Q&A: Dr. Francis Mercado on deferred care

Dr. Francis Mercado is the associate chief medical officer of primary care for Virginia Mason Franciscan Health. State of Reform spoke with him to discuss deferred care due to the COVID-19 pandemic, and the impact it has on both patients and health care systems. 

 

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Aaron Kunkler: How is deferred care impacting health care systems?

Dr. Francis Mercado: That’s a really good question. We’ve been experiencing this since March and April 2020. As you know we experienced this early in the pandemic, and we’ve been dealing with it for almost two years now. It certainly has had a significant impact, especially with the quality care that we’re trying to provide. We do have a lot of well meaning patients who would rather wait and not get care, especially during a surge. We experienced that in 2020, and then that summer, and then during the winter, and during this delta surge as well. So we certainly have ebbs and flows.

Even in 2020 we started realizing when we were able to see patients safely, and we were able to start seeing the patients in person, and I would say that was certainly as early as mid-2020. We wanted to make sure that we made the most out of every visit. So in terms of our own internal metrics, we were able to make some strides in improving some of that deferred care. But as you can imagine, there were ebbs and flows and then folks, for some reason or another would choose to defer care.”

AK: About those ebbs and flows, did you see folks rushing to book appointments all at once when they felt it was safe? 

FM: In both Virginia Mason and CHI Franciscan you had an uptick this year in annuals and physicals and preventive visits. Luckily, we’ve never really ran out of PPE, we never really ran out of masks, and we have been able to see a lot of our patients in-person as well as virtually. So we tried our best to continue care like before, without as much disruption.”

AK: How is the unpredictability of folks scheduling appointments, as well as incorporating telehealth, impacting health care?

FM: Aside from the early learning curve that we all had to go through when telemedicine was new, we’re sort of used to it by now. We still have services that we can do virtually. And especially if a lot of it is going to be interviews or advice that we have to give or information that we have to gather. But of course, there is that significant subset where we do have to see patients in person. Thankfully, we have been able to do it, especially with masking and social distancing, and making sure that we have adequate space for everybody… 

Right now, when when we see somebody in person, we recognize that this might be the only chance we have to get all of our screenings in, and all of our great health care: the proper evidence-based health care that they need to receive, all the vaccines that our patients need, we tried to maximize that every visit with all the services we can we can offer them.”

AK: How does that impact health care delivery for physicians and health care workers?

FM: It’s just more vigilance and to make sure that we’re going through our checklists to make sure all the necessary requirements are done. In the past, we might say why don’t you come back in a couple of weeks or talk about this at that time. Right now, we want to make sure that we cover as much as we can for the patient. We want to make sure that we cover what’s very important to them.

A lot of the patients’ concern is that if we don’t take care of them in the ambulatory setting or in the clinic setting, they do get worse. And if we don’t take care of that hypertension, if we don’t take care of the diabetes in the clinic setting, we can get worse and we might end up in the emergency room, which is probably the last place you want to be during a pandemic.”

AK: Is there anything you want patients to know?

FM: I just want to make sure that we drive home the message that deferring or delaying care can result in permanent damage, especially if you’re leaving things untreated. Anything from high blood pressure that can later on lead to heart problems, or diabetes which can lead to complications in your eyesight or kidneys, those things are very important.

You may think that you’re deferring care to stay safe, but in the long run, it can be especially bad for you as a patient. As long as the facilities that you enter have proper protocols, as long as everyone is masked, including patients, care can be delivered, especially when everyone’s diligent.”