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Melanie Cole: Welcome to Better Edge, a Northwestern Medicine Podcast for Physicians. I'm Melanie Cole, and today we're discussing the impact of COVID-19 an orthopedics. Joining me is Dr. Alpesh Patel. He's a Professor of Orthopedic and Neurological Surgery at Northwestern Medicine. Dr. Patel, it's such a pleasure to have you with us. How has the pandemic impacted your practice? How has your team responded to recommendations to delay elective surgeries and how are you and your team evolving care for your patients during this pandemic?

Dr. Patel: I think the last couple of months, since the COVID crisis really hit home here in the States, we've seen obviously the immense emotional toll that it has taken on our patients, that's on our communities, as well as on our healthcare teams. And I think any conversations that we have in this space first start off with a really important acknowledgement of the hard work and dedication that's shown through both at Northwestern and really at health systems around the country. And I think to me, that's an unbelievable positive that I've taken away so far is to see the level of dedication. And then to answer your question, when it comes to applying that level of dedication to orthopedic care, I've also been just astounded by the flexibility and the inventiveness of our healthcare teams at Northwestern, and also our patients really it's a Testament to everybody's resiliency and determination to see how much we've changed, how we deliver orthopedic care in such a short period of time.

Host: Well, it certainly is. You made a great point and tell us as elective surgeries had been on hold, what ones are you bringing back now? What's happening now?

Dr. Patel: Yeah, that's a great point. So when we think about surgery, I guess I get hung up a little bit on the term elective at times, because I think elective can be interpreted by some people to mean sort of non-important or optional type procedures. So I've, we've been trying to use a terminology around the word essential. So thinking about essential surgeries, not necessarily time-sensitive, where it has to be done today or tomorrow or next week, but still procedures that are important to do. So, the way we've handled that at Northwestern is really in a very rigorous sort of scientific approach to it, thinking about what is the patient and a very patient focused by the way, supremely patient focused perspective on this. So when we think about returning back to our operative schedule, the first question is always who's the patient, what's their condition?

 

How time sensitive is that condition, and then what are the issues around peri-operative safety? So is this patient safe to come into the hospital? Is it reasonable to expose them to the risks of surgery on top of the potential of COVID? And so it's a multilayer decision process, but it's always rooted in the idea of what's going on with the patient. What's their root problem. Is it time sensitive or not? And if it isn't, maybe we can wait, but if it is time sensitive, we've been able to shepherd a lot of resources at Northwestern to be able to take care of patients even through the worst of the crisis. And now, as we're reopening, we're seeing a very measured response, very slow, incremental response to reopening, fundamentally driven around the question of what's safe for patients. And that's the part that I appreciate the most as a surgeon is that we have an entire hospital system and entire health system at Northwestern, really focused on what's safe for the patient and then making decisions thereafter.

Host: Well, that's a great point. And thank you for that. Are there any unique challenges related to providing care for orthopedic specifically and spine patients during the pandemic? And while you're answering that about some of the unique challenges that you have faced, tell us how you're utilizing telehealth and how your clinic is leveraging this to help patients during this time?

Dr. Patel: Absolutely so unique to orthopedics and orthopedics and spine in particular, let's say is the idea that procedures that we're talking about are generally not life and death operations. Thankfully, they are however procedures that do cause disability. They cause pain. They cause it an impact on the quality of life of individuals. So as we first went into the COVID crisis, we looked at it in orthopedics as saying our best role as orthopedic surgeons is to get out of the way and let our other colleagues, our intensive care unit Doctors, our anesthesiologists, our emergency room Doctors. All the doctors that were taking care of patients during the height of the crisis. Our job was to get out of their way, and I thought a very simplistic response, but one that's really important. And now as we reopen, we really have a duty to get these patients back into our care. And that's the challenge, right? If you think about orthopedic patients, they oftentimes have challenges around mobility.

