Besides the expansion of telemedicine, how has COVID-19 affected your practice?

Urology Times reached out to 3 urologists (selected randomly) and asked them each the following question: Besides the expansion of telemedicine, how has the coronavirus disease 2019 (COVID-19) pandemic affected your practice?

“For a while, the hospital was not allowing elective surgeries, so we had to cancel procedures considered elective. A lot of patients wanted to stay home, and they canceled their appointments. There were some days we didn’t see a full day of patients, and a couple [of] days when we just closed the office because people wanted to stay home.

I respected that decision, …and worked on other projects so I could make good use of the time. That was probably March and April. By May, we basically had a full load of patients and it’s been very busy in the past few months.

I didn’t have any patients who suffered adverse consequences because of the delays. The urgencies we took care of just as we normally would. Some of the elective follow-up visits we postponed, then they came back a few months later and we’re getting caught up.

We’re taking it in stride. We don’t overbook to the point where we’re overwhelmed, and we’re not exhausting ourselves. We’re catching up.

As I said, none of my patients suffered because of the delays. The people who had true emergencies we took care of, and people who had things that could be electively postponed, we postponed, and now we’re getting back to normal.”

Sheldon Freedman, MD

Las Vegas, Nevada

“I’m a transplant surgeon as well as a urologist. We took a big step back when we first had [COVID-19]–positive patients [as] we were concerned about 2 things: Seattle had some of the first documented cases in the US, so we put a moratorium on living-donor transplants which were elective procedures. Then we cut way back on deceased-donor transplants because we [had additional concerns]. First, we worried about immunosuppressing patients who might then be exposed to COVID-19. Second, a lot of our patients come from outside the Seattle area—Montana, Alaska, Idaho. We didn’t want to bring people from low-frequency COVID-19 places into Seattle. That had a pretty significant impact on the transplant side of our practice.

Any time a patient doesn’t get an organ, you can say there’s a detrimental effect, but if you need a kidney, you can live on dialysis. Nobody we’re aware of died because he couldn’t get a transplant.

We’ve restarted both programs. Now that we know more about COVID-19, we realize most transmission is not hospital-acquired; people are getting it in the community. So we feel safe having people come in and stay 3 to 5 days.

We’ve been fortunate; just 1 transplant patient died of COVID-19. She was 6 months out from transplant; she and her mom both contracted it in the community. They came into the hospital and succumbed to the disease. Most of our transplant patients have comorbidities—diabetes, hypertension, [or] they’re elderly––we’ve had no new transplant patients develop it.

We still did cancer surgery. There wasn’t a day I didn’t do something in the operating room, but my clinical practice was down by 50% to 60% for a couple months. We’ve gone back to close to our normal practice now. Volumes are just down about 20%.”

Christian Kuhr, MD

Seattle, Washington

“The most obvious impact is that we all had a shutdown. I practice at the Minneapolis VA hospital. We’re continuing at reduced capacity. So that’s a major thing.

We have a more finite capacity and fixed resources at the VA. The government doesn’t just allow people to work overtime. Work stops at a certain time of day. We’re more restricted than the private sector, so there’s a backlog of cases. Surgery dates we can offer are somewhat in the distant future, making the backlog longer than is already usual at the VA.

I don’t think any patients were actually harmed. I think it’s more psychological. I’m talking mainly about prostate cancer. Once you’re diagnosed with any cancer and have chosen a certain path, it’s hard to understand that you have to wait another couple months to have it taken care of. Patients who were really urgent, however, [were taken care of]. It’s just the additional burden to waiting. We care for many older patients with comorbidities and they’re certainly worried about getting COVID-19.

We’ve had a few patients who had to cancel surgery because they developed COVID-19. Patients of mine developed [it] through community spread, not within the hospital, and they’ve all done OK.

We are catching up. Nobody I’m aware of is overwhelmed; we always have lots of work and stress, but it’s what we’re here for, isn’t it? It’s part of our social contract as physicians.”

Philipp Dahm, MD

Minneapolis, Minnesota