Patients skipping care worries physicians


It could take years to catch up on screenings, immunizations and fallout from pandemic delays

Scientists, doctors, and the world are starting to come to grips with the direct and indirect impacts the COVID-19 pandemic had on the healthcare system. That impact is not being measured by the number of COVID cases, but instead, the consequences of a large percentage of society skipping preventive screenings and general health care in 2020.

To assess the consequences of delayed care, the Centers for Disease Control and Prevention commissioned a web-based survey last year. Of the adults surveyed, 40.9% admitted to delaying medical care for fear of being infected with COVID. An added 12% admitted they avoided urgent-care clinics and emergency rooms. An estimated 31.5% avoided general health care altogether.

Kristin Orlowski, a UCHealth behavioral health expert in Highlands Ranch, said the pandemic created a lot of fear in adults, especially regarding health care. Messaging to stay home and avoid medical facilities went too far, causing fear, panic and anxiety, she said.

When it comes to general health care, family-care physicians said the pandemic was a tough year. Because general care is sometimes considered non-emergent, many patients figured 2020 was a good time to take the year off from seeing the family doctor.

“When all of this started, the messaging was to delay medical care if it could be delayed,” said Dr. Alison Shmerling, who practices family medicine for UCHealth in Westminster.

Shmerling said she is seeing cases where screening orders for preventive testing, including mammograms and colonoscopies, that she recommended a year ago have expired. For older patients, the less active lifestyle caused by stay-at-home orders has created complications in managing weight, blood pressure and keeping diabetes in check.

2020 left backlog of issues

With family medicine considered the first line of defense in many cases, Dr. Mihir Patel, a primary-care doctor in Castle Rock, said 2020 has caused a backlog of issues, including cancer diagnosis, depression, obesity and issues related to heart health such as cholesterol, blood pressure and exercise.

“In general, not everyone is compliant with screenings, but that was elevated in COVID,” he said. “Anything we can catch in the early stages and start treating means we can do the work to stop it.”

Dr. Amanda Babcock, family medicine provider at UCHealth Primary Care-Arvada West, said she has seen a trend of patients requesting prescription refills without coming in for annual exams.

“We provide that general care where we are able to get the whole picture,” Babcock said. “You might think something that is happening is normal and is no big deal. However, when you see (your general-care doctor), we might see something and order tests to make sure it is nothing.”

Dr. Lisa Wynn, an OB/GYN at UCHealth Highlands Ranch Hospital, said she is seeing signs of distress from 2020 through blood work. Patients had depression and heightened stress, and test results are showing that. Liver function in blood work is worrisome, Wynn said, as it is clear more women turned to alcohol to cope with the stressors of the pandemic.

“In 2019 all these tests were normal,” she said. “Now, in 2021, there are a lot of red flags with alcohol, cholesterol, and markers for pre-diabetes. An annual exam can really serve as a reset button. It is a reality check for getting diet and healthy habits back on track.”

Wynn joked that her entire family, including her dog, gained weight during the pandemic, noting that no one should feel ashamed or avoid a doctor just because everything is not perfect.

“We all handled our health-care decisions differently,” she said. “When you think zombies are going to be at your door tomorrow, you take the attitude of eating or doing whatever you want today. But the zombies are no longer at your door. It is time to get back on track.”

Troubling trend in mental health

Babcock and Patel said one of the most worrisome issues stemming from the pandemic concerns mental health.

“We definitely saw in uptick in mental-health cases,” Patel said. “Like other issues, mental health is something we can treat better if caught in its early stages.”

Babcock said she saw an increased number of patients complaining of anxiety, depression and insomnia.

“Patients need to understand that we are here in person or through virtual access to help relieve some of that anxiety,” she said.

Another unexpected trend during the pandemic, Wynn said, is an increase in diagnosing STDs in young patients. With dating being unpredictable and more of her patients getting into new relationships, Wynn said cases of sexually transmitted disease went up last year. However, Wynn said, in some cases patients waited too long to seek diagnosis and treatment.

“STDs are not an area that you want to continue to ignore,” Wynn said. “If an STD is left untreated in your 20s, you can experience infertility issues later in life.”

Besides preventive screenings having a backlog, vaccines and immunizations are also behind. Family doctors said they are behind with immunizations for children, giving teenagers the HPV vaccine and in giving recommended vaccinations to older patients.

“Patients have to understand that COVID is not the only thing out there,” Wynn said. “Patients may be thinking they are healthy, but there is nothing wrong with seeing your doctor to make sure. You might feel OK, but you need to know for sure.”


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