The outbreak of SARS-CoV-2 has disrupted rheumatology clinics and practices all over the world. In the U.S., many providers have turned to telemedicine to care for their patients, while balancing in-person visits. Nilanjana Bose, MD, MBA, who practices at the Rheumatology Center of Houston, Texas, spoke with The Rheumatologist about what she has learned and how her clinic has adapted to the pandemic to meet the needs of patients.
TR: What have you learned during the current pandemic?
Dr. Bose: We all learned firsthand what living and working through a pandemic really was like.
Like most practices, [we found] the initial transition was tough, having to severely curtail in-person visits and prepare for the pandemic. We switched to telemedicine early on, and despite the initial hiccups, we have adapted and integrated it well into our patient care model to seamlessly deliver quality care.
The initial phase of the pandemic was intimidating, having to learn new technology, navigate hurdles in its implementation and deal with patient reluctance and the general fear and anxiety among patients and staff.
Now that we are more than eight months into the pandemic, we are trying to stay positive—while being cognizant of the dangers of quarantine fatigue—and are encouraging our patients to do the same. We are currently offering both in-person and virtual visits. We now have protocols for cleaning and sanitization and an established workflow for staff in case all patient care becomes virtual again.
The most important lesson I’ve learned—nothing new about this though—is that health is wealth.
TR: What are you telling patients about the COVID-19 vaccination, and how are you using the ACR Vaccine Guidance/COVID-19 Guidance?
Dr. Bose: We are anxiously waiting for a safe and effective COVID-19 vaccine. However, we need to be certain of the risk-benefit ratio of the vaccine before we can broadly recommend it to our patients and staff—and ourselves and our families.
TR: What are the current plans for continuing or ending telemedicine services?
Dr. Bose: We plan to continue telemedicine as long as insurance companies and the Centers for Medicare & Medicaid Services continue to provide reimbursement for the service.
This [service] may also be a tool that needs to continue after the pandemic for us to be able to provide services to patients who live far away, cannot travel or have trouble taking time off from work for a doctor’s visit. It seems to me that telemedicine has finally come of age—not in the circumstances we would have liked it to—but on a positive note, it’s here to stay.
TR: How are patients currently feeling about telemedicine and in-person appointments?
Dr. Bose: Pandemic fatigue is real and affects all of us to varying extents. Most of our patients feel comfortable with telemedicine and some want to retain this service even after the pandemic. Some patients are worried about their immune system and the risk to others.
However, we also have patients who prefer in-office visits. Some of them are not comfortable with technology, and some feel that a true doctor visit must include in-person interaction. Overall, patients and physicians have adjusted to the pandemic in different ways to try and keep everyone healthy.
TR: How are reopening plans developing for rheumatology clinics? What changes have been made to resume in-person appointments?
Dr. Bose: We are reopening very carefully. We are trying to balance televisits with in-person visits to minimize the number of people on our premises. We are taking great care to sanitize the office, exam rooms and equipment to the extent possible and mandating universal facemask wearing for patients and staff. We are also trying to limit the number of family members accompanying patients to their visits.
We have plans in place in the event there is an increase in case load and we need to change to virtual care completely.
TR: What are you looking forward to doing after the pandemic is over?
Dr. Bose: I miss social interactions—with my patients, staff, friends and family. I’m looking forward to getting together with friends again, going on vacation, in-person shopping and an overall return to normalcy. I value being able to chat with our staff and patients.
I’m also looking forward to my children being able to return to in-person school and resume their social interactions. We love to travel as a family and look forward to being able to resume that.
Mary Choy, PharmD, BCGP, FASHP, is a medical writer and editor living in New York City. Dr. Choy is director of pharmacy practice at the New York State Council of Health-System Pharmacists. She is also the author of Healthcare Heroes: The Medical Careers Guide.