• Surviving in a Coronavirus World

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    Congratulations, you are now a full-fledged ophthalmologist.

    The last few months have been very different from your first two-and-a-half-plus years of training. Before COVID-19, you developed specific practice patterns, ways of interacting with patients and had follow-up protocols. 

    We have since pivoted — trying to determine how to best serve our patients and families safely and effectively. Ophthalmology is a very difficult specialty to practice over telemedicine — the eyes tell us a story that cannot always be translated over a mobile device. 

    My transition into pediatric ophthalmology telemedicine required significant time creating documents and handouts to send to my patients and their families. I created a four-point email with instructions on how to best perform telemedicine. It contains: 

    1. Instructions on how to download my preferred video conferencing platform (Zoom)
    2. Instructions on how to check vision (I attached a paper chart for adults and children with additional instructions)
    3. A list of equipment needed for the examination (flashlight, toys, large cooking spoon for an occluder) and an ideal setting for the videoconference (bright overhead light without a window in the background)
    4. Further instructions on how to log into the teleconference and a warning that I may be a few minutes late. By preparing the family for the telemedicine visit, I could see a patient very efficiently. 

    Ideally, all patients would be on your electronic health record (EHR) patient portal — that way you can send them this communication through your EHR without exposing your email address. In addition, you can ask them to share HIPAA information with you or your technician prior to their visit to speed up your visit: chief complaint, current medications, allergies, past medical history, family history and social history. Prior to the visit, you can have your technicians input this information into your EHR for quick access. 

    Issues will always arise with telemedicine, so always have a plan B. Anything that can go wrong, like:

    • Poor internet connection

      Plan B: Get all the visual information you can, then just call the patient. Often you will be able to perform a successful telemedicine visit this way. 
    • Difficulty using a smartphone

      Many times, my adult patients had extreme difficulty with the technology surrounding teleconferences. Sometimes, the video connected, but audio did not. 

      Plan B: Call patients on their phones for the audio. 
    • Difficulty using apps

      The patient or family cannot figure out how Zoom works. 

      Plan B: Use Doximity Dialer for video conferences — this sent a text directly to their phones and did not require a download. 
    • Patients did not check their email inboxes or even read your email. 

      These situations lead to the most frustrating visits, because they don’t have access to the video conference link, and they did not check their vision or have any of the needed equipment available. 

      Plan B: Have your technicians check in patients beforehand. If the patients did not do any of the requisite tasks, have the technician walk them through it so they are ready for you in advance. 

    Telemedicine can be fun. You get to see your patient’s home, which you would otherwise never be able to do. But telemedicine can also be extremely efficient for your patients and their families. An hour commute each way to your medical office plus an hour-and-a-half visit can be condensed into a 15-minute video encounter.

    Embrace this change and make it work for you and your patients. We can safely provide a standard of care to our patients during this pandemic with creativity and ingenuity.

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    Evan Silverstein, MDAbout the author: Evan Silverstein, MD completed his residency at Vanderbilt Eye Institute in 2014. He then completed a fellowship in pediatric ophthalmology and strabismus at Duke Eye Center in 2015. He is currently an Assistant Professor of Ophthalmology at Virginia Commonwealth University where he serves as the Associate Residency Program Director.