It's not easy to move. And so we would asking individuals to come into the office is a tax on them in terms of their time in the day, but also just their ability to do so, especially now when you add in the fear of COVID on top of that, it really makes it a big challenge to get patients to reengage with their orthopedic and spine care. And so one of the tactics, one of the things that we've done you know, proactively throughout the height of the crisis and continuing now into the end of May of 2020, is that we have reached out to our patients on a consistent basis. Tele-Health as you mentioned, is one of those vehicles by which we are available, whether it's by telephone, whether it's by video messaging or some combination of the two to keep in close contact with our patients, both so that we know what's going on with them, but they also then get eyes on what's going on in the hospital. And what I found to be a real light bulb moment for me is that that connection being connected to patients through a crisis like this is unbelievably important, obviously to our patients, they want to be connected.

They're living in a world of uncertainty. They may be hearing you know, the lay press and getting a lot of mixed messages about what's going on. So they seek us to as a source of truth for them, but it's equally been important to our doctors and our nurses and all of the healthcare providers that we work with at Northwestern to have those connections with the patients. So continuing that sort of human contact by telehealth has been extraordinarily important. And we've expanded that tremendously. We went from just a couple of providers within our orthopedic department offering telehealth to now a majority of our providers providing telehealth appointments. And as we look ahead and we foresee, you know, questions around how much of this will stick, I think a substantial amount of it will stay where we continue to offer telehealth options to patients and locally within the Chicago area, but also regionally. So I really look at this as an opportunity to continue to provide the great care we provide at Northwestern to even more people.

Host: Well, I certainly agree. And I think that I'm really glad that you brought up that this is something positive that's come out of this pandemic and that you might be using telehealth, and that you foresee using this in the future. Along those lines, Dr. Patel, do you see any long-term impact on orthopedic medicine or how you care for your patients? Tell us a little bit about how you're evolving care to keep your patients safe now and in the future. And most importantly, how will this pandemic change the way Northwestern Medicine department of orthopedics practices in the future?

Dr. Patel: So that's an absolutely great question. And I think to give you a simple, short answer, I would say that the result of this crisis and the way we've adapted and responded is going to drive our practice to be much more patient facing and much more patient friendly than we probably have been in the past. I think when we think about traditional healthcare, it's not always easy to get to your doctor, let alone the orthopedic surgeon, right? In terms of taking time out of your day time off of work, driving in parking, all the logistical hassles that can come into play. I think telehealth as it evolves and as it continues to improve over time will drive us and lead us towards a more patient friendly, patient facing practice.

Host: Well, thank you for that. And as we wrap up as for the challenges your patients face, and you've spoken about that for patients with orthopedic conditions, what do you want them to know about the importance of continuing their care during this time and for other providers, how can they help their patients to take forward this information you've given and help their patients to remain calm and the stress of all of this. As you said, at the beginning, when you have orthopedic conditions, there's an extra level of stress from not being able to move. So what would you like other providers to know about calming their patients and how you are helping with that at Northwestern Medicine Orthopedics?

Dr. Patel: Absolutely. I would say that you touched on a lot of the concerns that patients bring to us, that we hear from our referring physicians as well. We're living in an extreme uncertainty right now. Everybody's changing the way they run their lives, the way they run their medical practices. That's adding to the anxiety and adding to the uncertainty. And it's relatively easy to put orthopedic conditions at times on the back burner and say, well, you know, it's not life and death. Hang on, hang tight, bear with it. What I would remind everybody, patients referring providers is that there is a psychological toll that comes from orthopedic muscular skeletal conditions, that's been well-proven through both patient reported outcome studies, as well as database studies. There's lots of clinical studies that have identified a link between the pain and disability that comes from musculoskeletal conditions and a clear psychological impact that that has on individuals. And so we need to just keep in mind that there is a downside to pushing off care. There is a downside to delaying surgeries that could otherwise be done now. And those downsides, aren't just the physical ones. The ones that we typically think about as surgeons, they are absolutely as you point out, the psychological ones. Whether that be anxiety, whether that be depression, and a loss of the, of the quality of life that we want to live. So I guess that will be my reminder to patients and their referring providers is that there is a downside to pushing off surgical care that can make a substantial improvement in people's lives.

Host: Thank you so much, Dr. Patel, what a fascinating segment. Thank you for telling us about Northwestern Orthopedics and the implications of COVID-19 on orthopedic conditions. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for Physicians. To refer your patient, or for more information on COVID-19, please visit our website at NM.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.