Transcript
My name is Ghassan Abou-Alfa, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York.
As we are all living through the COVID-19 pandemic, by all means many questions come and arise to all of us as humans. We're asking the same questions, like all patients as well, who are worried. We're worried about our families. We're worried about our patients. We're all worried about everybody. And by all means this pandemic came from the left field and left us in a rather very perplexed situation.
By all means, we are seeing ourselves working and interacting with our patients more into the virtual world in what we call telemedicine. Telemedicine is not new to any of us; however, some institutions have been way ahead compared to others, and now, we are all into it because of necessity.
If anything, we're discovering a lot of value, a lot of advantages, but at the same time understanding some of the limitations to it.
One big advantage within the context of the COVID-19 pandemic is that patients are within their comfort and safety of their place, and as such, interacting with them through a video link component and, at worst, through a phone call might give them a lot of reassurance and comfort about risking them to get or acquire the COVID-19 infection.
Another important component which is a big advantage is that it's a great opportunity for us to actually see patients and see how they interact within their own environment. Remember, we see them in the artificial environment of the clinic. Now that we see them at home, it might give us a good opportunity about how they interact and how do they move around, and this can give you a great assessment of their performance status that you might not necessarily be able to get as much except by questions in the clinic.
How to do physical exam online? I would say that, admittedly, I am not an expert in any way, but interestingly, at this point in time, we are all evolving through what we can and cannot do. I give a lot of credit to a lot of the ideas that are coming from our colleagues and added some myself, like others.
For example, by all means you can ask patients to get their weight. Everybody has a weighing balance at home. It's a good idea to at least get the weight. Maybe you will not get the whole set of vital signs, but at least the weight. You want a temperature, that's also doable. A heart rate and the respiratory rate, by all means, are doable but they need some training if they are not really versed into that.
A journal assessment and the KPS is definitely doable. You can even have patients move around with their mobile phone and see how they move, how they track. This gives you a lot of clues about what they're capable of.
You can read the environment, where they are living. How they are sitting. Are they on a reclining couch all time? Are they sitting on a less comfortable chair, etc? Can really be a lot of clues that can provide you more information.
I got asked the question, “But you can't use a stethoscope online?” Of course you can't, even though, historically, we know that the RFDS or Royal Flying Doctors of Australia, used to have a stethoscope that connected to the radio in the old days. Now, of course, with electronic age I'm sure we're going to see stethoscopes and those kind of gadgets in our hands in no time.
Nonetheless, until then, you still can get some clues from your patients as they interact with you. Remember, you can see accessory muscle use as they are talking. You can see they're holding their breath as they answer a question. Maybe you will not get the accurate respiratory exam, but at least can give you some clues within the context and limitation of what we are dealing with.
More importantly, though, there's an important opportunity for talking to patients, and sadly, sometimes we have to either spell out some bad news and sometimes, unfortunately, some very unfortunate news about a CAT scan result, or maybe about the outcomes and course of care.
Very important, the same way we practice it in clinic. It's very important to pause, give the patient a chance to interact in-between. No rush on phone, same way on the video, same way as in clinic. It's to bring it in one piece at a time and let the patient reflect.
Also, if you think the patients are not ready or you feel like you have to stop it somewhere because there's more need for reflecting on whatever has been discussed, that's okay. Schedule another call. Let them reflect on it. You don't have to rush it all in one session.
I'm sure I've learned more from many of you, but, if anything, we're teaching from all, from each other, and we'll try to, hopefully get into a better grasp of the telemedicine that's coming to us in oncology, the same like in other disciplines.
However, it will not undermine the ultimate necessity for us to see patients. If anything, we will use it, it’ll probably be one of those things that will stay with us. We're going to probably forget about hand shaking as we move forward. A lot of things are going to be quite different as we move on with the pandemic and sort it out, but I think the telemedicine component is going to be more apparent and more useful and more helpful for us.
Within that component, a third issue that is brought up, beside the patient care, beside the fear about the COVID-19 pandemic, beside the research, and beside the telemedicine, is operational components.
We are, at the moment, living in a very dynamic state. In other words, things are changing and evolving very quickly in front of our eyes. I would say a very prompt and very efficacious way of bending our operations will be needed because we might not even use the same operational components that we decide on today and apply them tomorrow.
Nonetheless, be as nimble as possible and be as efficient as possible. I would say that contrary to our biggest fear beforehand about the need for making sure that everything is really well delegated with regard to how we're going to do things (I need the office to call, I need to connect), we've got to help each other. That's to make sure that we'll be as efficient as we can and just act on the problems.
I wish you all to be safe and I hope this all will be behind us in no time.
We're going to continue to take care of our patients with cancer, and hopefully will gain the learning experience from this opportunity that we never wished or hoped for. But at least, let's take the process from it and learn from them so we can take care of all patients better.
Thank you, and hope to see you soon in-person at some of the meetings.
