How Onclogists Feel About Telemedicine

Interesting article in the Journal of Clinical Oncology: "Oncologist Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network Survey." I have to say, I have mixed feelings about telemedicine and virtual visits with oncologists, so I was very interested in how our doctors feel about them.

And for the most part, they feel pretty good about them.

The article reports on a survey of 1,038 oncologists from 26 cancer institutions in the United States during summer 2020 (at the height of the Covid-19 scare, as things were locking down severely and cases were increasing dramatically). The oncologists were asked 20 questions about how they use telemedicine (meeting with patients either by phone or by video), how much more more often they were doing so than they were before the pandemic, and how they felt about it. (You should be able to see the questions here, if you're interested.)

 The results: 88% said that meeting a patient by video was the same or better than an office visit, and 805 said using the phone was the same or better than the office. That seems very high, but it gives a good indication of how positive the oncologists see telemedicine. 

However, when it came to establishing a personal connection, only 24% thought video was the same or better, and only 7% thought phone was the same or better. And that makes a lot of sense. It's certainly the same with much of the communicating I've had to do during the pandemic. Video is better than phone when speaking to a loved one, but neither is as good as being in the room. And when it comes to meeting someone new and establishing a connection, that's especially true. A small gesture like a hand on the shoulder from the doctor is really missed.

So while the oncologists might feel a certain way about connecting with patients, more importantly, did meeting virtual cause problems for the patient that might have been found in a face-to-face meeting? Only 6% felt like that happened occasionally, and 93% said it never happened or happened rarely.

In the end, the oncologists estimated that about 46% of all patient visits could be handled by phone or video.  

And that makes sense, especially for follow-up visits, like the kind of many of us with Follicular Lymphoma get after treatment. (I'm thinking especially of the kind of 6 month appointments I have these days, when I don't have problems or specific concerns to talk about or get checked out.)

For many of us, that might be a blessing. For many of us, we need to travel a bit to get to our oncologist. Maybe it might be easier to get a blood test near where we live, and have the results sent to the oncologist, and then talk about them during a phone call or Zoom meeting. That might make things easier for everyone.

On the other hand, there are potential problems, too. Not every patient has the kind of access to technology that would make these visits helpful. And, at least in the U.S., it's possible that insurance companies will pay for a telemedicine visit and not a face-t-face visit for certain kinds of issues, when the patient could use the reassurance of seeing and talking to the doctor.

As I said, I have mixed feelings about telemedicine. I have seen my oncologist face-to-face during the pandemic -- the timing was right so that we knew enough about Covid, and the hospital took enough precautions, to make things safe.  So I can't speak about telemedicine for cancer.

 But I did have a few doctor visits for some other health issues that we did over Zoom, and they just weren't the same as a usual visit. For one thing, I was having some breathing issues (and this was happening about the time the survey was being conducted). Asking me a bunch of questions just isn't the same as listening to my lungs through a stethoscope. It took a long time to resolve the issue, and I think it could have happened much more quickly with an office visit. (But I also understand why the doctor's office was being very cautious and not seeing patients face-to-face.)

Mostly, I worry about the kind of connection that will get lost if telemedicine becomes more common. If you've been reading a while, you know I like to say that Follicular Lymphoma is as much an emotional disease as it is a physical disease. And to me, part of the treatment for the emotional part of the disease is meeting with a doctor and feeling better afterwards, knowing the doctor has felt around and not found any problems. There is comfort that comes from physical touch. I don't want to lose that.

So I'm very curious about all of your experiences. Have you had a visit with an oncologist by phone or video? Doctors might feel satisfied after a telehealth visit, but did you feel satisfied? What was missing, if anything? What kinds of visits would you rather have in person than virtually? What kinds of problems would need to be overcome to make a telemedicine visit more satisfying? 

I think we'll probably have more of these virtual visits in the future. I'd like to hear about your experiences, if you're willing to share.