The dominant presence of COVID-19 has not meant the absence of cancer, ear infections, heart attacks, chronic pain, or other illnesses that need attention and care. Physicians have continued treatment for all types of maladies, and physician training has continued as well. But this treatment and this training look much different these days. Despite the challenges that came with major COVID shutdowns and changing requirements, the healthcare system and patients have been both creative and resilient in finding robust “temporary” solutions to these challenges. It is now looking like some of these COVID-era transitional steps will be preserved and play a lasting role in the future of medical education and telemedicine. What must be sacrificed to reap the benefits of these new protocols?
The rapid adoption of technology and virtual engagement tools has been both impressive and interesting to watch – Zoom meetings between medical association boards of directors, FaceTime calls between isolated patients and their family members at home, telehealth phone appointments with family practice physicians, or virtual medical conferences through Webex – the increasing reliance on these tools has pushed boundaries and exposed both opportunities and challenges with technology use for the future of healthcare.
As COVID-19 has significantly accelerated the feasibility and acceptance of telehealth care by physicians, patients, and payors, we now see healthcare systems navigating in real-time the complex issues with cybersecurity and patient privacy. Due to waivers, everyday technologies can be utilized right now, including FaceTime, Skype, Facebook Messenger video chat, Google Hangouts, and Zoom, but new regulatory guidance may be needed to develop safe, secure, and patient-friendly telehealth applications for the future. Cyber-security, already an important priority in the healthcare information space, is going to become that much more essential as doctor’s offices and clinics implement even more telehealth protocols faster than they ever would have normally planned or budgeted for.
These changes in practice and patient care have also impacted how controlled substances are prescribed. The Drug Enforcement Agency has modified policies to allow for the remote prescribing of controlled substances during the pandemic. Online counseling, informed consent, and follow-up with patients can be done in a virtual setting. Pill counts can be done in a video call and patients can still have their questions answered regarding their pain therapy, although it is likely that after the crisis, prescribing certain controlled substances may return to in-person visits. It is important that the regulatory climate continues to evolve at the pace needed to address the changing needs and realities of telehealth in the time of COVID.
While we have all become more comfortable on telehealth platforms, there continues to be an important role for in-person visits. Patients may appreciate the convenience of telemedicine; however, they must understand that it can limit a physician’s ability to perform a thorough examination and possibly reduce the chances of a physician detecting an unexpected complication or condition.
Moving forward, I expect there will be much greater reliance on telehealth strategies even post-COVID, but it will always have to be balanced with old-fashioned office visits.
Residency training has also experienced a profound shift this year. Conventional teaching approaches have either been cut back or have been canceled due to COVID risks, and reduced access to personal protective equipment (PPE) has limited the amount of time spent with patients being cared for during residency and fellowship programs. But we can’t stop training for the next generation of physicians or providing quality Continuing Medical Education (CME) for practicing physicians. E-learning techniques, such as webinars and online skills training, certainly play a role – and these may offer ways to actually enhance cross-departmental or multidisciplinary collaborative educational sessions. E-learning may be more cost-effective and easier to participate in than traveling to conferences or symposia, but the hands-on learning and deep discussions that can occur in breakout sessions or clinical training modules will need to be replaced somehow. And there must be careful vetting of online content in order to avoid a proliferation of commercially biased information, plagiarized materials, or simply false information. As we all adjust to new settings and styles for learning, there must be purposeful strategies to ensure online lectures are still supported with opportunities for learning from direct patient contact and collegial support.
Despite these concerns and challenges, new models for CME activities actually pose a great opportunity for increased access, cost-effectiveness, and practicality for busy clinicians.
Even before the first case of COVID-19 was diagnosed, technological innovation had already begun to change education, healthcare, and even social relationships. The COVID-19 crisis has simply accelerated the drive and interest in these new tools. But while the technological tools and platforms to a large extent existed years before COVID-19, they have never been used as purposefully, as rapidly, or with such intentionality, as they are being used now.
I am sure the shift toward technology and virtual engagement in medicine will not go away when we finally get past the COVID-19 crisis. There will likely be lasting changes with the reliance on distance-medicine techniques for both patient care and physician training. But we must keep a close eye on regulatory frameworks that need to be updated, and make extra efforts to build and maintain patient-physician relationships.
About Shalini Shah, MD
Shalini Shah, MD is Vice-Chair and Associate Professor, Department of Anesthesiology & Perioperative Care, and Enterprise Director of Pain Services, UC Irvine Health. Dr. Shah completed her residency in Anesthesiology from NYP-Cornell University and a combined fellowship in Adult and Pediatric Chronic Pain at Brigham and Women’s Hospital, Beth Israel Deaconess and Children’s Hospital of Boston, Harvard Medical School.
