Physicians and Patients Turn to Telemedicine Amidst COVID-19 Pandemic 


As the COVID-19 pandemic continues to escalate, patients have been asked to turn toward telemedicine — communicating with their physicians through online appointments and video calls — in place of their in-person appointments to mitigate the spread of the virus. 

This has been a shift for both parties: those receiving, and those providing, clinical care. 

“I think that COVID is affecting all aspects of clinical care,” Hala Borno, MD, medical oncologist and assistant professor of Medicine at UCSF, told UroToday.com. “It's affecting the way that we interact with patients. It's affecting the treatments we're making, the diagnostics that we're collecting, really all aspects of clinic, and a lot of it is because there's an imperative for risk reduction,” Dr. Borno added. 

Telemedicine is not a new phenomenon — health insurance companies have long offered patients the option of speaking to a provider online, instead of visiting an urgent care clinic, for example. Previously, patients have often decided against utilizing telehealth, opting instead for a traditional face-to-face appointment or clinic visit. A 2018 study published in the ASCO Educational Book noted that teleoncology practices can be at a minimum consistent with in-person care. The publication noted that teleoncology could play a vital role in increasing access to oncologic care by redistributing the work force.1

But the COVID-19 pandemic has asked physicians to quickly make their practices and treatment regiments telehealth compatible in order to minimize the risk of exposing their patients, hospital staff, and themselves to the novel coronavirus. 

At UCSF, Dr. Borno explained that she has shifted “most clinical encounters to be remote-based, to use telemedicine, whether it be Zoom, WebEx, or the telephone to touch base with the patient, make sure they're fine, to collect the clinical outcomes that we're interested in.” 

Looking forward, Dr. Borno hopes that a positive outcome of the drastic shift toward telemedicine in the face of the pandemic could be increased access to specialized care. “This actually may make clinical care and clinical trials more inclusive and accessible,” Dr. Borno said. “It certainly can help obviate the need for excessive travel to specialized centers, which tend to be in more urban contexts.” 

In early March, the Trump administration announced that previous rules limiting the use of telemedicine would be waived for Americans insured by Centers for Medicare and Medicaid services, which covers over 140 million people. 

In a statement, CMS said: “During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services.” CMS also said that providers could evaluate patients with access only to audio — a shift from when telemedicine was defined by CMS as requiring both audio and video. 2  

Now, physicians and patients are turning to telemedicine to not only receive continued medical care, but also to consult about whether symptoms they might be experiencing could be COVID-19. By encouraging patients to use telehealth methods to converse with a physician prior to coming to a hospital, physicians and public health officials note that those with mild symptoms could be told to self-quarantine — without exposing others during an appointment or emergency room visit.3 

At Mount Sinai Hospital in New York City, telemedicine techniques are well underway. Chief of the Division of Hematology and Medical Oncology William Oh, MD, explained in an interview with UroToday.com: “So (for) my clinic on Monday morning, we've canceled about half of the visits.”

Similar practices are being used by physicians globally. At the Institut Gustave Roussy in France, Head of the Department of Cancer Medicine Karim Fizazi, MD, Ph.D., is conducting much of his clinic over the phone. “You can ask them how (they) feel, how they're doing their treatment, most of it can be done by the phone,” Dr. Fizazi said in an interview with UroToday.com

But not all appointments can occur virtually. For patients scheduled for injections or radiation treatment, physicians are now weighing the risks of pausing treatment against those of their patients acquiring COVID-19 — and many are reconstructing their treatment plans. 

“I think that for many (patients) it is possible even that leaving their homes, coming to a clinic, waiting in a waiting room, being exposed to healthcare personnel — perhaps even in the context of a hospital-based clinic — could present more risks to them than skipping that appointment altogether and simply staying home,” said Chief of Oncology and Hematology at the University of Minnesota Charles Ryan, MD, in an interview with UroToday.com. In conversation with Alicia Morgans, MD, Associate Professor of Medicine in the Division of Hematology/Oncology at the Northwestern University Feinberg School of Medicine, Dr. Ryan noted that physicians are being cautious about the use of cytotoxic chemotherapy during this time, and said that for patients receiving Lupron® injections, it might be of greater benefit to delay injections for the time being. 

“A delay (of this kind) … is probably a minor delay and a minimal health risk compared to what we're seeing as a global public health risk for simply venturing out,” Dr. Ryan added. 

Making these treatment choices is not easy, but it is necessary. “'I'm having some really hard conversations with some of my patients about the treatment choice, whether they want to start with something like docetaxel chemotherapy in this setting in combination with their ADT or whether they'd prefer to use an AR directed therapy,” Dr. Morgans said. “At this point, given the equivalent efficacy that we appear to have and the differences in terms of what these therapies cause in terms of the immunosuppression, for any patient who has not yet started therapy, we're actually pursuing AR directed therapy.” 

Relying on Telemedicine “is a learning process,” Dr. Oh said. “But I think the goal is to really minimize exposure of the patients for the need to come into Mount Sinai, and vice versa, for our patients who may be carrying the virus to come in and expose staff and other patients. So we are taking a very aggressive tact towards this.” 
References: 

  1. Sirintrapun S., Lopez A. “Telemedicine in Cancer Care” American Society of Clinical Oncology Educational Book, Book 38 (May 23, 2018) 540-545. DOI: 10.1200/EDBK_200141 https://ascopubs.org/doi/10.1200/EDBK_200141 
  2. Lantry, L. (2020, April 1). Medicare and Medicaid patients get temporary access to telemedicine amid coronavirus crisis, but challenges remain. Retrieved from https://abcnews.go.com/Health/medicare-medicaid-patients-temporary-access-telemedicine-amid-coronavirus/story?id=69895621
  3. Abelson, R. (2020, March 11). Doctors and Patients Turn to Telemedicine in the Coronavirus Outbreak. Retrieved from https://www.nytimes.com/2020/03/11/health/telemedicine-coronavirus.html
Written by: Elise Ryan, Brown University, Providence, RI