feet. If closed much longer, those expenses that
don’t stop would have overtaken us.”
Even while the clinic was closed, the work
did not stop. Nurses took turns coming in to
check messages and take care of refills, deliveries,
and other critical tasks. The front office staff
came in for a few hours each week to do things
like update cancellations, post payments, check
mail, and make deposits. The clinic staff ordered
PPE as they could find it, shopped for wipes and
cleansers, utilized telemedicine as best they
could, and saw a few in-person patients on an
emergency basis.
Telemedicine at first proved a challenge for
the clinic staff, which was used to a much more
hands-on approach. “In a practice where the
physical exam is an integral part of initial and
ongoing treatment of patients, the current pandemic
has presented extreme challenges. We try
to do a complete assessment of the patient – an
ongoing assessment as pain can be complex,
multifactorial, and ever-changing,”
explained Dr. Swicegood. “When a
patient comes in, our staff is trained
to validate and to develop a bond so
that the patient experience is familiar
and welcoming rather than institutional.”
In addition to distance being a
factor, the clinic’s technology just
wasn’t there. “We were poorly prepared,”
he shared. “I immediately
began working to educate myself on
everything required for telemedicine. On that
note, I must commend David Wroten and the
Society staff for being so proactive. They stepped
up with information on coding, directions to help
with implementation, and later, PPE. By about
the fourth week, we began to get good results,
and we’ve worked our way from three to four
telehealth visits per day to around 10.”
Professional burnout was a real threat for
Dr. Swicegood, who felt responsible for his team.
“I’m committed to these people. I was concerned
about their health insurance. They have families
and children. You can’t just furlough somebody
and leave them no health insurance,” he said.
“You can’t just say, ‘oh, go get unemployment.
You’ll be fine.’ This was the thing that weighed on
me the most.”
John Swicegood, MD
The doctor’s burden didn’t end when the
clinic started assuming some regularity. “I still
have trepidation about it. We don’t feel the virus
is understood, we don’t see promising treatments,
we don’t have a vaccine, and we look for
a resurgence in the fall. I see this going on for
quite some time. I wonder if the clinic can survive
the additional cost and reduced patient load. If
we have a new wave of COVID-19, every patient
I have is a high-risk patient. As long as we don’t
get our practice interrupted again, I think we’ll
make it.”
Clinic employees are continuing to pull together,
assured Office Manager Cindy Swicegood,
who runs the office with positivity. “We are all like
family here, and we understand each other,” she
said. “We are strong and determined.”
Clinic Meets Patients Where They Are
Although Randy Walker, MD, never felt his
practice was threatened with extinction during
this pandemic, he and his clinic in DeQueen met
plenty of challenges and fought to conquer them
in an area of the state that lost its hospital in February
of 2019.
Dr. Walker is a board-certified
family medicine physician there
and with help from three nurse
practitioners, he usually sees
around 90-100 patients each day.
To bridge the area’s gap in care,
the clinic was already keeping extended
hours (seven days a week)
with an on-call nurse in place for
emergencies. In addition, they had
already established relationships
with other area clinics and had some telemedicine
options in place.
Office Manager Angie Walker explains how
the clinic went into overdrive at the onset of
COVID-19.
“I don’t think we’ve seen as dramatic a hit as
some clinics have,” said Angie. “At the beginning,
we had a day or two where we were throwing a
little bit of extra equipment in place, but really,
we adjusted pretty quick. We took on the mindset
of, ‘okay we’re going to make sure patients
know that we’re here, we’re going to take advantage
of getting their wellness visits done, and
we’re going to do whatever it takes to care for our
patients.’”
Reaching out to patients was already somewhat
routine for the Comprehensive Primary
Care Initiative Clinic, but as the pandemic hit,
the staff took things up a notch. Angie explained,
>>Continued on page 14.
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Volume 117 • Number 1 JULY 2020 • 11