Adapting Care During COVID-19: Q&A with Brett Smith, DO

Dr. Smith

The COVID-19 global pandemic has disrupted rheumatology clinics and practices all over the world. In the U.S., many providers have used telemedicine to expand access to care for their patients while managing in-person visits. Brett Smith, DO, who practices at the Blount Memorial Physicians Group, East Tennessee Children’s Hospital, Knoxville, spoke with The Rheumatologist about his patient care experiences during the pandemic and recommendations for the COVID19 vaccine.

TR: What have you learned during the current pandemic?
Dr. Smith: During the pandemic, I have learned how quickly our world can change and how little control we have over many events. These changes create significant stress in our lives and in the lives of our patients. Part of this stress is due to our expectations and where our hope lies. I have continued to learn that our expectations are not how the world operates, and we must continue to have hope in something greater than the brokenness of this world.

In a turbulent year, I continue to learn how much our patients trust us. They are openly asking how to handle their immune suppression, timing of vaccination administration and bringing their anxiety to us.

I’ve also learned it takes not only physical stamina, but continued emotional and mental stamina. It’s one thing to know you are on a rotation in residency for 30 days. It’s entirely different to be working and living in a pandemic with no clear end in sight. Although difficult, this too shall pass.

TR: What are you telling patients about the COVID-19 vaccination, and how are you using the ACR Vaccine Guidance/COVID-19 Guidance?
Dr. Smith: Patients have started to inquire about the vaccine status and what my recommendation will be about the vaccine. My response currently is that vaccines are highly effective for various infectious diseases, and a COVID-19 vaccination is likely to be effective. But I cannot form a formal response until I see the data.

After the vaccines are available, I expect a surge of patient encounters and phone calls to discuss the vaccine. I’m currently advising patients to await the publication of the clinical trial so we can evaluate the data.

The ACR has expressed it may strongly recommend administration of a COVID-19 vaccine once available. I believe this will ease the concerns of patients and rheumatologists alike, knowing the ACR will thoroughly review available data prior to their recommendation for or against vaccine administration.

I share the ACR’s COVID-19 Guidance with patients to improve adherence to immunosuppressants and build confidence in our response as a rheumatology community.

Q: How are patients currently feeling about telemedicine and in-person appointments?
Dr. Smith: Like many other practices, we saw a surge of telemedicine visits in April and May. Prior to the pandemic, we conducted no telemedicine visits. In April, [telemedicine appointments] increased to approximately one-third of our encounters.

Now, we still have patients desiring telemedicine appointments mainly due to concern of exposure to the virus in healthcare facilities and the community. They feel connected to their physician, even through virtual visits, and feel we are acknowledging their concerns about exposure to the virus and desires for continued healthcare access.

Many patients who are on stable doses of medications and have minimal disease activity prefer telemedicine visits. But many patients prefer in-person appointments because they desire a face-to-face discussion and a complete physical examination. A positive note from the pandemic is the expanding visit options offered to patients.

TR: What are your current plans for continuing or ending telemedicine services?
Dr. Smith: If reimbursement continues for telemedicine, I see it being a valuable tool for physicians and patients. I would like to continue to offer telemedicine services even after the pandemic, because I believe it improves show rates for those with long travel times and for those who have jobs with changing schedules. It also allows patients to be seen when they may have fevers, family emergencies or other conflicts.

New patients should be evaluated in person, because the lack of a formal physical exam may make diagnosis and long-term management challenging. So that component will remain, even if telemedicine stays, in my clinic. I plan to continue to offer telemedicine for all established patients.

TR: What are you looking forward to doing after the pandemic is over?
Dr. Smith: I’m personally looking forward to removing my mask in public and during office visits, recapturing the face-to-face interactions and expressions that make up a great deal of our communication.

I’m also looking forward to being able to travel with my family to various parts of the U.S.

Mary Choy, PharmD, BCGP, FASHP, is a medical writer and editor living in New York City. Dr. Choy is director of pharmacy practice at the New York State Council of Health-System Pharmacists. She is also the author of Healthcare Heroes: The Medical Careers Guide.