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How Doctors Are Adapting To Provide Care During COVID-19

Surgery is the definition of “hands-on” care—so in this new world of telemedicine, how are doctors adapting? One surgeon pulls back the curtain.
Surgery is the definition of “hands-on” care—so in this new world of telemedicine, how are doctors adapting? One surgeon pulls back the curtain. Photo Credit: iStock.com/franckreporter

Throughout the COVID-19 pandemic, almost every single person has had to make changes to the way they live their lives and do their jobs. Working remotely, wearing masks, carrying bottles of hand sanitizer, and keeping our distance—even from those we love—have all become part of a new normal that has no clear end in sight. As doctors, we’ve been faced with the reality of reconsidering how to best approach health care.

We’ve had to adapt to resources like telemedicine with unprecedented speed, and while the sudden switch has provided its challenges, it’s also improved care in ways we could have never expected. This, I’ve found, has been especially true for surgery.

As a hepatobiliary surgeon and head of cancer surgery for Northwell Health, I operate mostly on patients with cancer in the pancreas, liver, bile ducts, and gallbladder—which means that the surgeries I perform are hardly considered “elective.” So when Northwell tasked my colleagues and me with slowing surgeries down in early March, we knew we had to make sure cancer patients didn’t become secondary victims of COVID.

Because even the smallest delays in cancer care can cause major complications, the first step was to determine which patients needed immediate surgery and which could swap the order of their care—for example, getting chemotherapy for a few months before surgery, rather than the other way around.

At first, the pandemic forced us to limit our in-person interactions with patients and their families, which posed a truly unique challenge. Traditionally, patients would come to my clinic for in-person consultations with physicians across various specialties, leaving later the same day with a comprehensive treatment plan in hand. Suddenly, bringing patients in to visit with several different doctors in a single day was no longer safe. We worried about what this would mean for our patients and how it would affect their outcomes in the long term.

Fortunately, Northwell already had a robust telehealth platform that was immediately available for use. With a healthy dose of skepticism, I decided to give telehealth a try, and I’ve never been happier to have my doubts proven wrong.

Over these past months, telehealth has helped us not just survive, but to actually improve our patients' care in many cases, and has helped manage these “visits” more seamlessly than we expected. Now patients can meet with three to four providers virtually, saving both patients and physicians time in the process.

Even in cases where the patient and physician were both initially apprehensive, we’ve seen unexpected benefits. For example, when surgery is on the horizon, a patient would typically come in for a consultation with their family before the big day. This appointment irons out the details of the procedure and follow-up care, but it’s also a great opportunity to let the patient and family get to know the surgeon and feel more at ease. Now, the patient and their support network can meet the whole care team virtually, reassuring them that they’re in safe hands.

It’s been awe-inspiring to see how quickly we have all adapted in the face of the pandemic. From virtual consultations to meeting for the first time in person on the day of their procedures, our patients and physicians have been incredibly brave and cooperative—even if it was hard for all of us to make such a fast, drastic change at first.

Fast-forward from those uncertain, early days of the pandemic, and this process has evolved—and is even being harnessed to benefit patients.

Now, those who live far away and often traveled long distances on a regular basis for our follow-up appointments can get the care they need from the comfort of their own home. We’re still using telehealth for some pre-op evaluations, post-op follow-up visits, and communicating with families while their loved one is recovering. 

I think this process is here to stay, and for the better.

Now we're more prepared than ever to handle the uptick in infection rates and a second wave. We’re using data from the height of the pandemic for resource planning—such as setting aside COVID-free facilities for safe procedures and performing some surgeries at our ambulatory suites so COVID-negative patients don’t need to go to the hospital. Our clinical advisory team has continuously developed and implemented best practice guidelines for safe surgery during the pandemic. 

The only fear we have is what some of this delayed care may mean for cancer patients, especially when it comes to screening and surveillance. The risk of foregoing care is much higher than the risk of contracting the coronavirus from one of our facilities, yet many have chosen to put off routine screenings. As a result, we’re seeing a new uptick in cancer diagnoses as people return to their regular schedules, and we may see more advanced disease in the future.

But if that’s the case, we’re here and ready to provide the care patients need—and provide it safely. I am a big believer that we learned a great deal from this pandemic—that it took an impossible, unprecedented challenge to show us all what we’re truly capable of, and that we’re stronger for it.

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