On March 10, 2020, my workday as a pediatric radiation oncologist felt very normal – I saw patients and discussed complicated cases with my trusted colleagues in friendly meetings and in close quarters. Three days later, my professional world as I knew it came to a halt. The novel coronavirus (COVID-19) had been working its way across the globe insidiously for many weeks at that point, but March 13, 2020 was the day that everything changed in Philadelphia: schools, places of work, the entire city shut down.
Even in this brave, unsettling, scary, and sad new world, certain constants persisted from the past. Unfortunately, one of these was the ongoing need of children needing radiotherapy for life-threatening malignancies. Our center is a big one, and a major referral center for children all over the country and world. Families were scared to come into the city, or across the nation or world, during a global pandemic – but they were more scared of not being able to obtain cancer care desperately needed for their children. In those uncertain early days of coronavirus, we healthcare providers were scared too – scared of contracting the virus and unwittingly spreading it to patients and our own family members and scared of becoming ill and unable to work at all.
Our health system presented us with a solution in those early days: Telemedicine. I, like most other physicians, had never performed a virtual visit with a patient and family. I worried about how I would establish a connection with a child and their family over a computer screen. I worried that I would not be able to communicate effectively regarding life and death issues this way. I worried about small things – would the platform work? What app did I need? Did my computer have a webcam? I am grateful to Penn Medicine for many things over the course of my education and professional life here . . . and during this time, I was incredibly grateful to the team who helped us navigate these new waters. The first platform had lots of glitches – we had a new one within a day. We had concerns about patient privacy – private virtual rooms were established. Logistics were difficult – a virtual switchboard that transparently communicated with patients and providers became available. Thanks to the nimble nature of the system, we were able to use telemedicine without the logistical headaches that concerned me back in March.
Here we are in June, 2020. I can say overwhelmingly that telemedicine has been a huge success for my specific patient population. Over the past few months, families who would have driven or flown many hours in order to hear about proton therapy and other pediatric radiation services at our center have been able to meet the team and hear about proposed therapies without travelling at all. Children in pain from progressive cancer have been able to relax on their own couches or beds while their parents talked about treatment options, rather than being dragged into the city to park the car, navigate medical buildings, and sit in a clinic. On a personal level, I have enjoyed the level of focus that I am able to achieve in these one on one encounters, without interruptions that inevitably happen in busy oncology clinics. In this new world, telemedicine visits allow patients and families to see my whole face, and me to see theirs. When we see each other during daily radiation treatments and visits and are behind masks, I think that it makes us feel more personally connected to have seen each other’s smiles at least once.
Is telemedicine perfect? Of course not. Some patients and families will always benefit from in person visits, for innumerable reasons, and in-person medicine will always have value. I do feel, however, that telemedicine is a useful addition to our toolbox as providers. It goes without saying that the pandemic has wrought havoc on our world. Thanks to telemedicine, it did not shake our ability to take care of patients who needed radiotherapy in a timely way. I hope that most of our world can go back to “normal” someday; however, I also hope that telemedicine will stay around for a long time, and that its benefits will represent a silver lining of this global upheaval.
Dr. Chrissie Hill-Kayser is Chief of the pediatrics radiation oncology service at the Penn Medicine and the Editor-in-Chief of OncoLink. Her research interests include proton therapy for pediatric cancers and cancer survivorship.