Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Preventive Care And COVID


As a gastroenterologist, I’ve been encouraging people to continue with colon cancer screening through the pandemic. A delay may have serious health consequences.

Since the pandemic started, preventing COVID infection has been the top concern for clinicians and the public. But we can’t forget about preventive clinic visits and screenings. As a gastroenterologist, I have been encouraging people to resume lifesaving colon cancer screening!


I recently met a 52-year-old man during a telehealth visit who was referred by his primary care physician to discuss screening colonoscopy. He quickly expressed to me that his greatest concern about proceeding with a colonoscopy is being exposed to COVID in the endoscopy suite. “I’ve been really careful since the pandemic started. I avoid crowds and indoor gatherings, work from home, and wear a mask when I leave my house. Can I wait a little longer, until the pandemic is over?“


I commended him for taking all the right precautions to keep himself and his loved ones safe during this pandemic, and then we discussed how important it is to also continue with preventative health screenings. At the time of his colonoscopy, we found a large polyp in the right colon that we removed. We were both glad he came in. Waiting longer could have been too late to prevent a colon cancer.


How can we encourage our patients to resume routine screenings during the pandemic? Here are my PREVENT tips: 



Bring up the topic of preventive health during any non-acute patient encounter and review the patient’s health maintenance needs and screening tests (colonoscopy, mammogram, pap smear, etc.) they might have put off since the pandemic started.


Risk stratify the patient and Redress the balance and focus from the risk of getting infected with COVID to the consequences of delaying preventative care and screenings.

Assess the urgency to proceed with a screening based on your patient’s age, symptoms, family history, risk factors and time since the last screening. Most people have put off screening tests since March 2020, so even people at low risk should be encouraged to proceed with screening. Plus, while COVID stopped the clock for many medical services, gastrointestinal societies announced that 45 is now the new 50 to start colon cancer screening, putting many people “behind” on their planned colonoscopy!



Educate patients about the value of preventive care. For instance, colorectal cancer is the third most common cancer in American men and women. Yet, it’s  one of the most preventable type of cancer: screening colonoscopies detect and remove pre-cancerous polyps in one step, and diagnose ealry stage cancer when it’s still treatable. Colonoscopy saves lives!



Validate patients’ concerns and emotions around coming into a clinic or hospital, but also inform them about the measures taken by your facility to protect everyone from exposure to COVID and educate them about the vaccination’s high efficacy in preventing serious COVID. In these delicate conversations, talk to patients from a place of empathy and without judgement.



Educate with facts to help patients make informed decisions. In 2020, at the peak of the pandemic, total death from COVID19 came third (345,323 people) after death from heart disease (690,882 people) and cancer (598,932).  Knowing that 1 in 23 men and 1 in 25 women are at lifetime risk for colorectal cancer, and that colon cancer is affecting younger people in recent years, truly highlights the lifesaving value of screening colonoscopy.



Negotiate and find a compromise.  If a colonoscopy is still a daunting thought to a patient, offer alternatives such as home stool tests and explain benefits and limitations of these tests.



Team up with your staff to effectively communicate that it is now safe for people to come into a medical facility for preventive care. People can protect themselves from COVID and continue to protect themselves from other serious illnesses.







This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.