Patients Are Returning to Doctors’ Offices After Putting Off Treatment During Pandemic

People who delayed medical and dental care as a result of the COVID-19 pandemic are returning to doctors’ offices across Southern California, sometimes with exacerbated symptoms and conditions due to the delay in treatment, according to doctors.

A report from the U.S. Centers for Disease Control and Prevention looking at a nationwide sampling of patient data during the summer of 2020 found that about 41% of American adults either delayed or altogether avoided medical care because of COVID-19 concerns. An estimated 32% delayed or avoided routine care, while 12% delayed or avoided emergency care.

“Avoidance of urgent or emergency care was more prevalent among unpaid caregivers for adults, persons with underlying medical conditions, Black adults, Hispanic adults, young adults and persons with disabilities,” according to the CDC report. The researchers noted that an increase in the use of telecare may have contributed, in part, to the trend.

Dr. John Mafi, an assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at UCLA’s David Geffen School of Medicine, said the data seems to match his own observations.

“That has been my experience, just anecdotally, as a physician practicing,” said Mafi, who also serves as an affiliated natural scientist in health policy at RAND Corp.

While patients seem to be less hesitant to visit a medical office in more recent months, “…the rates, even by January 2021, were still below historic expected levels given the season and even during the spikes in cases, particularly the West Coast, as well in late-2020. Office visits were still below expected levels by around 5%, maybe even more, despite the fact that during the winter there was a surge,” according to Mafi.

“We know that, according to the CDC report, four in 10 Americans reported avoiding medical care because of concerns related to COVID-19. That was in the early months of the pandemic,” Mafi said. “But we’re seeing delays in care even at the end of 2020 persisting. So I think they’re still concerned about coming to the doctor, despite a lot of very strict protocols that have been developed to protect patients and staff from contagion.”

During the peak months of the pandemic in Southern California, hospitals postponed non-urgent surgeries and procedures to accommodate the influx of coronavirus patients, as patients grew more reluctant to visit a medical facility amid the pandemic.

“But the problem is… the early data is telling us that it’s a mixture of both necessary and unnecessary care that we see in the declines,” Mafi said. “While it’s beneficial that people who don’t need to come in are not coming in, it’s hurtful when people who do need to come in are not coming in. And it’s very hard, as a patient, to know when it’s really a good time to go and when it’s not necessary.”

“If you’re an older adult and you have chest symptoms, breathing symptoms, that’s an absolute must,” Mafi said.

“There was a study from Beth Israel Deaconess Medical Center that looked and saw that new cancer diagnoses had gone down during the pandemic because patients weren’t coming in,” Mafi said. “It’s not because cancer is magically going away. It’s because people aren’t coming in, which implies that they’re going to be coming in later with later-stage cancers. And so that is a concern.”

UCLA Assistant Clinical Professor Dr. Pauline Yi said she also noticed the trend.

“It is true. During the lockdown, I think people were afraid to come to the doctor, which is very understandable. But the concern was that people with chronic illnesses, like diabetes and hypertension, weren’t monitored,” she said.

“Usually, we have them come in every few months to check their blood pressure, to do blood tests, to make sure the medications aren’t interacting and to sort of monitor their diseases,” Yi said. “And if they weren’t coming, they would just kind of take medications and monitor their own conditions.”

Now, some patients are returning to see their doctors with exacerbated medical issues.

“A lot of mental health — depression and anxiety — has worsened tremendously during the past year,” Yi said.

Additionally, many people have packed on extra pounds during the pandemic.

“People have gained weight during COVID. They’re more sedentary during COVID. So you’re seeing a lot of people with weight gains, high cholesterol levels,” according to Yi.

The doctor also urged exercise enthusiasts to take it easy as they return to recently reopened gyms following more than a year of reduced physical activity.

“People are trying to get back into exercising, but they’re causing themselves injuries. They’re so happy that they’re going to the gym, but like not doing it carefully. They’re like going at it at 150%,” she said. 

Yi urged those who wish to schedule medical appointments to schedule them early, if possible, due to long waits at some providers and patient loads increase.

“So I’m hearing from patients that they’re trying to get their mammogram done and it’s almost a four-month wait because there’s a backlog of people who didn’t get it last year or they were rescheduled or canceled,” she said. “There’s an influx of people that have been waiting.”

Demand for dental care has also been on the upswing, said Dr. Aaron Kang, owner of Ohana Dental in Pasadena.

“I’ve been getting a lot of calls. We’re getting a lot of new patients right now,” he said.

The clinic was continuing to limit the number of patients treated to maintain social distancing, he added.

While many patients haven’t had a cleaning in well over a year, leading to an increase in gingivitis, Kang said that on the whole, most patients have done a good job of brushing and flossing during quarantine.

“But what I often see is a lot of people are getting stressed out over quarantine… So they tend to grind their teeth harder,” he said. “I’ve seen a lot of wear and tear on their teeth.”