Cold-weather medicine: Barriers to care that patients may face in the winter

After fall, winter is my other favorite season. Fuzzy socks, big blankets, hot chocolate … I think of winter and see some of my favorite things. I embrace the cold air because I have a warm home and dependable transportation readily available. I’m also from Florida, so my experience with the cold might be a little limited. However, now that I’m a resident of New York City and I’ve come to experience a few true winter months, I realize that not everyone who comes into the hospital or clinic feels the same way.

In the emergency department (ED), patients come to us for myriad reasons. Chest pain, shortness of breath, falls. Sometimes they come in for refills of their blood pressure medications. Sometimes they come in for wound checks. Sometimes, as it turns out, they come in because they’re cold. I remember a specific day during my last ED rotation when one patient came in for this exact reason. He was undomiciled, and it had been pouring rain outside all day. It was cold out and miserable. I had taken a Lyft to work that morning because of it.

He came in reporting chest pain, but it seemed like what he really came in for was hunger and cold. He declined repeat lab tests until after he had slept, instead only requesting sandwich after sandwich and blanket after blanket. When his repeat labs were done, I told my attending he was ready to be discharged. “Let him stay a few more hours,” he told me. “No one needs the bed yet.”

Being a resident means that I am always thinking about discharge criteria, but it wasn’t until this ED rotation, when people were literally coming to us from the street, that I realized there were a few aspects of a safe discharge plan I had been missing. My attending that day explained that while we could discharge this patient, we didn’t actually have to.

“He came in seeking shelter, so give it to him,” he said.

The lesson made me think about times I might be missing when I could better advocate for my patients, especially during inclement weather in the winter months. Here are a few of the options I’ve since considered.

Outpatient settings

Offer telehealth visits when able. If you don’t want to leave the warmth of your bed in freezing cold weather, neither do your patients. It’s easy to just schedule in-person visits (they’re often better for many, many reasons), but when you’re scheduling a patient’s follow-up, ask yourself if that visit can be a telehealth visit instead. For those with chronic pain, difficulty ambulating in the cold or snow or high fall risks, a telehealth visit might actually be a safer choice.

Ensure safe transportation

For those patients who do need an in-person visit, ask them if they have safe transportation to and from their visits. Transportation is a social determinant of health and a barrier to health equity. There are a lot of problems we’re expected to address in the short period of time that we have during our visits, but consider asking this one additional question. Just because a patient has no transportation barriers at other times during the year does not mean they don’t face unique barriers during the winter.

For patients of mine who do, I refer them to social work for additional support. I also ask them if a specific time slot works better than another. They might have a family member who can drive them to an evening visit or a friend who can accompany them on a morning off from work.

Offer family visits

As a family medicine resident, I see a lot of, well, families. It’s not unusual for me to treat two siblings at the same time. Our clinic frequently offers paired visits and special clinics like dyad care. When I have a parent trying to traverse the snow in the middle of December three separate times to bring their three children to different appointment times, I reach out to our clinic’s front desk for some creative ways to schedule them all together in order to minimize that burden. (I also like to do this for families in general, which I find to be a really special aspect of family medicine.)

Schedule multiple appointments on the same day

It’s not uncommon for me to also order multiple screenings or images for a patient. When one of my prenatal patients comes in for routine care and they need an anatomy ultrasound scheduled, I encourage them to think about whether scheduling their ultrasound for the same day as their follow-up visit would decrease their health care burden. Again, this can benefit patients at all times throughout the year, but minimizing the number of times a pregnant person has to navigate possible snow, ice and freezing conditions is particularly helpful.

Inpatient settings

Be intentional about discharge time. I come to this suggestion from the personal perspective that if I were a patient, and I could technically be discharged from the hospital at 10:00 p.m. instead of the next morning, get me out of here. However, this isn’t the case for everyone. During the winter, I try to remember to ask my patients about their preferred discharge time.

Consider safe discharge plans for the season

Social workers are a patient’s best friend at all times, but especially during the winter. Patients don’t always describe their home lives or social situations when they come to the hospital for an asthma exacerbation or pneumonia. When they’re admitted, we typically ask them for information like their preferred pharmacy. Then we discharge them and expect them to pick meds up from that pharmacy the same or the next day.

Thinking about routine answers from the context of the winter season may prompt patients to change their minds about some of these answers. The 80-year-old patient who uses a walker every day may be able to walk up the hill to their pharmacy in the summer, but this may not be the case for them when it’s snowing.

Be generous with extra blankets

This one is pretty straightforward. I am not the blanket police—when a patient asks me for an extra blanket, I bring it to them. 

Being there for our patients and taking extra time to consider their specific needs in colder weather can help them feel more confident that they’re receiving the care they need, even if it’s as simple as getting them a hot beverage.

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