As the COVID-19 pandemic swiftly, radically changes daily life, rheumatologists, rheumatology professionals and clinics are adapting as quickly as possible to protect and continue to care for their patients. Some say their practices have implemented telemedicine, using teleconference software, such as Zoom, or smartphone-based apps, such as FaceTime, for many appointments. This approach allows patients to stay in their homes, limiting their risk of infection by SARS-CoV-2.
Telemedicine Use Soars
“I am now practicing telemedicine, which has provided a helpful way to maintain contact with patients remotely, while everything is shut down,” says Susan M. Goodman, MD, a rheumatologist at the Hospital for Special Surgery, New York. She is working from home and simultaneously helping take care of her grandson.
COVID-19 is affecting her patients’ lives as well. “A major effect is the difficulty in getting hold of hydroxychloroquine because of its putative role in combating COVID-19,” she says. “This has made it very hard to get by for our patients.”
The rheumatology clinic at the University of Nebraska Medical Center, Omaha, is also ramping up remote appointments, says Ted R. Mikuls, MD, MSPH, Umbach Professor of Rheumatology and vice chair for research.
“We are actively building capacity to do more of our visits by phone or via video conferencing,” says Dr. Mikuls, who calls this a challenging and unprecedented atmosphere for his staff, patients and community. “It’s obviously a work in progress, but we are clearly committed to providing our patients with the best care we can under challenging circumstances, to ensure our patients have the best outcomes at the end of the day.”
At Northwell Health in Huntington, N.Y., Christine Stamatos, CNP, says she is consulting with most patients over the phone using FaceTime or Zoom.
“We had been trying to get telemedicine up and running, and we have a telehealth system that we had already downloaded,” she says. Her hospital, which includes both academic and private practices, provided guidance on how to submit bills for reimbursement for telemedicine care. Video appointments bring unexpected challenges, such as how to examine patients with skin ulcerations, she says. “I don’t know if all of our patients will know how to use the technology. And in one FaceTime appointment yesterday, I was trying to talk with the patient, and her kids were there—home from school—jumping on her back.”
Researchers Change Focus
At the University of California, Los Angeles (UCLA), rheumatologist Veena Ranganath, MD, MS, associate clinical professor of medicine, usually spends one day a week seeing 20 patients and the rest of her time in the research lab. Now, she is handling 20 patient consultations a day, mostly over the phone.
“We are seeing some patients in the clinic as urgent consults. I’m also hearing from colleagues that many patients cancel their appointments because they’re worried about leaving the house. One question I am getting from patients is, ‘Do you offer telemedicine?’ Yes, we do,” says Dr. Ranganath, who conducted her first telemedicine appointment on March 19.
“It went much better than I thought it would!” she says. “But this is definitely uncharted territory and creates new ways to conduct medical examinations, where you’re more dependent on technology and listening carefully to your patient. In some ways, it may be good for us, but in other ways, it can be scary.” Video chats make it very difficult or impossible to examine patients with oral ulcers or swollen joints, she notes.
Dr. Ranganath worries about the mental health effects of the pandemic and the disruptions it will have on healthcare providers and staff. She’s also concerned about clinical trials, which are now on hold. “How will we bounce back? If staff are at home and unable to recruit patients, how will we continue?”
Dr. Ranganath tries to take a mental health walk around the area every day. “Or I walk around our house,” she says. “I tell the kids, we have to do a certain number of laps around the house. I have three kids at home, and although they’re a little older, they still expect to be fed, even if I’m working and doing conference calls.”
In New York’s Hudson Valley, Suleman Bhana, MD, FACR, a rheumatologist at Crystal Run Healthcare, says it’s not only a challenging time for healthcare providers at work, but the pandemic has also had a significant impact on their families.
“It’s complete societal disruption,” says Dr. Bhana, who works for a large, multi-specialty group that has taken a proactive, organized approach to the crisis. “We have been aggressively screening any person who enters one of our medical buildings, including patients and anyone who accompanies them. We ask them a series of screening questions for COVID-19, including about travel, symptoms they’ve experienced or direct exposure to a person who has tested positive for coronavirus. If they answer yes to any of them, they’re not allowed in the building.”
His practice has switched to telemedicine for follow-up appointments, but still sees patients for other examinations and laboratory tests. Dr. Bhana also says payers are now reimbursing his clinic’s telemedicine appointments at the same level as regular office visits, which was not the case in the past. He is working at his clinic five days a week to conduct both telemedicine and in-person appointments, and most of his staff is still working in the office. However, he’s changed his usual attire.
“I worry a lot about what I may bring home to my family,” Dr. Bhana says. “I have a 10-year-old and a 5-year-old at home, and my spouse works from home. I usually wear a lab coat every day, with dress pants and a dress shirt. But now I am in scrubs all the time. My lab coat stays at work. When I come home, I can easily take off the scrubs and wash them. I had to adapt.”
Dr. Bhana watched a Curious George cartoon, “Toots and the Germettes,” with his children to teach them how infections are spread and the importance of hand washing.
Life outside the rheumatology clinic at MD Anderson Cancer Center, Houston, where advanced practice provider Barbara A. Slusher, MSW, PA-C, sees patients and supervises staff, has changed dramatically too.
“I haven’t been to the grocery store for two weeks. I have an 18-year-old high school senior at home, and I leave him money and a list so he can buy the groceries. I told him to buy some brownies to bake during the day,” says Ms. Slusher, who lives in Galveston County, where there is a shelter-in-place order for all residents after midnight each night. Her son’s college applications have been put to the side for now, because the university admissions offices are closed.
She says, “My faith is very important to me. I would not be able to do what I am doing without my faith. I have had conversations with my son about ethics. Be good to your patient. Be kind to your coworker. Enjoy your brownie or the breaks you’re able to take. Have a sense of appreciation for all of those small things.”
Susan Bernstein is a freelance journalist based in Atlanta.