COVID-19 Diary Day 13: Oncology Practices Are Businesses Too

Don S. Dizon, MD


April 23, 2020

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I just finished another busy clinic using our hybrid approach during COVID-19: half of the visits done in person, the other half via telehealth.

Don S. Dizon, MD

Just 4 months ago, I would never have dreamed of scheduling a virtual visit during clinic. It just felt too busy. All of my phone calls and check-ins were done on non-clinic days.

I now think of telehealth in a very different way. While I still prefer in-person visits, I'm getting used to virtual visits—and billing them, too, which is an important shift. I realized long ago how much work oncologists, and all healthcare providers, do outside of their clinic: the time spent after hours entering chemotherapy orders, coordinating care with our nurses and patient navigators; the evenings at home writing notes and making phone calls to those seeking our help. We do this work as part of our job without compensation, or even a means to ask for it.

During the outbreak, videovisits and telephone calls have become part of our normal clinical work processes and we are expected to bill for our time. It might sound unsavory to our patients, but as I've moved into leadership roles, I now understand more clearly how medicine is also a business. Many sectors of our economy are now suffering and so are we.

The state of medical practice was laid bare by Yul Ejnes, MD, in a short thread on Twitter. We have stopped elective surgeries and outpatient procedures, deferred elective admissions, and reduced clinic traffic and overall volume, all while paying more for PPE, more for supplies, and more for critical medicines. As Ejnes points out, patients themselves are also delaying care and staying at home, in some cases missing critical follow-up visits.

We all fear that once COVID-19 is controlled, the healthcare landscape will be a very different place. We don't know which hospitals and practices will be left standing and remain open.

Everyone is anxious about the future.

The critical needs of patients with conditions having nothing to do with the pandemic are even more troubling than the economics: the requests for a callback by a patient on chemotherapy anxious about her bloodwork; another who wants to discuss whether radiation therapy is really necessary. There's the request for an appointment ASAP by a young woman with stage IV ovarian cancer, and the patient in a clinical trial who appears to be developing colitis.

People are continuing to face new cancer diagnoses every day. Those with cancer require frequent visits and follow-up. People with cancer cannot be told that oncology programs are "closed until further notice."

I am fortunate that so far, the number of people infected and hospitalized for COVID-19 at Rhode Island Hospital has not stressed the system. We are able to do what we have normally done, albeit in different ways.

Every cancer center is being tested in many different ways, however. While we struggle as a global cancer community to care for our patients, we are also struggling as institutions to remain financially solvent. Whether I like it or not, the two are intimately linked.

Don S. Dizon, MD, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

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