This perspective is provided by Robert Weker, a three time cancer survivor, including pancreatic cancer. As a former pharmaceutical R&D professional, he represents the patient voice as a member of patient councils with pharmaceutical companies and healthcare systems and writes a patient blog, Through the Patient Lens. In this post, Robert tells of the new normal of his hospital visits, and alternative ways to stay safe while receiving needed medical care during the COVID-19 pandemic.
Patients are constantly challenged by their new normal. It often starts during diagnosis, when a patient’s life can be immediately upended and transformed with a dire diagnosis. At that point, nothing is normal anymore, or rather, there’s a new sheriff in town – our new normal. Our new normal continues to meander and evolve as we receive treatment and through recovery, and often for patients post recovery, though we may appear as our former selves we are adjusting to the reality of our new normal.
But COVID-19 has transformed the landscape. Society was confronted with a dire diagnosis and everything changed instantaneously. Well, maybe not instantaneously, but the pandemic has touched every corner of global society. Fundamentally, life will change for all of us from this experience.
During the quarantine period, I had two appointments scheduled. The first was a dermatological procedure. This was not a medically critical procedure and I quickly decided to defer it. The second was an ultrasound, which was past due, and my medical team informed me that this particular test was important and should not be delayed any further. I must admit, I was a bit anxious. I tried to move the procedure to a facility closer to my home and not part of the urban hospital, but unfortunately it could only be performed in town. I was able to schedule my associated doctor consults to be virtual phone calls, but still had to venture to the hospital. And yes, things were quite different.
It hit me quickly. After the routine questions on whether I was a patient, I proceeded into the parking garage with the gate up – free parking today! But seriously, I exited the elevator and was immediately scanned for my temperature. I was wearing my mask and gloves. I checked in and sat in one of the “every other seat available” chairs. All of my pre-screening – basic medical questions, insurance details – was conducted by phone in advance of my appointment. Nobody could come with me to the hospital. I actually felt quite comfortable, particularly as COVID patients were being treated in a different part of the hospital. All of the nurses and technicians were fully protected – EPE, face masks, shields – and I don’t know if they washed their hands more than normal, but I certainly was more observant than normal. Everything went quite smoothly, though it is important to note that there were very few patients being seen, significantly below a normal visit.
How should patients consider managing their new normal against the backdrop of the new abnormal driven by the pandemic? (It is important to note, that just like a patient appears “normal” post recovery, society will ultimately establish its new normal, different than the past).
1: Determine your risk and manage it prudently
For patients, this can be particularly challenging. How does a patient honestly assess his or her risk? If I consider my own situation, the most important question in trying to ‘quantify’ my risk – am I immuno-compromised? That is a tough question. My last chemotherapy treatment was over five years ago, so from a purely technical, medical perspective the answer is probably no! After all, my oncologist would tell me that I am cancer free. But in my mind, I will always consider myself immuno-compromised. My ongoing side effects serve as a constant reminder of where I was.
At a more general level, older people and people with pre-existing medical conditions (like asthma, diabetes, heart disease) are more vulnerable to becoming ill from the virus. This at-risk population should avoid as much as possible significant societal interaction and quarantine. If you must go out, be smart – wear a mask, practice social distancing, wear gloves and wash your hands frequently and thoroughly. My best high-risk KPI (Key Performance Indicator) is my adult children, who refuse to come visit as they do not want to put their old man at any additional risk.
2: Leverage Technology
Adoption of new technology can often be slow for routine activities, particularly in a regulated medical environment, but a pandemic has a way of focusing the mind on what is possible as options can be limited. Technology can touch many aspects of a medical interaction.
- Telemedicine for Doctor Visits
Now that everyone can Zoom/Webex/Bluejeans (yes, another noun that has been transformed into a verb), telemedicine doctor visits are viable options. Some doctor visits require in-person interactions, but many appointments can be conducted effectively via video – with no commuting time wasted, no traffic, no parking – all in the comfort of your home. As stated in an earlier time, “Is it Live or is it Memorex?” As long as this question is relevant, then video appointments are an excellent option;
My best medical engagements always occur based on facts and data. In the past, this was often limited by the availability of equipment to capture information, but now with wearables and cellphone applications, data are literally at our fingertips (through pulse oximeters) or on our wrists (through blood pressure or heart rate monitors) or monitoring of diabetic sugar levels without finger sticks. The data, and associated trends, are very convenient and continuous, with the potential to communicate this information directly to your doctor;
- There’s No Place Like Home I have frequently advocated that patient preference, when possible, should be as close to home as possible. Ideally, simple procedures like blood draws or home healthcare in a pandemic/post pandemic world should occur at home. We need to ensure that any ‘visiting’ healthcare worker takes the necessary precautions to keep the patient, family and the healthcare worker safe – wearing PPE, but also should be a healthcare worker who is not working with COVID patients. Other procedures that might require more sophisticated equipment can be done in a clinic closer to home with a video appointment with your doctor as appropriate.
3: Navigating the New Normal by Acting "SMART"
So how does an at-risk patient manage in tomorrow’s new normal? The first step is to accept the fact that you are an at-risk patient and no longer an indestructible youth, and of course, those of us with a few more rings-around-our-trunks understand there is no such thing as an indestructible youth. As we all learned at an early age, avoid dangerous situations and just be smart:
S: Social distancing
M: wear Masks to protect and respect others
A: Avoid crowds and confined spaces
R: assess and manage Risk
We all know somebody directly impacted by COVID-19, be it someone who was diagnosed or succumbed to the disease or first responders or our nurses and doctors on the frontline or essential workers – hospital staff, grocery workers, delivery people – who keep us functioning. We owe it to their legacy, and to our own wellbeing, to learn from this experience. To reach new heights, we must stand on the shoulders of those before us.