Some procedure protocols also have been modified to enhance patient safety and social distancing. “In the past, patients undergoing Mohs treatment would move to a common area to wait while the doctors assess whether additional tissue must be removed,” Aasi said. “Now, each patient stays in a separate room throughout the procedure. We were also able to fast-track this process for Mr. Lewis and perform a biopsy to confirm the cancer and perform the surgery to remove the cancer all during the same appointment.”
Lewis was impressed with the safety measures at the Stanford Medicine Outpatient Center in Redwood City, where he underwent the surgery. “There were signs and markers on the floor to remind people to socially distance, and mask usage was rigorously followed,” he said. “I wasn’t worried at all.”
Telemedicine as a triage tool
In addition to modifying surgical visits like Lewis’, Aasi and her colleagues have increasingly turned to telemedicine, which ensures patients will not be exposed to the virus during a consultation. “Many of our examinations in dermatology are very visual,” Aasi said. “So telemedicine, or video consultation, is perfectly suited to triage dermatology patients and sometimes even diagnose particular problems. We can help people decide whether it’s appropriate to delay care, or if they should make an appointment to see us sooner.”
These are principles and tools we’ve developed over years.
For example, patients concerned about a dermatological problem can discuss it with their primary care physicians, who can refer them to Stanford Health Care’s telemedicine clinic for a remote consultation that in most instances obviates the need for an in-person visit. When elective procedures were suspended Stanford Health Care in the spring, televisits made up about 70% of all clinical visits. Patients can download the MyHealth app to any computer or smartphone to launch the visit with a Stanford Health Care doctor, without leaving their homes.
“These are principles and tools we’ve developed over years,” said Justin Ko, MD, MBA, medical director and chief of medical dermatology, “and, particularly in the setting of COVID, they are transforming dermatological practice. They help us provide care for patients where they need it, when they need it. We can talk over their concerns, look at the problem area together. ‘Is this a safe spot, or is it a skin cancer that needs to be removed?’”
Despite the hurdles posed by the pandemic, Aasi and her colleagues are committed to providing timely, appropriate medical treatment for all types of dermatological problems.
“We need to continue to treat our patients regardless of challenges in our environment,” Aasi said. “One of the things I love about Mohs surgery is that we can treat a patient with cancer, and then in that same day look them in the eye and tell them they are cured. But we can do that only if patients don’t delay their care. If you miss that window, the situation can get much more dire.”
Lewis had no trepidation about visiting Stanford Health Care. “I know I will always be taken care of,” he said. “It’s a very caring, very streamlined process, and they fit me right in within a week or two of my referral. I’m never in any doubt that everyone there really knows what they are doing.”
“Stanford has saved my life three times,” Lewis said, referring to previous medical procedures at Stanford Medicine. “My wife, Esther, and I tell people we are never going to live more than a 30-minute ambulance ride from Stanford.”