By Robert Lin, CPO
In 2019, I worked in an office/clinic setting seeing multiple patients per day. On a normal day, I would shake their hand, touch as clinically necessary, fit and adjust prostheses. I would talk with colleagues in the breakroom while reaching for adjoining coffee mugs and exchange pleasantries with the patients of colleagues I passed near shoulder-to-shoulder in the hall. No mask. No hand sanitizer between patients. Just as we had been doing business since I started some 30 years ago. Then, the pandemic struck, taking us all offline…and more importantly, off kilter. The world as we knew it would need to change.
The past 16 months have sent shock waves throughout the global infrastructure. Never before has any healthcare crisis precipitated such devastation to medical institutions plus every facet of society. And it happened in a wave of tragedy.
COVID-19 illuminated the flaws in our response strategies to widespread disease, the production and dissemination of vaccines, and the effects of closures/isolation on the foundation of how the world functions. Relative to healthcare outside the diagnosis and treatment of COVID-19, the basic paradigm of how we interacted with patients had to be reevaluated and modified seemingly overnight and then continued slowly evolving for over 16 months.
Healthcare specialties that have historically been dependent on hands-on assessment/treatment had to convert to telemedicine/telehealth for everything short of direct invasive treatments (i.e., emergency surgeries). Orthotics and prosthetics (O&P), which has fundamentally relied on in-person assessment/treatment planning and execution, was deferred or slowed to a snail’s pace. Those practices that had a large acute care population had to convert to new strategies to provide the ongoing care that our patients needed. We had to rely on technology to gain access/diagnose issues and plan appropriate interventions while minimizing office visits or exposure.
Telehealth or telemedicine had heretofore been utilized for the dissemination of healthcare expertise from advanced medical institutions to impoverished or third world countries to close the gap between countries separated by thousands of miles. During the COVID-19 crisis, this separation wasn’t a vast ocean or miles of terrain, but rather a few city blocks, a neighboring county, or a positive diagnosis.
So how did the pandemic change the healthcare arena, and more specifically the O&P world? In my particular practice, the reliance on technology was amplified to where discussions about signs/symptoms and issues with specific orthoses/prostheses were first described over the phone, and if needed, shared video clips of functional challenges or real-time Zoom calls with patients/therapists or both simultaneously. Problem-solving strategies, donning techniques, and wear/care directives were effectively shared and implemented via these non-contact initiatives. Yes, there are certain interventions that absolutely require in-person management, but these were largely minimized especially in the elective care arena. And more importantly, thankfully, these telehealth visits were covered by insurance.
As we emerge from the pinnacle of COVID-19 in the United States, recent outcomes studies and patient survey assessments have shown that quality of care was largely maintained and many specialties are now more analytical about when to schedule follow-up or problem-solving appointments.1 Personally, today I share more Zoom calls and view more smart phone images than ever before while maintaining a less crowded waiting room and providing the same high standard of care. As a private practice with privileges with several major hospital systems, access to their electronic medical records are even more critical. However, the effects of COVID-19 are still evident in the mandatory use of masks, face shields/goggles, and hand sanitizing with unprecedented frequency (after every elevator/door knob/medical records contact, etc.). In my office, the complete sterilization of exam rooms between patients has lengthened appointment times and hamstrung scheduling. On the positive side, I feel these precautions will better protect us during upcoming flu seasons or certainly in the event of a resurgence of this or like viral outbreaks. The paradigm of healthcare delivery has changed dramatically because of COVID-19 and my small O&P practice is certainly no exception.
Robert Lin, CPO, is managing partner at Biometrics INC., in Hartford, Connecticut. He also serves on the Lower Extremity Review Editorial Advisory Board.
- Shafi K, Loveccho F, Fortston K, et al. The efficacy of telehealth for the treatment of spinal disorders. HSS J. 2020;16(Suppl 1):1–7.