The Executive Suite: Expert Advice: Responding to patient panic about the Coronavirus

Ask patients open-ended questions when they call the physician practice panicked about the novel coronavirus. That’s the first piece of advice from Stephen Benning, PhD, professor of psychology at University of Nevada, Las Vegas. “As clinicians, we have all kinds of questions that might panic people, but it’s up to the patient as to what’s actually bothering them,” he counsels.

For example, some patients may be worried about having COVID-19, the infectious disease, whereas others are concerned about their parents or other family members contracting the virus. Still, other people may be concerned about losing their job due to governmental efforts to prevent increased community spread of the virus.

His point? “If we, as clinicians, don’t ask open-ended questions, our answers may not be applicable,” says Benning.

Provide accurate information about COVID-19 testing
Tista Ghosh, MD, MPH, an epidemiologist and senior director of impact evaluation at San Francisco-based Grand Rounds, points out that many patients call physician practices because they want to get tested for the virus. Updated information about COVID-19 testing should be provided to the person responsible for answering the practice’s phone, she says.

In addition, the practice should record testing information on its pre-recorded message that greets patients when they call, says Ghosh, who previously served as Colorado’s director of public health and chief medical officer.

Be honest and comforting
Physician practices should communicate the accurate, current information they have about the coronavirus, says Simon Rego, PsyD, chief of psychology at Montefiore Medical Center in Bronx, N.Y.

For example, according to the Centers for Disease Control and Prevention (CDC), the elderly are at higher risk for severe illness with the coronavirus. In fact, the federal agency reports that 8 out of 10 deaths in the United States due to the virus occurred among adults 65 years of age and older. CDC also says that the elderly and people of any age with serious medical conditions, such as heart disease, diabetes, or lung disease, may be at higher risk for serious complications.

In addition, the CDC revealed that 38% of people sick enough to require hospitalization due to the virus were under the age of 55.

The most important thing is to provide patients with reliable information, says Rego. He points specifically to the World Health Organization and the CDC, which are constantly updating their resources and offering guidelines on hygiene practices and travel alerts.

“Educating the patient starts with alleviating their concerns. Part of that is educating them about reliable sources of information,” he adds. State and local health departments are additional sources of reliable information, says Rose Willis, JD, an attorney with Detroit-based law firm Dickinson Wright, where she advises physician practice and hospital clients.

Paul Gionfriddo, president and CEO of Mental Health America, advised in a statement that healthcare providers should do the following:

Screen all patients for anxiety at both sick- and well-care visits.
Take extra time with patients to assess the need for more intensive mental-health treatment that they receive right away. He stressed that mental-health effects, if untreated, could last for weeks or months and return unexpectedly.
Manage healthcare capacity to enable responses to mental health crises as they arise during the next weeks and months.
Refer patients to a variety of informational and support resources for mental-health follow-up. He also counselled against giving up if no clinicians are immediately available to take a referral. Peer support services are available from his organization’s affiliates, in addition to local advocates across the country who can provide clinical- and non-clinical support services.

Benning says the person answering the practice’s phone should tell patients when they should expect to get a call back, if their concern can’t be addressed during the initial phone call. That time period should allow the team member to consult with a clinician. Communicating a timeline can help alleviate some uncertainty for patients, he explains.

Don’t get ahead of the science
Bill Hopkins, JD, healthcare partner in the Austin, Texas office of law firm Shackelford, Bowen, McKinley, and Norton, agrees that patients are looking for reassurance and comfort. “While that sounds nice and wonderful to the average person, from a clinical and liability standpoint, that is where the trouble areas are for healthcare providers,” he explains.

Being reassuring and comforting is easier when a clinical condition is known and predictable, but healthcare providers don’t have this level of information about the coronavirus, points out Hopkins. Specifically, “overzealous words of reassurance and comfort can come back to haunt a healthcare provider if their compassion allows them to provide a false sense of security to [a] patient that isn’t backed in anything other than a desire to get the patient to stop panicking and calm down,” he advises.

If the information provided by the physician practice later turns out to be inaccurate or not backed up by clinical information, the patient could come after the practice for being negligent in providing that information, regardless of the intent to calm the patient, says Hopkins.

“Ultimately, healthcare providers should always err on the side of providing factual and clinical information, as well as compassion for the fear that the patient is feeling, but should always refrain from ‘going too far’ or ‘beyond the science’ in making promises or predictions that they can’t keep and could be accountable for if they’re wrong and didn’t have a clinical basis for the statements,” he says.

Align resources appropriately
The practice administrator must plan staffing for answering the phone and ensuring the environmental cleanliness of the practice, says Ghosh, a former member of the U.S. Preventive Services Task Force, which provides science-based recommendations to improve population health.

It may be appropriate to invest in a virtual-call provider that can respond to patient calls, she adds. Physician practices that are part of large health networks can also inquire about tapping into their call-center resources.

Willis recommends providing a checklist to the person who answers the practice’s phone line. “Front desk people can’t practice medicine. They may have to refer the patient to a provider... make sure they’re having an appropriate dialog about the situation, not the medical piece.”

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Regarding the cleanliness of the practice, Ghosh says it’s important to ensure that the waiting rooms and exams are cleaned frequently. Top of mind should be wiping clean doorknobs, touchpads provided to patients, desk surfaces, and TV remote controls in the waiting room.

Promote virtual care; update practice’s website
Physician practices can use social media to educate patients about telehealth visits, which can reduce the strain on emergency rooms and physician practices, according to Patric Wiesmann, managing director and general manager of Reputation.com’s healthcare and life sciences division.

Patients experiencing anxiety may never call the practice. That’s why it’s important to update individual clinician’s webpages and the practice’s website to include information about telehealth options, he advises.

Protocols developed by the CDC and other governmental entities continue to be updated. Thus, Weismann advises practices to add an emergency response message to the top of their websites and individual provider pages with important updates and information about the virus.