Rheumatologists coping well with major disruption caused by COVID-19

Rheumatologists are adapting “well” to the major disruptions to practice and training caused by COVID-19, according to NSW clinicians.

Faced with the sudden need to avoid face-to-face contact with patients wherever possible, the traditionally “hands-on” speciality has embraced telehealth consultations and other measures such as getting patients to do self-reported joint assessments, according to Dr Ken Cai and colleagues at the Department of Rheumatology, Westmead Hospital, Sydney.

But while rheumatologists have coped well in the first few weeks of the COVID-19 pandemic there are concerns about disruption to training, research and the economic viability of private practice rheumatologists if the pandemic restrictions remain in place for the next few months, they write in the European Journal of Rheumatology.

Dr Cai describes how the COVID-19 pandemic has had a profound effect on the delivery of care in public hospital settings, particularly with the swift transition of 80% of outpatient clinic appointments to phone or telehealth consultations.

“This has worked surprisingly well … including the need for conference calls when interpreter services are required … and patients have been very understanding. Outpatient clinic face-to-face consultations are limited to new urgent patients,” he says.

Inpatient management has been less changed, with ward rounds and consultations continuing but performed with the minimum number of medical staff, with appropriate social distancing. Routine radiology, histology and research meetings have been cancelled or switched to  videoconference, and most non-ur­gent investigations are postponed to reduce patient exposure to COVID-19.

And since the infection risk seems to be most severe in the over 65 age group, Dr Cai notes that moves have been made to limit exposure to infection of more “senior” colleagues by removing them from the on-call roster.

The effects on rheumatology teaching and training have been profound and present many challenges, according to Dr Cai. There has been a successful shift to online and vid­eo-enabled classes, and stu­dents meeting together in a larger webinar for­mat. However the clinic closures and social distancing restrictions mean there are few chances for students to have patient access and to gain basic skills in physical examination.

For rheumatology trainees COVID-19 has meant similar disruption to face-to-face patient exposure and also to consultant-led teaching with meetings and teaching sessions moving to online formats.

“Patients are asked to examine their own joints (e.g. measuring and recording the diameter of their wrist to assess joint effusion, counting the number of gouty tophi, etc),” notes Dr Cai.

His article also warns about the economic impact of COVID-19, which is likely to be severe for the two thirds of rheumatologists who work in private practice .

With ongoing business expenses such as wages, the reduction in income from seeing fewer patients and relying more on bulk-billing telehealth items means that many rheumatologists in private practice may have to reduce staff, and temporarily or even perma­nently close their businesses, he warns.

“There is significant anxiety amongst private practice rheumatologists regarding the financial viability of their businesses, many of which may require economic support through recently introduced Australian Government initiatives to retain employees and keep busi­nesses open,” writes Dr Cai.

“We continue to work and teach, modifying our approach as we learn from countries such as Italy, Spain and the United States. However, it is almost certain that we as individuals, and our societies will be in­delibly affected by this pandemic,” he concludes.

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