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How Telehealth is Changing Ocular Melanoma Care | The Eye Believe Podcast · The Eye Believe Podcast

0:03
hey everybody
0:03
welcome back to the Eye Believe Podcast
0:05
I'm joined today by the famous Doctor Carol Shields
0:09
world renowned ocular oncologist
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and Doctor Shields I just want to
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thank you so much for being a part of our podcast
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last year um
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your episode did phenomenally well
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and I also just wanted to give you a moment to um
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well just give a moment to offer my condolences in the
0:23
the wake of losing your husband
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Doctor Jerry Shields do you want to
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just take a minute and tell the community
0:29
just what what should he be most remembered for
0:31
I know he's got a great legacy
0:34
yes so
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I've had some time to think about this
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because he was
0:39
not in the greatest health over the past three years
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and
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um you know
0:45
I think he came into this field of ocular oncology
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with a background in retina
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and a background in ophthalmic pathology
0:55
and he knew that the field of ocular oncology
0:59
back in the early 70s needed a lot of organization
1:04
so Jerry spent most of his time
1:08
just organizing various tumors
1:11
and together we worked
1:13
and we would
1:14
review current treatments for various tumors
1:18
what works what doesn't work
1:20
and we took a field that I believe
1:23
was kind of the Wild West
1:26
and made it into a very organized
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cultured field of ocular oncology
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where specific diagnoses can have specific protocols
1:38
and we have good imaging protocols for various tumors
1:44
and I just think he
1:45
brought us from being very disorganized
1:48
into a very organized field now
1:50
when you go to our meetings
1:52
it's amazing how advanced how
1:55
how advanced we are in genetics and new treatments
1:59
and saving vision and saving lives
2:03
well I think it's absolutely incredible
2:04
the work that you two have done
2:06
over the last few decades
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um I don't even think I know exactly how many decades
2:09
cause I'm kind of a baby myself as the
2:11
as the patient who's newer to this
2:14
at least comparatively like I'm
2:15
I've been in this for five years
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but I know
2:17
patients all around the world know who the Shields are
2:20
and we know
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so much of the
2:22
forward movement that we've seen in ocular melanoma
2:25
has come because of your guys' research
2:27
and the research done by all of the people
2:29
you guys have on your team
2:30
at Wills Eye so thank you guys so much
2:32
and those of you guys listening today
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just send up some good energy
2:35
your prayers whatever it is that you use
2:38
and just send that to the Shields family in
2:40
in the wake of this um
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this loss but we are so grateful to see you here
2:44
and
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we know that you are so passionate about what you do
2:46
for OM
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and I've heard from a few little
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you know little bugs in my ear
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that you've actually been doing a lot of telehealth
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appointments for ocular melanoma
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and I'm not gonna lie I'm not too surprised
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cause you know
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we all did Covid right
2:58
we survived that era so with that in mind
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will you just give us an idea of
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you know why telehealth
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why is this becoming a little bit more
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of an advantage in your field
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as an ocular oncologist sure
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I can I can talk for hours on virtual telehealth
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um so it was actually before Covid that we
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the main people in our office
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sat down and had a meeting
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and we said you know
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we've got to be able to provide care for patients
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so that
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they don't have to drive downtown in Philadelphia
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with all the traffic and the trouble
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and pay for expensive parking
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and we should be able to see them
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at various remote sites
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and provide their care just as well
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and those that really need to come down
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well then we'll tell them no
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we must see you downtown
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but I think maybe 80% of our patients
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we can see at virtual sites
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so we've set up three sites
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we have one northwest of Philadelphia
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one directly east of Philadelphia
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and one directly south of Philadelphia
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and they're all approximately
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say 30 to 60 minutes away from Philadelphia
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and these are sites where we bought office space
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and we set up
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we had a there was a set up cost
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we had to buy the cameras
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the ultrasound
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the OCT
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and have enough office space
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to provide care for patients
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so there was a a startup cost
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and what we decided to do was
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we would buy the same cameras we have downtown Philly
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which we think are the best cameras available
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we bought them for each of those sites
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so that when we see a patient
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it's seamless we're looking through the same camera
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the same eye to see the fundus
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and then what we do is every Monday
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Tuesday Wednesday
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we will see a group of patients at a remote site
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for example uh
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on Monday we might see a group of patients
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directly east of Philadelphia
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in Cherry Hill
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New Jersey and these are mostly New Jersey people
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but we do see some Virginia people
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who prefer to go there
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get a quick all their imaging done
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and then we hop on via zoom
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review all their images in front of them
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dictate the letter in front of them and then set
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discuss it with the patient
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it's really a great way to save them from
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coming downtown and you know
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we have free parking at these places
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and it's a lot more chill to go to a satellite
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than it is to come
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and go up the elevator to the 14th floor here yeah
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and I love what you said
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you said a satellite clinic right
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so if I'm understanding it
