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This article raises and addresses several concerning indirect effects of the COVID-19 pandemic on routine care of patients with pulmonary diseases. Topics include both benefits and shortcomings of telehealth with suggested strategies to maximize positive impact of virtual encounters, as well as considerations when deciding whether the risk of exposing a vulnerable patient to the healthcare setting is worthwhile to achieve a diagnostic or treatment modality.
This paper suggests strategies to best balance continuing diagnostic and treatment pathways while being cautious of unnecessary healthcare setting exposures for these vulnerable patients.
– Amy S. Korwin, MD
This abstract is available on the publisher's site.
On a new-normal afternoon of calling patients virtually for follow-up visits, I was jolted by a conversation that typically would have ended with a seamlessly executed plan. I called Ms. M, my 67-year old patient with interstitial lung disease. She promptly answered the phone, having been recently reminded of her virtual appointment by our clinic coordinator. She explained that she was still coughing, and that perhaps her dyspnea had worsened, though it was hard to tell as she was sheltering-in-place. As our conversation went on, I was slowly becoming aware that the challenges of this visit were going to transcend beyond the initial stumble of how to check someone into the virtual waiting room. Exactly how far could she walk before having to stop because of dyspnea? Did her lungs sound different? Had her FEV1 declined? Was her fibrosis progressing? Was a CT scan worth exposing her to the risk of COVID-19 infection? Would I increase immunosuppression even if it was progressing? Each clinic visit now posed these new and unanticipated dilemmas.