PracticeUpdate: The COVID-19 pandemic has disrupted many elements of society. What are the most notable ways that it has changed the way oncology practices operate?
Dr. Henry: Well, this has been a huge impact on our practice of oncology, which largely these days is outpatient. So, patients are afraid to come. We had to be sure in making things safe here for us, for them, for our treating nurses in the infusion suite. We solved that pretty quickly, I think, but then we couldn't see a lot of these patients unless they were getting chemotherapy, and we tried not to see them as much. So the net of this was, these patients who are sick and having a terrible time in their life of getting through this, hopefully successfully, can't see their doctor as much, their nurse as much, or their caregiver, and had to be treated on an outpatient setting.
We tried to flip that to infusions at home. Then, inpatient, we'd have to get all gowned and glove, patients gowned and gloved, and the family is not allowed to visit. I should have mentioned the outpatient setting also. I'm just seeing this one person who is maybe terrified of getting a cancer treatment, maybe it's new, maybe not going well, has to be alone, same thing in the hospital. It's a very upsetting, frightening experience for many of our patients who didn't get as much care as we would like to give or not as personal as we would like to give.
PracticeUpdate: What changes have occurred on the inpatient side to accommodate the social distancing safety measures?
Dr. Henry: On our inpatient side, what used to happen? Well, we would talk about the patients we were about to see. The team, the attending, resident, couple interns, some students go into the patient room, often family would be in there, and we would many times, if something was changing, sit down and talk. Not happening. The patient can't have a visitor unless desperately ill. The visiting physician is usually either one or the other, either a house officer or attending, not both. Why have both exposed to patient, patient to physician? No sitting down and talking about the patient at the nurses' station or some conference room because we can't all get together. It's become much less bedside, much less collegial talking it out to each other, to the patient, than before.
PracticeUpdate: What impact do you think the new rounding structures have had on delivery of care for hospitalized patients?
Dr. Henry: I think it's made it a lot less personal. We are only one in the room, one at the bedside, family's not there to help the patient ask other questions. When you're a patient, you're so focused on what's frightening, you may forget to ask simple questions, then your significant other or family says, "Why didn't you ask him about this?" And they say, "Oh, I forgot." Or "Did you remember what he said?" "No, I forgot." So, it's really changed the personal nature of exchanging information to patients, them to us, us to them.
PracticeUpdate: What challenges do patients and providers face with the increased use of telemedicine in the outpatient practice?
Dr. Henry: We can actually do a fairly good job interviewing each other, either by video or by phone. It completely deletes the ability to do some bedside examination. We're all taught about [how] touch for the patient is very helpful and warm, for the patient feels cared for. So that's missing. I think absent that, almost 90% of the exchange of information can occur. When I do my tele-visits, phone or video, often others are involved, so you may hear family or friend right there with the patient, either on screen or in the background, being sure questions are asked and everything is answered. So, it works, minus the in-person visit, but works 90% of the time.
PracticeUpdate: Do you anticipate that our experiences with these new practice methods will lead to longer-term changes even in a post pandemic world?
Dr. Henry: We caregivers talk about this all the time. Will this change? The way we deliver care. I think it will. We lived in an era that didn't have telemedicine in 1980s besides the phone. Now, we have all these abilities to do much more personal electronic care via the web, the phone, the video. I think we're finding out that for a certain subset of our population, this can work. Of course, billing structure, what are you doing that's different? This will have to be worked out, but I think in terms of getting the same information and care accomplished for a subset of patients, this will work after this epidemic's all over.