Wondering: Where Have All My Dermatologists Gone?
When I was about to finish the chemotherapy needed to prepare me for my first stem cell transplant, I got fungal pneumonia that temporarily put a wrench in the plans. It was over the fourth of July weekend, and my regular doctor wasn’t around to weigh in on how to proceed. I laid in my bed unhappily waiting.
And when I went into labor prematurely for my second son, there was a delay in getting test results from the amniotic fluid that had been sent out to determine if his lungs were mature. It was, coincidentally over Labor Day weekend. They had given me a drug to stop the labor, and I couldn’t get out of bed.
One of the nurses at the cancer institute said to me, “Never get sick over a holiday weekend.”
COVID-19's impact on healthcare
Of course, you can’t plan the date of your illness or your premature labor. The nurse’s comment was tongue-in-cheek, but it speaks to the way things can stall when healthcare workers have other priorities. On those holiday weekends, the doctors were off having fun. Nobody is having fun in the COVID-19 pandemic. But it has similarly slowed down response time.
COVID-19 and dermatologists
I tried calling the office of one of my dermatologists. It went in a loop without even the option of leaving a message. I wrote a note on Patient Gateway, the patient portal. I sent one to the Mohs surgery office and one to my regular dermatologist. I said I had been waiting a week for an answer regarding what to do about the squamous cell cancer that didn’t seem to react to the combination cream therapy of calcipotriene and Efudex. I attached a photo of the spot on my thumb.
“Should I try treating again and try to keep the thumb bandaged during the day or hold it away from the water when I'm washing my hands?” I asked. “Sorry for my ‘medical’ terminology but there are also a few ‘funky’ spots that you can see on the right side of my thumb,” I said.
These grow slowly. It is not an immediate life-or-death issue. But they can spread if not attended to.
Dealing with dermatology telemedicine
About a week later, a doctor from the Mohs center called. He said that since most visits had switched to telemedicine, he would bill my insurance. I might have a co-pay. I said these follow-up phone calls have never been billed before. He insisted it was a “new visit” and needed to be billed as such. I said, “It’s not a new visit, but go ahead.”
I couldn’t remember exactly what date I started the treatment. (Sometimes I write it down, but sometimes I forget). He looked it up for me. And he said that even though it didn’t look like it had responded, it might have, albeit in a different way than the others. He recommended watching it and waiting until my next dermatology visit. I will meet with the doctor virtually. I’m not sure how you show a dermatologist your skin on the screen, but I guess I’ll find out.
My telemedicine appointment summary
I had to laugh at the visit summary. It began, “Patient presents patient-initiated concern issued over Epic portal regarding a lesion on her thumb. Patient consented to a telemedicine visit.” Translation into real English: “Patient placed a phone call and agreed to listen to the doctor.”
The gobbledygook in the rest of the note cracked me up. “I spent a total of 12 minutes during this real-time, interactive virtual clinical encounter, which was conducted virtually using TELEPHONE ONLY technology. Greater than 50% of the time spent was devoted to counseling and coordinating care including review of records, pertinent lab data and studies, as well as discussing diagnostic evaluation and work up, planned therapeutic interventions and future disposition of care.”
Meaning, we talked on the phone for 12 minutes and he said to watch and wait.
Note: This article was written on March 30, 2020. Further developments in what we know about the Coronavirus are continuously emerging.
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