Boyd W. Haynes III, MD
Providing patient care safely during the Coronavirus crisis has presented physicians and patients with many challenges to overcome. Caring for patients once their surgery is completed and they are out of the hospital is no exception. In this article, I will address how COVID-19 has changed our procedures for post-operative follow-up visits.
Typically, I want to see my patients in person 10-14 days after their surgery to assess how they are healing. If they had a joint replacement or another major surgery, I may wish to take x-rays to assess how their bone is healing. I observe how the patient is moving, walking, how well they can get in and out of a chair. I usually do strength testing which requires that a patient provide resistance, pull, press, or squeeze when asked to perform a variety of motions.
Another important aspect of this visit is the assessment of the surgical incision. I look for signs of infection as well as healing progress. For most surgeries, I typically glue the incision closed, but other surgeons at OSC may use staples or sutures depending on the type of surgery and the location on the body. Surgical sutures or staples are almost always removed during this first follow-up visit.
Follow-up visits are also used to assess when the patient is ready to be weaned from assistive devices or to transition to a different one. Maybe you were given a walker to use after your knee replacement, but now I feel that you can safely transition to a cane. You may have had a knee-high walking boot on, but now you can transition to a smaller, less cumbersome ankle boot. You get the picture.
I believe that it’s important to reassure my patients about their progress and healing. Sometimes, I tell them that they aren’t where I expect them to be in their recovery and provide encouragement and motivation for them to work harder at their rehab exercises.
All of these aspects of the follow-up visit are important, and I prefer to do them in person with the patient. However, in the era of COVID-19, I want to lessen the risk of patient exposure to the virus in any way possible, especially after surgery. I now encourage patients to do post-operative follow-up visits by telehealth video consultation. Although I’m limited in being able to physically examine them, I can talk to the patient, observe their general appearance, assess their incision and ask them to move and walk. We can discuss in detail how they’re feeling, what issues need to be addressed and refill any prescriptions if needed. During this crisis, I feel it’s a good option to help keep patients safe as they recover from surgery. However, if I ascertain that the patient’s post-surgical healing is not going well during the video consultation, I may request that they come into the office to be seen in person for a closer look.
For patients with sutures or staples that must be removed, there is also another option that can be utilized. If the patient has had home health nursing approved for post-surgical care, the nurse can remove the sutures or staples while in the patient’s home during a post-surgical health check visit. Otherwise, patients must come to the office to have this taken care of by their physician.
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