This topic contains 10 replies, has 8 voices, and was last updated by 
Eric Lambert, DC March 23, 2020 at 10:10 pm.
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Christopher Stepien
Hi All,
Curious what all of your plans are as we’re in these crazy times.
Any plans on pivoting business?
Any resources for floating by financially?
What are you thinking about now?I just watched this free webinar – super helpful.
https://hanlystrategic.com.securechkout.com/adapt-or-die-oi
I hope you and your families are all safe and healthy.
Eric Lambert, DC
I’m just happy Bill made a table that can handle all the disinfectant I’ve put on it that last few weeks.
I’m still open taking care of patients as long as they will let me. Taking plenty of precautions and my hands are taking a beating from all the washing and cleaning.
Eric Lambert, DC
For those who may be stressed here was something nice. Share it with your doc friends. We all need a little stress reduction right now.
Free Headspace App for a year to help healthcare providers with stress from pandemic. All you need is your NPI number and sign up.
Here’s the link:
Brandon Cohen DC, CSCS
Tonight at 5 pm, my county is instituting a “shelter-at-home.” This apparently means you stay home except to go out for essential stuff. Doctor’s visits are included on that list. It is for an indeterminate amount of time. The expectation is 30 days, with a check-in date at 14 days.
What are you all planning to do? We have 7 cases in our county since Sunday. I will see patients today, already had no patients scheduled for tomorrow because of a wedding (long story), and was planning on going dark for the next two weeks and re-evaluating.
We have been disinfecting everything like mad in the office and do our best. Up to today, we have missed 15 appointments this week. Today looks to be full, but I imagine we will get a couple of cancelations.
The majority of our patients are at home and essentially only come to us and then back home. I have a couple who work at prisons, and one who is reckless and went to the movies on Tuesday.
I have contemplated cutting the schedule down to give more time between patients for cleaning and disinfecting, but I really don’t know. I feel like our offices are pretty safe places, but the concern is that an asymptomatic carrier comes in and infects everybody. This could have already happened or could happen in a month so far as I can tell.
This is such a weird spot. I had not, until 2 weeks ago, considered that something this far out of my control would control my business and capacity. I’m used to being the rate-limiting step.
So, for those who have closed, do you have a plan to re-open? and for those who have yet to close, what is your threshold and plan to shut it down?
Matthew Ellerbrock
Those are great ideas.
One thing they are ‘asking’ us to do in ohio, not mandating (yet) is to take the temp of every employee as they show up into work. We are doing that and politely asking patients if they have any symptoms (cough, fever, sob) on intake.
Ohio has been the first to cancel everything before its cool…. so some people here are losing their shit and others insist its a conspiracy to take our liberties away.
The hope is we all keep our cool and be nice to each other. This too will pass.
Matthew Buffan
I decided to close yesterday. Another ID provider asked me about the tipping point and there were a few of them for me. I get most of my information about the outbreak from Chris Martenson at peak prosperity
https://www.youtube.com/user/ChrisMartensondotcom/featured
he sent out an alert in late January that was concerning. He has reported to the best of his ability almost daily since then. He seems extreme, yet what he said could happen, has happened.The tipping points for me were:
1. The number of symptomatic self quarantined people in my area doubled only from 70-150, and confirmed cases were at 18.
2. The virus transmits asymptomatically. The R0 (# of people a single person gives it to) is between 2.5-7. A bad flu is 1.2.
3. The pattern of spread of this virus is case, case case case, cluster, then BOOM.
4. One of my front desk girls son has a rare lung condition and I saw a patient who returned from Seattle, (albeit fully healthy and allowed to continue to see patients as a nurse at the hospital). At that point I started second guessing.
5. Lastly, I have a 9.5 month old and don’t want to bring it to her and my wife.This decision was extremely tough b/c I am the only one working. As for business pivots, yes I’m looking to utilize my skills and knowledge in non-hands on activities, and would love to start seeing MSK patients in 2-3 weeks, yet that is an unknown and will depend on the local situation.
Eric thanks for the link.
William Brady, DC
Great conversation. Closing our offices is a tough decision. I think everyone will close their offices, the only question is when… and then for how long.
Big picture, the entire world is suffering. Priority one is how do I help slow the spread of this highly contagious and potentially deadly disease? Stop seeing patients. If you get it from a patient you will then unknowingly become a super-spreader of the virus for 2-14 days. We are in close contact with 100% of our patients. Many MD’s don’t touch their patients and they have protective equipment, we don’t. Disinfecting surfaces is important, but don’t think that is a huge help. This flu mostly spreads person to person- being within 6 feet of an infected person or inhaling an infected droplet from a cough or sneeze. If you are still seeing patients wear a N95 or N99 mask. The problem is these are disposable and you would need a lot of them, unless you stockpiled these in January you don’t have any.
When you close your office, put everyone on unemployment (look into your state rules). Hire them back when the world is back to normal. In the meantime it looks like banks may suspend mortgage payments, the federal government may provide a cash payment to some citizens.
I just want everyone the have an appropriate level of concern and take necessary action. The government runs simulations to test what would happen in a pandemic. The last one they ran (last year) had nearly 50% of the population get a virus and 500,000 people die. This actual pandemic is similar so far: https://khn.org/morning-breakout/government-pandemic-simulations-over-past-year-highlighted-u-s-vulnerabilities-but-little-was-done-to-correct-flaws/
It’s up to you to weigh the risks and benefits of staying open a few more days or a week.
Stay healthy! Thanks
Christopher Stepien
TY Bill, that’s super helpful.
The unemployment idea is a good one. WE’ve already let one employee go and didn’t think to just put everyone on unemployment.
In the meantime, I’m going to have doctors work on omnipresence doc and I plan on using the 2-8 weeks off to develop online income.
If you all have any other ideas or other brainstorms, please feel free to share. It’s better to use our hive mind than a single one.
Adam Holen D.C.
We closed this past week because the western slope has more confirmed cases than Denver due to international travel.
Not legally yet, but to Dr. Brady’s point I wasn’t comfortable being a possible common vector. No matter how much you clean or how good you feel, an asymptomatic carrier can have (unintended) ripple effects for dozens if not hundreds of people.
You may be fine, since we’re all relatively young, but it’s not about us. It’s about keeping our patients/families/friends safe and being open does not help that cause or the efforts that most organizations are taking, forcibly or not.
Everyone will struggle financially, but at a certain point trying to squeeze that extra bit becomes a moral issue.
Dealing with an uncertain circumstance does not yield much for certainties with time. However, as best I can tell, it’s now on us as a nation to take aggressive action. To control the spread, minimize the effects, and come out of this sooner rather than later, we all need to minimize any social interaction, professional or not.
As Dr Brady noted, there is virtually no way around the possibility of spreading this virus within our offices. If you have to wear a mask, should you really be touching people?
We are taking this week by week, hoping to open again in a week or so, on limited schedule. But that depends on the state of affairs at that time, which again, depends on what everyone does now.
I am obviously not an infectious disease expert, but what I’ve learned is that the most important piece is time when it comes to pandemics. The earlier we take action, the better. Unfortunately time is no longer a luxury we have in this case. We have squandered any chance at controlling this disease without mass action.
Keith Puri, DC
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