“The good physician treats the disease;” said William Osler, a pioneer of modern medicine, “the great physician treats the patient who has the disease.” That principle has guided physicians for more than a century. But in a health crisis that demands physical distancing and conserving protective equipment, we must now attempt what seems impossible: providing high-touch care to patients while, at times, remaining apart.
One solution comes from Stanford Medicine’s hospitals and clinics, located in an early epicenter of the COVID-19 outbreak. In a matter of days, the health system made a tectonic shift toward delivering patient care virtually. Our experience shows how other health care systems preparing for a surge of patients can use digital health to navigate the complex, and sometimes opposing, needs of this crisis.
Individuals who test positive for the coronavirus typically go through a battery of tests, such as blood draws, IVs, x-rays, and CT scans—a process that includes several in-person meetings with a doctor. And depending on the severity of illness and underlying conditions, that could involve one doctor or more than five.
This personalized approach is the care that every patient deserves. Yet, as more hospitals contend with national shortages of masks and other personal protective equipment (PPE)—which must be discarded each time the health care professional leaves the room—new strategies are needed to continue delivering high-touch care.
To answer that challenge, over the past week, our emergency medicine department has introduced a new member to the care team: an iPad. Following an initial in-person consultation, patients and doctors can now “meet” freely using live video conferencing on iPads stationed in patient rooms throughout our hospital. These changes were enabled by a recent relaxation of federal regulations governing the use of communications technology in the delivery of medical care.
Practically overnight, our emergency medicine clinicians have become virtual care providers. Wielding iPads, they help to screen patients for our drive-through COVID-19 testing sites and conduct virtual followups with patients, while conferencing in specialists such as endocrinologists, oncologists, and even translators when needed.
This digital-first approach delivers several benefits. It conserves PPE and expands patient access to our services (our doctors can now see far more patients in a day). But most of all, and perhaps counterintuitively, it enhances human connection.
Our physicians report that as they’ve used the iPads, they’ve been able to bring empathy back to the bedside. Many found that being encased in PPE severely constrained their ability to build trust and rapport with patients. Meeting virtually has enabled them to strip away these layers, creating space for empathy at a time when it is needed most.
Recently, a Spanish-speaking patient in her late thirties who had tested positive for COVID-19 came to Stanford Medicine for care. She was anxious about her diagnosis and especially so about protecting her mother, who lived with her. Using the iPad-based telehealth system, we were able to deliver frequent updates to the patient using a virtual translator and involved her family when communicating a safe plan for discharge. It is in these small gestures that the humanizing potential of digital health is revealed.
That is not to say that transitioning from physical clinical workflows—established over years—to virtual ones comes without challenges. Recently, Stanford Medicine’s health care delivery system conducted approximately 3,000 ambulatory video visits in a single day—a 50-fold increase over our baseline rate. While it was a significant milestone, it also represented a massive technical feat.
Moreover, some assert that these kinds of extreme measures, propelled by physical distancing, may be an overreaction. Until more testing data is available to discern the actual fatality rate of COVID-19, which some argue is currently overblown, we could be doing more harm than good.
We agree that there is an urgent need for more testing. But until that testing (and the data that’s generated from it) is available, the safest—and most responsible—step is to maintain safeguards that will minimize human contact. Relaxing the guidance on distancing could lead to a surge of COVID-19 infections—threatening to overwhelm health systems and creating health risks for anyone needing treatment (beyond just those with the virus).
If there is a silver lining to be found in the COVID-19 crisis, it is that necessity has catalyzed promising new care innovations. That shift, which will also be accelerated by Congress’s recent appropriation of $200 million to support telehealth services, is delivering immediate dividends that are sure to continue far into the future.
Lloyd B. Minor is a scientist, surgeon, and the Carl and Elizabeth Naumann dean of the Stanford University School of Medicine.
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