“It’s been weird,” Dr. Todd Bouchier, M.D. said, as he described finding himself conducting examination visits entirely in the parking lot of his office, a new protocol meant to minimize exposure risk.

Bouchier, one of the owners and primary care providers at Bouchier-Pritchett Family Medicine in Grass Valley, has seen many changes as he navigates work as a physician during a time of physical distancing from patients.

Whereas the practice normally runs on a packed daily schedule, patient volume quickly dwindled as awareness of COVID-19 and its spread surged, and as patients were quick to cancel appointments to stay home.

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Bouchier said his practice began focusing heavily on telehealth, making use of electronic medical records and communication platforms such as Zoom and Apple’s FaceTime.

“I can’t imagine the strain that it places on all of our local residents and small businesses, but we’re really thankful for the (shelter-at-home) efforts everyone has made.”Dr. Glenn Gookin, Sierra Nevada Memorial Hospital hospitalist

“Patients tend to love it, and also comment that they hope we can continue doing this when all is said and done,” Bouchier said, adding around 80% of the practice’s daily visits are now done either through a video service or a phone call.

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Bouchier said telehealth visits had been a possibility for years now, but many health providers were disincentivized from making use of the technology as some insurers refused to reimburse for it at the same rate as in-person visits.

In an effort to maximize social distancing, telehealth visits are temporarily being valued equal to in-person visits by insurers, a move Bouchier believes will be reversed once coronavirus-related concerns lift.

Amid the financial repercussions of decreased patient volume, including layoffs and furloughs of nearly half the practice’s staff, some good news came Monday for Bouchier and his team — their application for the U.S. Small Business Administration’s second round of Paycheck Protection Program loans was approved.

“We are thrilled,” said Bouchier.

Regarding COVID-19 testing, he said that supply of the tests themselves has improved since the situation began to develop.

“When this first happened, the emphasis was just on triaging those who were mildly ill and keeping them at home, not doing tests because it ultimately wouldn’t change management of the illness,” Bouchier said, noting such patients were asked to isolate at home and rest.

“But as this has evolved, and the emphasis has turned to doing more testing to just better capture what’s going on community-wise, we’ve been trying to do more testing,” he said.

getting results

“As a family doctor, we’ve always emphasized involving family,” Dr. Glenn Gookin said of having to tell close-knit families that visiting is not allowed amid coronavirus-related precautions.

Gookin is a hospitalist at Sierra Nevada Memorial Hospital, where he said many are making great strides to bridge the gap between patients and loved ones despite restrictions surrounding physical visits.

“People working in community development and social workers are helping family be present with their loved ones,” he said, pointing to iPad video communication and group phone calls as some methods used.

Gookin said a recent drill on increased testing capability showed Sierra Nevada Memorial Hospital has done well in preparing for a surge of COVID-19 patients — which they have, so far, been thankful not to see.

“It’s been two or three weeks now that we’ve really had amazing access to testing,” Gookin said. “We have one of the rapid tests for acutely infected COVID patients, and that’s really streamlined and maximized our use of personal protective equipment because we’re getting results so quickly now.”

He added that, while there is no shortage of tests at this moment, it is still recommended that those who do not feel that their symptoms warrant a hospital visit either seek testing through local primary care providers or do what they can to manage any mild symptoms at home.

According to Gookin, an ongoing conversation among hospital administration in the greater Sacramento area, and the state, is the future implementation of serologic testing — a development which would better reveal how pervasive antibodies fare in the community to indicate prior exposure to the novel coronavirus.

WITH THANKS

Gookin said it was touching to find that his next-door neighbor, who has been creating homemade masks, had begun producing some in a size that fit children — and provided him with one of the small masks for his daughter.

This moment of neighborly kindness, a reinvigorated respect for his fellow hospital staff in all positions, and the experience of seeing a patient’s prolonged struggle with COVID-19 culminate in successful recovery — these are just some of the bright spots which have stoked Gookin’s appreciation for his community during a difficult time.

“I just really want to say thank you to everybody in western Nevada County for their sheltering in place efforts,” he said. “I can’t imagine the strain that it places on all of our local residents and small businesses, but we’re really thankful for the efforts everyone has made.”

Looking toward the future and “opening back up”, Gookin is optimistic that progress on this front will be made soon. However, he urges that we continue following all public health recommendations until that moment comes, in order to protect the most vulnerable in our community.

Victoria Penate is a staff writer with The Union.