With his face hidden behind an N-95 respirator, a level-three surgical mask, a plastic face shield and goggles, Dr. Jeffrey Goldschmidt of Periodontal Associates in New Britain, Connecticut has certainly felt the immense impact of COVID-19 on his practice.
When the state of Connecticut shut down in mid-March, so did Goldschmidt’s office. But despite not being physically present with his patients and staff members in the quaint brick building on Park Place, Goldschmidt never stopped working.
He spent hours researching the necessary personal protective equipment (PPE) that would be needed upon the practice’s reopening, and he reviewed the ever-changing guidelines that were being put into place by the Centers for Disease Control, the American Dental Association and the State of Connecticut. Goldschmidt and his staff also collaborated to figure out the best way to contact patients once the office reopened, what kinds of questions should be asked of patients prior to their visit and how they would ensure a healthy working environment.
Along with determining how his practice would reopen, Dr. Goldschmidt also had to continue to address any patient needs during the lockdown period. “I tried to handle their issues whenever I could by phone, which was easier with my long-term patients whose charts and information could be readily accessed,” he said. Luckily, Dr. Goldschmidt faced few problems that needed to be looked at in person.
The meaning of “a normal day at the office” has drastically changed since the practice’s reopening on May 25. In the past, many people could sit together in the waiting room and enjoy magazines, and the office could move patients from the waiting room to a patient exam room with few concerns. Now, however, certain measures have been put into effect in order to ensure that patients enter and leave the office efficiently and safely.
The day before their appointment, patients are pre-screened by phone with a series of questions related to their health. When patients arrive at the office the following day, they are asked the same questions a second time.
“The purpose of re-asking our patients the questions is to best ensure that they are healthy,” Goldschmidt said. “We also take their temperature, and we may need to take it more than once because in order to have as few people as we can in the office at one time, we limit the number of patients in the waiting room. So, some patients may have to wait in their car for a few minutes before entering the office. Waiting in a warm car or outside the office may increase your temperature, so we take it more than once to ensure accuracy.”
Once patients are in an exam room, they read and sign a COVID-19 consent form, which explains any risks, and they confirm that they understand this risk despite the safety measures the office has put in place.
Goldschmidt and his staff have been able to ease any patient’s concerns by explaining to them the different types of PPE worn and by giving them the opportunity to ask their own questions. He also staggers patients so that there is never more than one person in the waiting room or at the front desk at one time. By going through multiple levels of screening, patients feel more comfortable in Goldschmidt’s office.
Sheena Castillo, Dr. Goldschmidt’s surgical assistant, also noted that following protocols makes her patients feel confident in the office’s ability to maintain a healthy environment.
“We always go above and beyond for our patients,” Castillo said. “It’s key to make them feel certain that our office is following proper protocols. We make them feel safe and comfortable before, during and after any procedure.”
Not only has the way the office operates been altered, but how Goldschmidt carries out some of his procedures has changed as well. Aerosolization is a part of some periodontal surgeries. However, according to the US National Library of Medicine, aerosols- fine sprays emitted from a patient’s mouth as a result of the use of certain instruments- pose a great risk of spreading COVID-19. Thus, Dr. Goldschmidt has currently eliminated the instruments and devices that create aerosol; consequently, his surgeries may take longer because the devices that create aerosol may increase the efficiency of procedures. Despite this, Goldschmidt has been able to use other instruments to treat his patients just as effectively, including standard scalers and other hand-held equipment that do not generate any water.
The biggest challenge Goldschmidt has faced, he says, is wearing so many layers of PPE.
“I wear two layers of masks, a face shield, goggles and a surgical cap for at least eight hours a day, every day, which is extremely draining and challenging,” he said.
Castillo agreed. “Having to wear all of the PPE takes away all of my energy and causes me to be tired by lunchtime,” she said. Both Dr. Goldschmidt and Castillo find it difficult at times to breathe while speaking with patients because of the reduction in air flow. This is both fatiguing and dehydrating.
But even though his team at Periodontal Associates faces hurdles, Goldschmidt and the rest of his staff have ultimately been able to maintain a safe environment for themselves and for their patients. Dr. Goldschmidt does not plan on making any additional changes at this time with the way his office runs, and he foresees maintaining the same protocols and strict procedures until there is a vaccine and predictable treatment for the virus.