How are rheumatology professionals affected by the physical distancing and other challenges presented by COVID-19? The Rheumatologist interviewed Adena Batterman, MSW, LCSW, senior manager of inflammatory arthritis support and education programs at the Hospital for Special Surgery, New York, to discuss how the pandemic has changed the way she and her staff maintain continuity of care for their patients.
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Q: How are you and your staff adapting to the changes brought about by the COVID-19 pandemic?
As the hospital’s response to New York City’s needs regarding COVID-19 has evolved, more and more rheumatology patients have been accessing non-urgent services via telemedicine. Still, there are essential rheumatology services in place for our patients who need to be seen on site. In our hospital, social workers are essential personnel and continue to be available to address the essential psychosocial needs of patients in person or virtually to help them manage their conditions through this crisis.
In our department, some staff members are working from home, while others are on site on a rotating schedule, depending on patient need. To support our staff, our hospital is providing childcare benefits to employees working on site and at home—[aiding] employees with children or those in caregiving roles to elderly loved ones—and [providing] transportation for staff, if their commute is affected by social distancing guidelines.
Our rheumatology social workers have developed long-term relationships with many of our patients. This is challenging work, physically and emotionally, especially when so many of our patients are in a state of crisis. We are all, as individuals, professionals and a country, experiencing this trauma together. We all have families, friends, colleagues and loved ones who we worry about, and we’re all trying our best to process this [pandemic] and stay grounded.
One universal theme, I think—for all my colleagues right now—is the concern that we are keeping our families safe and taking care of ourselves, while also being present for and taking care of our patients’ needs and concerns. An essential support throughout this [crisis] is the leadership in our department and our hospital. There is transparent and frequent communication, and the sense that, together, we are committed to caring for our patients, communities and staff.
Q: How are you using telemedicine or other technology right now?
The Hospital for Special Surgery has many well-established, disease-specific support and education groups. We needed to ensure these supportive communities continued to be available to our patients, especially now. It’s been a quick learning curve. We have now transitioned all our support and education groups and patient education lectures to virtual platforms—all in a matter of weeks. Our clinical social workers and group facilitators have now had the experience of running virtual group sessions with excellent patient participation.
Patients are quickly learning to use this technology, [because] they need to be connected to essential sources of support and feel a sense of continuity and community. Our group members share that the opportunity to see, speak and connect with us, [as well as] their peers who understand the specific challenges people with rheumatic illness face, are of particular value.
We’ve created staff forums to help support and learn from each other as we have transitioned to virtual platforms [and] to share vital information and lessons learned as these initiatives roll out. Much of our work with individual patients has also been done by teleconference, [because] many of our patients are at home. We are in the process of rolling out telemedicine for social work interventions, alongside our medical colleagues.
Q: What are your patients’ chief concerns about COVID-19’s specific effects on people with rheumatic diseases, such as increased infection risk or access to medications?
Many of my patients, all with some type of inflammatory arthritis, are on immunosuppressant medications. Many have comorbidities, which contribute to concern about [COVID-19] risk factors. Some patients have reached out to their rheumatologists for information and reassurance about staying on their medications or what to do should they start feeling ill. Already underlying, familiar concerns about being at higher risk for complications with viral and bacterial infections are now amplified by COVID-19.
I have spoken with patients who have not felt comfortable reaching out to their doctors, and some of these patients have decided, on their own, to stop their medications. Patients have shared guilt around contacting their clinicians due to reporting of how busy clinicians are with COVID-19 patients. We have worked with patients to proactively assure them the clinical team continues to be available to them, and they’re not adding an additional burden. Our discussions include encouragement and support to connect with their rheumatologists to discuss their specific clinical picture and to work out a plan together.
Some patients have had difficulty accessing medication or worry about when they’ll need to refill [their prescriptions]. We’ve helped problem-solve these issues, sometimes speaking to pharmacists or helping to find pharmacies with an adequate supply [of drugs].
Q: How are you and your staff helping patients manage the psychosocial effect of the pandemic on their daily lives?
Lives have been turned upside down. People are grieving the loss of normalcy, routine and being able to connect with friends, family, colleagues and loved ones—all while continuing to manage a chronic illness. Some of my work around this [subject] is helping patients find ways to feel more grounded in the present and take this day by day. This [help] involves supportive counseling, mindfulness and breathwork, and in part, sometimes simply acknowledging their experiences. When appropriate, using selective self-disclosure to underscore and acknowledge some mutual challenges and concerns we share during this time can be an important intervention.
We also discuss minimizing stressors and connecting with activities that feel joyful and nourishing, whether that’s going for a walk, listening to music, connecting with their religious or spiritual communities or practicing mindfulness.
Sheltering at home with others in close quarters, without the ability to get out as often [as they would like], can be emotionally charging [to patients]. Relationships and communication may be strained. This [effect] is especially amplified if relationships were strained before sheltering at home. Some patients are taking care of or are isolated from children, older parents and family members, so their concerns are, of course, amplified. Some worry about or have had loved ones, friends or neighbors become ill or die, and they are grieving. Some have lost employment, are experiencing food insecurity, are faced with lack of access to medication and have concerns about continuing to pay for other essential immediate needs.
In real time, all my social work colleagues are learning about newly created resources, many of them online, to accommodate patients who are unable to access them in person and are sharing these with each other.
Susan Bernstein is a freelance journalist based in Atlanta.