Tauseef Ali, MD, on How I Practice Now

Dr Ali talks about how the pandemic has affected his gastroenterology practice, how the recent increase in incidence of COVID-19 in the middle of the United States is complicating care, and the challenges clinicians and patients alike are facing, particularly in cases of immune-suppressed patients with inflammatory bowel disease and those recovering from liver transplant.

Tauseef Ali, MD, is a gastroenterologist at SSM Health/St Anthony Hospital in Oklahoma City, Oklahoma.

Transcript:

Hello, everyone. I'm Dr. Tauseef Ali. I'm a consultant gastroenterologist at SSM Health St. Anthony Hospital, Oklahoma City, Oklahoma. This is the month of November. The year is 2020.

We have more than 30 million people suffering from COVID-19 and about a million deaths in the world due to COVID-19. This has certainly brought sadness, fear, despair, and strain to our societies. Today, I'm going to be sharing with you as a physician, how I am practicing in this pandemic.

While we are getting frustrated, there is strain on our society and health care system, but I have watched and witnessed some colors of humanity, resilience among ourselves, innovation and hope.

If anything this pandemic has taught me in my practice is that we cannot live alone. We need to believe in science and evidence.

We identified who are the real heroes in our life—our nurses, our health care staff, they are all at the forefront on this pandemic. The health care system has been affected by many aspects, the whole health care delivery system where the deliverers are the physicians, health care staff, nurses, the delivery system.

Let's see how the deliverers or the physicians got affected. How we are practicing. What are the difficult situations that we are facing. As a physician, in the first phase of this pandemic, we were frustrated, because we didn't know how to answer a lot of questions that our patients were asking. That was making us frustrated because this is not how we were taught. We were taught to give answers, to heal our patients. This time, we didn't have anything to tell our patients. That frustrating phase was very difficult for us.

Soon, we learned a lot.

Thousands of collaborations around the world happened. We got publications. We got evidence about different aspects of this pandemic. As a gastroenterologist, I learned that this pandemic, this infection, can affect your gastrointestinal tract. Many patient's scans present with gastrointestinal symptoms.

We became very careful. We also learned that, in gastroenterology, we have many immunocompromised patients—patients with liver transplant, patients with inflammatory bowel disease, on immunosuppressive therapy—and how to take care of our patients.

After this initial phase of not knowing what to do, we entered into an era of virtual visits, reassuring our patients from what we have learned so far. Now we are moving forward. Things that have changed in my practice are virtual visits, telemedicine. It became an important tool to communicate with my patients. There are different limitations that I was challenged with. Which platform to use? How to use it? Training my medical staff how to schedule patients on daily visit platforms.

From a patient's perspective, we have challenges with patients who have issues with technology. They didn't have resources to utilize technology. Patients had to learn how to conduct an interview and communicate with the physicians on televisits.

They were not used to talk to a computer telling them their complaints. This was very unusual for the patients also. I had patients who were very shy coming to the camera. I had patients who didn't know how to communicate in front of a camera.

There was a limitation. There is still a limitation about having that sixth sense, having that feeling of touch—body language that tells us a lot when we are talking to our patients. We still miss that part.

As the pandemic eased, we started having our patients coming back to our clinic. We were seeing them but there was a different routine for them. They were getting their temperature checked before entering the building. They were getting asked a lot of questions. To some of my patients that was very frustrating. They were not allowed to have a lot of family members with them in the room. Social distancing, waiting room structure, it all changed. This is a difficult time for our practices.

We have staff whose family members were sick. They had to quarantine themselves. Some of our staff got furloughed. Our health care system got a financial impact. That led to change in our practice pattern. We had limited staff in the beginning. We had staff working virtually from home. That changed the communication style of our practices.

I do a lot of endoscopies. Endoscopy scheduling got changed. We had to hire more personnel Before performing any procedure, we had to get our patients tested for COVID-19. Patients who lived long distance had to get this coordinated, where they can get the test done. Then someone can communicate the results to them.

It was quite frustrating when we saw a lot of patients getting COVID-19 positive. We had to relay that information timely back to them and to their primary care physician. That did put a strain to our endoscopy center.

Besides endoscopy, besides the actual delivery of health care, we saw a difficult time in terms of choosing medical therapy for our patients. Most of my patients have inflammatory bowel disease. They need to get on immunosuppressive therapy including IV infusions of certain drugs. We were having a difficult time selecting and identifying infusion centers and getting our patients to those infusion centers in timely fashion.

We are still struggling. A lot of infusion centers changed their SOPs and cannot accommodate patients in timely fashion. We are still struggling with a lot of payers getting these drugs approved in a timely fashion. They're also getting strained. They're getting an impact and are short staffed. When our clinics call the payers and the insurers for benefit verification, prior authorization, we have a long waiting time now. That does impact the health of our patients.

Selecting a therapy, selecting a test is a challenge now, especially when I'm conducting my visit through a televisit. Remotely, I had to identify a process. How these tests will be done. How the medications will be delivered. How I will follow up with my patient. We are redefining and refining all these processes as we are going through this pandemic.

If this was not enough, in Oklahoma, we saw a surge of cases. Our hospitals are full capacity right now. That's putting stress and strain to our health care systems. We want our patients who are at risk to be safe. Those patients who are not at risk for COVID-19, we want them to be safe and healthy. They do not need to come to the emergency rooms, urgent cares, so they do not create an extra strain to the health care system, which is already working at its full capacity. The message about masking and social distancing is becoming extremely important.

We are making our best effort that our patients understand the science behind all these recommendations. If they don't have the knowledge about why we are recommending this, it's hard for them to practice and carry out all these recommendations.

In terms of procedures, we are making all our priorities to get our emergent and urgent procedures done, but we are pausing to schedule our elective cases. That's going to have its own consequences later on. These elective cases are elective, but they are important.

When we talk about health, preventive health care measures are also extremely important. There has been a debate about who's going to take charge of vaccination, especially in our at-risk patient population. In gastroenterology, we have our Crohn's and colitis patients. We have our liver transplant patients. We have patients who have other autoimmune diseases who are supposed to be on immunosuppressive therapy or who need to be vaccinated to prevent any illnesses or infections.

In general, the majority of gastroenterologists were making recommendations to the primary care physicians to carry out these vaccinations on schedule. With televisits, with limited resources, we are all in it together.

We are making sure that wherever, whenever we get a chance, we help our patients get vaccinated. We are giving them resources. We are providing them information. They can go to their pharmacy. They can go to their nearest place where vaccinations could be available. It could be Walmart, Walgreen, retail pharmacies, or their specialty pharmacies, or our endoscopy center, our infusion centers, our gastroenterology specialty clinics. Wherever we can help them and however we can help them, we need to get them vaccinated so that they don't get sick, they don't get an unnecessary infection that can put an extra strain not only on them, but to our health care system also. That's a very important message that I want to share with all the listeners.

This is wonderful that we are making use of technology. We are learning how to interact globally now, sharing our experiences, so that we can learn from each other.

I hope we all stay safe, and we recover from this pandemic. We learn as a society that we all need to be working together. We cannot live alone. We need to listen to the science and the evidence behind all these recommendations and follow those recommendations.

Only then we can be a successful society and can come and we can prevent all the health care consequences that might happen even when the pandemic is over. We need to face those challenges. I hope this was a useful exchange of information. Stay safe. Thank you.