We are in the midst of the COVID-19 crisis. We now have 28 confirmed community transmitted cases here in San Antonio as of this morning March 20 2020. I wanted to say a few things about this crisis. It looks like from everything that I have learned that social distancing is the best technique. Washing hands and cleaning surfaces frequently seems to be very helpful. The worst results are seen in the elderly while the younger may be the vectors of the virus so the young can transmit it to their elder family members.
There is a Medicare guideline that we limit elective surgery including spinal surgery for chronic pain until this crisis is passed. In general anything that could be postponed for 6 weeks or 3 months probably should be delayed. Today Santa Rosa Hospital said that elective surgery would go on but that the hospital recommendation could change at any time. I would prefer any elective surgery outpatient or that has been previously scheduled with the patient's permission and the permission of the hospital. As a general rule outpatient surgery or single night stay will probably be the limit I currently support. The permission of the hospital and my agreement may change on a daily basis. I intend to stay in touch with my surgical patients on a daily basis.
In the office and for after hour calls I will manage this over the phone as much as possible. I do have limited video calling that I can use for office visits. There is a new national and state rule that doctors may charge an office visit code for a video call and do medical dictation to be included in the patient's chart at the time of the visit. I would suggest new patients should submit imaging and I will do an initial phone call and determine whether the patient needs to get more imaging or to come to the office for a physical exam. For follow-up patients I would like the patient to obtain x-rays as required and then I would manage this over the phone as much as possible. Of course I would continue to see anyone with an emergency related to surgery or acute exacerbation of their back pain.