Many families and providers are taking advantage of the newly expanded virtual care appointment options at Gillette Children’s. During the “stay at home” orders due to COVID-19, Gillette continues to focus on ensuring families are safe and have access to our expert medical care.
When clinically appropriate, Gillette is offering virtual appointments that are secure and can be done via computer, laptop, iPad or smart phone.
Pediatric neurologist, Randal Richardson, MD, is seeing patients via virtual care and is excited about how technology makes it more convenient for his patients. In fact, he’s so enthusiastic about virtual care appointments that he spent time cleaning and improving the appearance of his office.
Describe what a virtual care appointment is like for you and your patients.
Let’s start with what the patients see. I’ve gotten into the virtual clinic concept and have had fun redecorating the office. I generally believe that life should be novel and interesting. My wife used to be Director of Contemporary Prints at Davidson Galleries when we lived in Seattle, so I’ve had fun hanging some of the artwork that we love. I tried to make it interesting so they don’t just have to stare at my face.
I honestly don’t pay much attention to the patient’s home environment when I am in a virtual clinic. I am a dedicated gardener, so I do notice when it is a sunny day (my office has no windows). More important to me is listening to my patient with my eyes. There is some old social sciences statistic that says 90% of communication is nonverbal. I agree with that. I utilize virtual clinics to better understand my patient such that I can devise ways to best understand and therefore engage them.
Teaching is a very important aspect of what I do. Virtual clinics undoubtedly maximize the educational opportunities that can be missed by a simple phone call.
Have you noticed anything special about virtual care appointments?
One of the things that has been a pleasant surprise is how much more talkative my patients (including the children) are in their home environment. I actually embrace the concept of taking a little extra time with my patients.
As a pediatric subspecialist who continues to see patients in adulthood in Gillette’s Adult Muscular Dystrophy Association clinic, one of the areas I encourage children to develop is that of developing a sense of control over their disease. I want to see my patients grow into adulthood and develop a sense of ownership and responsibility for their own health. In other words, eventually the patient manages their own health, not their parents or other guardians.
Seeing a young child feeling comfortable enough to ask open and honest questions really makes my day. Being in a home environment, children are much more comfortable with asking questions that they otherwise would not in our physical clinic. Purely for that reason alone, I’d like to continue virtual clinics when appropriate even after the stay at home restrictions are gone.
Why is virtual care a useful option for patients and families?
It is convenient. As a doctor who treats Muscular Dystrophy, a lot of my patients have physical disability. Ambulation is impossible or at least difficult, not to mention that many of my patients come from a distance.
For my patients, a virtual clinic changes a clinic visit from an epic journey, reminiscent of Frodo’s quest from Lord of the Rings trilogy, to something that could be as simple as waking up to breakfast in bed. Physical clinics still need to eventually occur for pesky things like labs, other tests, and the physical examination, but sometimes all that is needed is open communication, teaching, and decision making.
It cannot get much more convenient than this. One doesn’t even have to brush their teeth…although I am supposed to encourage that for other reasons.
Why are the benefits of a virtual care appointment vs. a phone appointment?
By far the most important thing is the promotion of nonverbal communication as mentioned earlier. There are other things that I really like.
At Gillette, we use the software program Microsoft Teams and it allows for conferences. This means multiple providers could see the patient simultaneously and enter and leave the virtual room as they like. Just as it is important for me to have nonverbal communication with my patients, it is also important for me to have the same nonverbal communication with other caregivers on the team.
The software allows for other neat things. I have three computer screens that I utilize. I can point out and review X-rays and MRIs with my patients.
I also extensively use Google Image to find salient teaching images. Yesterday I used Google Image to show the patient the distribution of the superficial peroneal sensory nerve (a nerve in the lower limb) to indicate that their numbness was a near perfect match.
What are you hearing from patients and families who have had a virtual care appointment?
Honestly, it is so early, I haven’t got much spoken feedback, but because I get to use my nonverbal communication skills, I get a sense from people that they are largely impressed by what they got from the visit. Science and technology are cool. It’s neat to see simple yet innovative advances actually make a difference.
Do you have any advice for people thinking about booking a virtual care appointment?
When people think about a new appointment with a neurologist, this often means they are looking for an underlying diagnosis. This may require physical testing that cannot be done through a virtual visit. For example, patients might need a physical examination, an EMG, a lumbar puncture, blood tests or neuro imaging. That is undoubtedly true, but first you actually have to meet a neurologist and develop a diagnostic plan. Sometimes this requires nothing more than a virtual visit. Other times, this may require genetic tests.
We can often set up a genetic counseling visit same day and even coordinate DNA testing by sending them a swab or saliva kit that can be done without leaving home. I cannot guarantee that for everyone obviously, but these are novel times. I do pride myself on crafting novel solutions for the patient despite the restrictions of our environment.
How have you, personally, been coping with this COVID-19 situation? Is there anything you’d like to share?
I remember a story one of my cherished residents told me about a decade earlier. She and her family were walking in Seattle outside of one of the malls. Gunshots erupted. Her husband was ex-military. He made sure that they were safe and then progressed to run not away from, but towards, the gunfire.
I’m not that type of guy, but I do see a problem and I want to help get to the solution. I am not on the front line for COVID-19, but I can support those who are. I do this by trying to take care of my patients at home. Keep them healthy. Keep everyone sane. Stay out of the emergency room unless a person truly needs to be there.
Right now, staying home helps America. I’m doing everything I can do to help. That knowledge keeps the worry away because I know that I am changing the things I can. I do operate under the belief that all of us try to find that symbolic gunfire, and then run to help. We’re a community.