The outbreak of the SARS-CoV-2 virus is disrupting rheumatology clinics and practices all over the world. In the U.S., many providers are turning to telemedicine to care for their patients, but struggles remain. Philip A. Waller, MD, who practices at Accurate Clinical Research, Houston, spoke with The Rheumatologist about how the pandemic is affecting his research and clinic.
Q: How are you and your staff adapting to the sudden changes brought about by the pandemic?
As of right now, I am still trying to see research patients in the clinic and give them their study medications. However, most studies have been put on hold, and some companies have put global holds on research protocols. … [The clinic has] laid off the majority of employees. Unfortunately, we have now had to let some employees go permanently. We are applying for loans and grants that are to be provided by the CARES Act, but that is going slowly. The few coordinators and other essential staff are working only 50% of their normal schedules. Most physicians who we do research with are seeing no patients at all, so no research patients are being seen at their clinics.
Q: What types of appointments are you conducting?
On the clinic [non-research patient] side, we are doing 95% telemedicine visits. Patients who are on infusion treatments are still being brought into the clinic. They are isolated in an exam room. They cannot have fevers, recently traveled out of Texas, coughs, etc. We are also bringing in very few patients for joint injections—only if that treatment is absolutely necessary.
The majority of our patients are comfortable with telemedicine, and I have to admit it’s gone well for myself and mid-level [practitioners]. We are usually exhausted at the end of the day.
So far, we have been able to keep some clinic employees, but they understand it’s a week-to-week process and layoffs may need to occur.
Q: What are you telling patients about COVID-19’s potential risks and symptoms? What are their chief concerns?
Most patients are quite comfortable being in their homes and still have access to medical care. Obviously, we are telling patients everything we know and do not know about the virus. Although most of our patients are on immunosuppressive drugs, they are not showing out-of-proportion concern or worries. They are staying at home, and again, with access to our staff and myself, they seem more comfortable. I have not had any patients—research or clinic—who want to stop their medicines.
The main concern we are dealing with is that patients who are on Plaquenil (hydroxychloroquine) are concerned they will not be able to get their medicine because the drug is being used in the treatment of COVID-19.
Q: How is the pandemic affecting you and your staff personally?
I seem to be the most anxious person in the office. New York frightened me. I am doing my best to reassure staff and patients, which is difficult because I’m a negative person in daily life.
My staff has been wonderful through everything so far. That may change as more people get the virus and die, but they are making patients as comfortable as they can. They have really stepped up. We, of course, are checking temperatures, asking medical questions, etc. every day on every staff member.
My biggest concern is that insurance companies will not pay the amount for telemedicine visits as promised. If the payments are delayed or paid incorrectly, we will need to lay off employees.
With everything in the world being so fluid on a daily basis, everything [I’ve said here] could change completely tomorrow. [Our staff members] are doing everything they can do to deliver quality medical care to all of our patients, and hoping we all stay healthy and get through this.
Susan Bernstein is a freelance journalist based in Atlanta.
