A Transition to 90% Telemedicine: Q&A with Karim Masri, MD

How are COVID-19 and current restrictions on physical distancing affecting rheumatologists? The Rheumatologist interviewed Karim Masri, MD, to ask how the pandemic has changed the way he and his clinic staff deliver patient care, and how these unprecedented times affect patients, staff and life outside the office.

Dr. Masri is a practicing rheumatologist at Bon Secours Rheumatology Center, Richmond, Va. He earned his medical degree at the American University of Beirut, Lebanon. He completed his internal medicine residency at the University of Kansas School of Medicine, Wichita, followed by a rheumatology fellowship at the Johns Hopkins University School of Medicine, Baltimore.

Karim Masri, MD

Q: How are you and your staff adapting to the sudden changes brought about by the pandemic?
It was difficult initially. As the shockwave of the pandemic became real and the mandate that we have to avoid each other to minimize spread, our acceptance of what needs to be done and implementing it happened rapidly. Staff have recruited their families to help with childcare while they are at work. Puppies still go to playgroup.

Q: What types of appointments are you conducting?
We’ve transitioned to telemedicine almost 90%, either via Doxy.me or Epic MyChart, or by telephone calls if patients do not have access to telemedicine technology. New patients are still being seen in person for first-time visits according to the providers’ choice. We are not changing or adjusting any patients’ immunosuppression treatments. We are prescribing as normal.

Q: What are you telling patients about COVID-19’s potential risks and symptoms? What are their chief concerns?
We are telling our patients not to withhold their immunosuppressive treatments, so they minimize their risk of a flare. A flare would require taking prednisone, which is worse than their immunosuppressive therapy when it comes to infection risk. We are counseling [contact] avoidance with social distancing and remaining home, if possible. This is allergy season, so we are disseminating education on the differences between allergies and viral infections. Patients are able to get access to care via telemedicine. Lab testing is also being ordered for patients preferring telemedicine.

Q: How is this affecting you and your staff personally?
I do not speak on behalf of my staff or my employer, Bon Secours Mercy Health (BSMH), but the risk of furlough was the biggest concern for staff due to BMSH reporting last week. But thankfully, it has not affected staffing in our clinic yet. Frustration weighs heavy during this time financially, because some staff do not have savings to rely on, while others have savings locked in the market.

We do not know what will come with the transition to 90% telemedicine regarding jobs. Salaries may be reduced, but this is unknown yet. Telemedicine had been stressful from a logistics and practical standpoint. There was not much guidance initially, but BSMH was rapid and efficient in activating the telemedicine encounters via our electronic medical record, Epic, and they have been supportive with this transition. Patients are being called and screened prior to their appointments, and they’re rescheduled if ill or exposed and/or redirected to appropriate clinic/screening services. Our workflow is developing, and efficiency is improving. Patients are being seen and accommodated readily, which is not affecting patient care.

I am happy and proud to work for BSMH, because they have rallied the troops with good leadership. Mentally, it’s business as usual as we are trained to adapt to change. Emotionally, it has been stressful. Access to patient care has not been disrupted, and that is the ultimate goal.

Susan Bernstein is a freelance journalist based in Atlanta.