UPDATE TO The New Normal at NJNBI

As we all continue to meet the challenge brought by the pandemic, NJNBI remains committed to your care. We are still treating patients under the current circumstances and will fulfill our pledge to giving our patients the best surgical care possible.

While two of our locations remain open and we are able to perform urgent surgeries that meet certain criteria, I wanted to briefly address a relatively new phenomenon in health care that is quickly entering all of our lives during the pandemic – telemedicine.  Essentially, telemedicine is any health care that is done over phone or video as opposed to seeing a provider in person.

You may have gotten messages from other health care providers that they are seeing patients on a telehealth platform that facilitates consults while you are at your computer or mobile device.  This is an effort to reduce the transmission rates of the virus by opting for video contact rather than in person.  This is in general a good idea and it may be perfect for several medical disciplines.  Behavioral health services such as addiction counseling or psychiatry are a perfect application for a telemedicine platform because they seldom involve touching or other physical interaction.  A significant portion of primary and family medicine can be achieved through video consult as well.  Telemedicine is nothing new. It was pioneered by the Department of Defense as a way of delivering battlefield medicine in the early 1970’s. Some of the capabilities are truly mind boggling such as remote control surgeries and drug delivery by drone.  Technology companies all around the world have created secure platforms that are compliant with privacy laws and safeguard and secure electronic medical records.  Telemedicine was already long underway as the new normal in health care but emerging very slowly until the pandemic kicked its widespread adoption into high gear.

The degree to which spine surgery can find utility in a telemedical platform remains to be seen.  We are after all addressing structural and anatomical issues that require observation and in-person diagnostic exams, many of which cannot be done over video.  There is of course, a portion of my interaction with patients during routine care that may not require an office visit – things like evaluating options after a diagnosis, devising a surgical plan, and other post-operative discussions seem like services that could thrive on a telemedical platform. However, when a patient is describing symptoms and I must determine the source and pathology of the symptoms it is almost impossible to do so through conversation and video alone.   However, in the effort to find every possible way to reduce transmission of COVID-19, NJNBI is committed to deploying as much telemedicine as is reasonable without compromising any quality of patient care.  Five years from now, spine surgeons will have a general consensus on what can be done on a telemedical platform and what requires in person interaction.  For now however, rather than allow telemedical visits to be an arbitrary decision, we plan to apply an abundance of caution and adopt a conservative stance that when in doubt – even a little – we conduct an office visit.

My staff will review each patient inquiry and reason for calls, and instead of automatically deciding on a time for patients to report to one of our offices we will review whether a face to face visit is necessary.  I expect that we will still have a higher frequency of office visits than other medical disciplines.  You may have had a great telemedical visit with your urologist and even received prescriptions –that doesn’t mean it will work with your spine surgery.  I will however, try to identify as many circumstances as possible to default to a telemedical visit.

Once again, as our health system devises the best approach to triage COVID-19 patients, you should expect your date of surgery as well as the location may change.

If you are in need of a surgical consultation we will still triage according to the severity of symptoms.  Any decision to see patients immediately or delay evaluation will be consistent with our practice policies as they relate to the COVID-19 concerns. To minimize risks, we will be attending to the most acute patients in need of immediate care.

Two office locations remain open – North Brunswick and Lawrenceville. We are strictly following CDC guidelines of sanitation and infection control, and we will not overlap appointments and have waiting rooms full of patients and family members. We have incorporated a strict screening process prior to any patient encounter to minimize the risk of exposure.  With the exception of a physical exam, the staff will practice social distancing and wear masks.  You may be asked to use hand sanitizer in the office before we interact.  The original hospital we planned to perform your surgery at could change to a different facility and some may be an increased distance from your home.  While that is an inconvenience, an increased driving distance is a relatively small obstacle to endure.

While all of our neck and back surgeries are medically necessary, some are more urgent than others. Those surgeries that can wait a few weeks may simply get rescheduled once our health care system devises a way of directing and managing the increased COVID-19 patient flow.

If you have been waiting to schedule an appointment and are likely in need of surgery, it’s important that we still evaluate your situation and we come up with a plan.  Disc herniations and stenosis don’t spontaneously heal or stop hurting because there is a pandemic and it’s important we address a surgical strategy to prevent any worsening even it means scheduling a surgery date further in the future.

It’s important we remember that life will in fact go back to normal once we get through this phase.  While I share the universal feeling wishing this pandemic never happened and ends as soon as possible, solutions and responses to practical concerns like the advent of telemedicine are exciting and unexpected changes that will permanently change our lives going forward for the better.

My staff and I are immediately available to talk on the phone or email and answer any questions and to help with planning. Stay safe and stay positive!