Time for the ALARA alarm!
Hi again. All is well this week. Well, not really. The continued, and accelerated partisanship of the pandemic is alarming, as is the lack of a nationally coordinated reopening. We do have much to celebrate, as the stay in place rules clearly had a positive impact to most of the country, but our inability to couple that success with how to move forward in a coordinated manner is disappointing, to say the least.
This week, though, I am really upset and angry. Angry with (some of) us; radiation oncologists.
I do not use this forum lightly and have appreciated the opportunity to journal our efforts in New York. It has served as a catharsis for me personally and based on emails, informative to many.
I was asked to referee a manuscript and will shield the authors and journal. This manuscript was to outline the successful implementation of Virtual On Treatment Visits.
With the impending tsunami of COVID-19 ASTRO rightly requested several changes from CMS not knowing how things would be and fortunately they were granted. One of these requests was to perform On Treatment Visits via telehealth. That said, an arrow in the quiver is better to have but does not serve as an excuse for its use. I'll explain.
The authors of this study suggest an ALARA analogy to avoid the virus; time and distance. Makes sense. Everything anyone can do to limit risk is worthwhile. But who is 'anyone'?
There are many things wrong with this. First, it is critical during the pandemic that our patients are hyper-acutely managed during treatment to avoid side effects, ED's and hospitalizations. This may require several weekly OTV's and more vigilant management by the physican.
Next, our patients are risking themselves to come daily for treatment. Some using public transportation. It is well recognized that fear of healthcare is a significant collateral casualty of this pandemic. Patients are petrified of us-healthcare, but they are treating their cancer, so they come. And our health system's internal marketing data suggests that hearing from their physician is THE most important factor to allay these fears. Our patients are physically present for care – we should be physically present to see them.
And lastly, all I will say is what about our Therapists! They are just like everyone else, fearful for what they do, which is to literally and physically treat all our patients daily without social distancing. They are at the front lines and it is most fortunate that during this pandemic they have remained healthy and engaged. They represent the real hero's for radiation oncology!
And with a final call out to our MA's, nurses and ACP's who room the patients and take vital signs and initial assessments. And then to have them turn on the virtual tele-program for us to do a virtual OTV?
ALARA -shmara. This ain't radioactivity. Those who do not run to the fire to help put it out serve no good. And to think we took an oath to do this, not our techs. And to think, virtual OTV's should be celebrated in a peer reviewed publication that will go on a few CV's?
Do me a favor this week and take 30 minutes from one of your days and sit at your machine with your techs; buy them lunch, give them a gift card and celebrate what it is they do every day for our patients. And then take your patient, gloved hand to gloved hand to an exam room for an OTV while telling your nurse its ok, you got it covered.
I am glad that ASTRO helped to have resources available if needed, like the opportunity to do a virtual OTV. Because the only way I would use it is if I was sick and needed to see my patients on treatment from being quarantined. That's an ALARA that makes sense.
This is my opinion and I welcome everyone's comments – good or bad.
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Louis Potters
Department Chairman
Northwell Health
Lake Success NY
(516) 321-2248
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www.sciencedirect.com
