My Rheumatology Practice during COVID-19: North Carolina

By Suneya G. Hogarty, DO, FACOI

It’s been almost two months since my last posting. “COVID time” passes both quickly and slowly, as each day brings new challenges and situations, requiring creativity and flexibility. Living in the “now” is certainly a useful skill set and one that I am honing!

We have now brought back all staff we had furloughed in April. I began seeing new patients again last week following a six weeks hiatus, so we have all rheumatology services being offered again… DXA, X-ray, musculoskeletal US, infusion, lab. For all of April and May, my practice was virtually exclusively telemedicine, but in the last few weeks, I have started having more patients return to the office. Some of these are by patient choice, and some are being asked to come in because I have not performed a joint count in several months. The MAs have new duties since COVID: extensive cleaning of exam rooms, spending time educating patients regarding logistics of virtual appointments, and now combing through the charts to determine the date of the last recorded CDAI. If that had been more than four months ago, those patients are being asked to make an in-person appointment. I would estimate now that telemedicine makes up 60-75% of my practice, rather than 95%. Our PM&R doctor’s schedule is closer to pre-COVID than before. Due to the nature of his heavily procedure-oriented practice, telemedicine was not as good a surrogate for him. But his volume has started to pick up again, as patients have tolerated as much suffering as they can and as fear in the community has lessened. Due to reduced volume, we had closed Fridays in April and May, but we have now re-opened Fridays starting in June.

Our community COVID numbers continue to rise, albeit slowly. Our local hospital has not been overwhelmed so far and has taken the opportunity afforded by flattening the curve, to convert two floors to negative pressure rooms. In NC, we witnessed a “mad dash” to the beach over Memorial Day weekend, so physicians in our community remain wary that a surge of COVID cases may be coming over the next few days. My patients, for the most part, remain cautious as well, although the pain of isolation is starting to wear on many. In the community at large, unfortunately, the partisanship of mask-wearing has taken a toll on that simple protective measure, so that many in the community are not covered. We require masks on all patients before they can enter the building, however. And we have a new position for an MA each day: door keeper, who checks temperatures, queries symptoms, and passes out masks as needed.

As for PPE, our supply has improved, although we are still reusing masks daily. We have implemented a protocol to sterilize our N95 and KN95 masks daily with UVC germicidal light. All staff wears either one of these masks throughout the day, with the exception of the billing department who do not have routine face-to-face contact with patients. Masks are inspected daily for wear and fit, and are discarded as soon as any deficiency is suspected. On average, I would estimate that we are “zapping” them five times before discarding.

Infusion services continue fairly unabated. We continue to use unused exam rooms to administer medicines and to keep 6 ft distance between chairs in the main suite. We have expanded some infusion hours to accommodate fewer patients at a time in the suite. We have also offered some “parking lot services” in the form of administering Prolia to long-established patients in their cars and drawing lab on some patients from their car as well. These are not routine practices but have been offered for patients who are markedly anxious about exposure. The vast majority of patients are comfortable with entering the building, especially when they see the precautions we are routinely taking. My waiting room has taken an interior-design downturn with widely-separated chairs, but those very few patients briefly waiting there don’t seem to mind!

We have found a new routine that seems to be working for now. But I have discovered that I don’t like telemedicine much. I miss the physical contact with patients, and I have come to appreciate the importance of that part of the visit. It is not just obtaining a CDAI, which is certainly important to me. But it is also the opportunity to put a hand on an arm or auscultate a worried heart that conveys my care. One of the aspects of rheumatology that I love is the long-term relationships that are created between my patients and me. I have discovered how much my concern for them is expressed via touch, as well as voice. Telemedicine has allowed for an important connection, and I am grateful for its filling the gap, but I, for one, don’t look for it to become a large part of my future practice. 

To close, I also want to express my deep gratitude for United Rheumatology, my trusted resource. What a fellowship! I continue to rely on UR for guidance and support. In the last five years, my membership has never been more important. 2020 has proven to be a taxing year, but you have helped me meet the challenge!

Suneya G. Hogarty, DO, FACOI
Member – Medical Policy Committee
Integrative Arthritis and Pain Consultants
Goldsboro, North Carolina

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