This is part of a blog series from genetic counselors at the Basser Center. This was written by Jacquelyn Powers, MS, LCGC.
As discussed in part one of this blog post on telehealth and genetic counseling, over the last few months genetic counselors at the Basser Center—as at many other places—have seen the majority of our patients virtually, via teleheath. I have had some incredibly meaningful interactions with patients during this time, including a virtual family counseling session of 5 siblings, all logging in from their respective homes. I have tested multiple family members for a BRCA1 mutation, all of whom reunited under the same roof, having left New York City and Northern New Jersey, for their parents’ house in the Pennsylvania suburbs.
Patients are surprised when I let them know that testing can be facilitated in their own home via saliva collection kit (or phlebotomist). Results are disclosed via phone or video, and follow-up consultations with our physicians can be arranged virtually. Elective procedures were cancelled or delayed in March and April at the beginning of quarantine, but recently Penn Medicine has resumed these procedures. This allows patients to act on medical recommendations, such as mammograms, breast MRIs, and colonoscopies.
Though we have found ways to adapt and accommodate patients’ needs for genetic counseling and testing during this period, there are distinct differences from our in-person appointments. I hope those changes will not be overlooked as we plan what healthcare may look like in the long-term future. One example is that the expected turnaround time for receiving genetic testing results is naturally a bit delayed. It takes time, typically 72 hours, for the patient to receive a test kit by mail. We are also finding that some patients are not collecting their samples and shipping them back as quickly as if they had been in the office for a same-day blood draw. For those patients who require expedient testing (i.e. genetic testing prior to surgery), laboratories are working hard to be able to ship more quickly and we are trying to better impress upon the patient the importance of timely specimen collection.
There are also new psychosocial considerations. When conducting a session by telehealth, I find I have to be more intentional about explaining certain behaviors that would otherwise be obvious during an in-person session. For example, informing the patient that I am looking away from the screen because I am taking notes or updating the family tree. I have also found the assessment of non-verbal cues more challenging over an electronic connection. I cannot as easily assess shifts in posture or position, or if an individual is on the verge of tears (especially if connectivity is weak). I find myself having to try harder to maintain presence and I believe this to be reciprocal.
To my surprise, I have realized that a day of patient visits via telehealth is more fatiguing as compared to in-person. And I believe this fatigue to be two-fold; it’s the fatigue of looking at a computer screen continuously throughout the work day, plus the emotional and mental fatigue of missing that authentic human-to-human interaction. This is an aspect I find hugely fulfilling as a genetic counselor—it “fills my tank,” so to speak.
But I do think there is an important role for telehealth in genetic counseling. I believe it is here to stay and has become a more mainstream part of what we do as genetic counselors. It has enabled us to continue to care for patients during this uncertain time. I am really proud of my team at the Basser Center and proud of Penn Medicine for making this an option for our patients. Until we see each other in person again…