Telemedicine for Patients With CLL

Nicole Lamanna, MD: Given the recent pandemic, of course, a lot of us are doing a lot more telemedicine these days. This was already starting to brew in many of the medicine departments for other reasons prior to the pandemic, but the pandemic definitely pushed this out to the forefront. I think there are many patients you can do this for, and a good proportion of my patients now are on telemedicine, although it’s actually a little less than previously during the height of the pandemic in New York. I assume this will be evolving across the country depending upon their incidence of COVID-19 [coronavirus disease 2019] around them. Where it was mostly telemedicine then, now probably it’s changed back, in my practice it is maybe 60/40 right now. But I think that’s evolving because patients are coming back to clinic.

There are a proportion of our patients who are on active observation, for example, who certainly can be on telemedicine. They can have local laboratory tests; there are services that some patients use that can have labs drawn at home depending upon their insurance or capabilities, or they can go to a local lab and then have a telemedicine visit because they’ve been stable for years; they’re doing well otherwise. The thing that I always stress to patients, even during the pandemic, is that their health needs are more important. If somebody is sick and they need to be evaluated, I think that’s a no-brainer. They need to come in and see their physician or their care provider because otherwise their medical issues are not being attended to because they’re so fearful of the virus.

Many medical centers and practices are providing PPE [personal protective equipment], or patients have PPE when they walk through the door. They are cleaning facilities, providing masks and gloves, and doing what they need to appropriately try to control the environment, to try to reduce the risk of infection from COVID-19. I think if patients need to be seen, they need to be seen. It’s a crime not to have those individuals who are sick be seen because then they wind up coming to the emergency department really sick. For some of our patients with chronic lymphocytic leukemia [CLL], that can be really life-threatening depending upon the circumstance.

There are many patients, though, for whom I think even continuing telemedicine is completely appropriate, and then if there’s something that seems alarming on that telemedicine visit, then you can convert them to coming into the office. I think this will stay. There are many patients who appreciate this. I think it makes it easier even for patients who come long distances, or don’t have the social support in which they could otherwise. Depending upon where they’re visiting, there may not be visitors allowed into the center and they need their social support, their spouse, their family member, their friend to come with them, unless that changes depending upon the pandemic. I think that doing telemedicine makes it very easy to have access to their physician or their providers, and they very much appreciate it. We, as physicians, just need to have a heightened level of escalating that visit if there seems like there’s something that’s not OK with that patient.

Many of our patients converted to telemedicine. I think that’s changing now that patients are feeling more comfortable, depending on where they are in the country. Each of us will need to find the right balance for our patients with CLL to figure out that some of them can continue telemedicine and decrease the frequency of their in-person visits, and other patients, if they’re active, will be coming in routinely.

Transcript Edited for Clarity