to delay their procedure. Then, I’d go back to the four points I just mentioned. Depending on my relationship with the patient, I’d start with one or two of the points that I think would be most persuasive.

Finally, I’d develop an alternative plan for management of whatever the elective procedure is expected to resolve. For example, if a patient was supposed to have a knee replacement, they probably have a significant amount of pain and maybe a problem with mobility. I’d come up with a pain management plan, some way to make them feel more comfortable as they wait for their surgery. So, it’s not simply saying, “Sorry, your procedure is canceled.” It’s being proactive with a management plan for the delay.

What elective procedures shouldn’t be delayed, and how do you make those decisions?

The only elective procedures I see value moving forward with at this point are super-urgent cancer surgeries or procedures. For example, if someone has a lung cancer that appears to be in Stage 1, there’s a fair chance for a cure if they have surgery. They’ll be spending a week in the hospital after the surgery, and if someone recovering from a cancer surgery were to be infected with COVID they could get very sick. But with this kind of cancer, we know that if it’s not treated quickly, it spreads in a very short amount of time. We have to keep our eyes on the target: There is a bigger chance of the cancer significantly harming or killing them than COVID.

In any conversation about elective procedures during this uncertain time, what’s the most important thing a physician can do to help put patients more at ease?

I think it’s helpful to address what’s called the typical course of the disease — what you expect to happen if they don’t get the treatment or procedure right now. Take the knee surgery example: You’ll have to deal with the pain a little longer, but there’s no threat to your overall health. The vast majority of elective procedures are like that.

Having the conversations to put patients at ease right now — whether it’s concerning the coronavirus or an elective procedure — can have a lasting impact on your relationship with them and, ultimately, with patient outcomes.