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Wills eyes kind of the mother ship so to speak
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and then you guys have three satellite locations
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that are just a little bit further out
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so that and and please correct me
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if I'm wrong
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people still would need to travel to Philadelphia
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or to the Pennsylvania area
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to attend one of these clinics correct
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but this just saves them the downtown
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or is there a way to like say
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see someone out here in Arizona
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right so in order for us to see a patient in Arizona
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we have to have an Arizona license
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so in order for us to see a patient in Pennsylvania
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we have to have a Pennsylvania medical license
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and we do and we have two offices in New Jersey
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in Cherry Hill and one in Pennsville
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and the one in Pennsville
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is right across the bridge from Wilmington
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so we call that our Wilmington office
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the Cherry Hills are east office
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so we we do have a medical license in
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in New Jersey and in Pennsylvania
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so that we can see patients in either the two states
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the only way we can see patients from other states is
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if the doctor sends the information to us
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then we can do what's called a doctor to doctor uh
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consult um
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but for most other states
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we have to see the patient in Philadelphia
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no that makes total sense
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I just wanted to make sure
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to clear that up for any of our people listening
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so that they just understand
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you know this
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this satellite clinic saves them the downtown
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all of those expenses like you said
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but
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they still do need to be in the state of Pennsylvania
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in some way or in the state of New Jersey
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where you guys have a license to
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do this kind of appointment
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and obviously the
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and it sounds like an incredible imaging center
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where you guys have all of the latest
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like the ability to diagnose someone
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for example
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with ocular melanoma just by having them get scanned
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and then you talk to them
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after looking at all of the imaging
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so you know
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it's more than the cost of just coming down and parking
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part of it is uh
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the cost of having a son or daughter
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take off time from work and bring their father
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or their mother down to see us
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and the other is some people from long distances um
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have to pay for hotels so
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it's estimated that telehealth in general
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will save the patient about $2,000 a year
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now some patients spend more
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some spend less but still it's strong patient benefit
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but it's also a benefit to doctors too
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with telehealth we can see patients very efficiently
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there's no movement into a room
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movement out of a room um the
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in general the patients are um
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you know
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very happy that they're being seen at some place
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close to home
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so it makes the discussion a little bit easier
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the one thing that we have to provide though
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for the telehealth offices
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and these are called hybrid offices
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cause true telehealth is where you measure
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you know via a glucometer
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the patient glucose at home
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these are hybrid telehealth offices
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where you have to actually go to an office
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but you get all your imaging done
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so
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we provide a technician and we provide a photographer
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the same photographer that comes and does our photos
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you know at date first seen in our office
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and so we really we don't miss those two
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the days we do telehealth
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and they'll see on average 30
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sometimes 35 patients
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that they'll get all organized in telehealth
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and then every hour on the hour
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we try to zoom in to the telehealth office
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in between our patients at Wills
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we'll zoom in and then we'll see four or five patients
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and get them on their way
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and it saves them the whole day
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we even have patients who do telehealth with us
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and they go to work
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it's it's incredible
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well I'm just thinking back
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even to my experience of getting diagnosed
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and it was like a full day in the office
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I mean it was a full day
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yeah
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so new patients we tend to see in our office because we
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it's
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it's ideal when you see patients in the office
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cause if you have to do special tests in the office
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like gonioscopy where we put a lens on the eye
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to look in some of the corners of the eye
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we get the best view right in person
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so we always try to do our new patients in the office
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but I have to say during covid
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I mean I
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I we saw patients in every state
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because they took down that restriction
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that you had to see patients
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in states where you had a medical license
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I remember seeing a man uh
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in Alaska
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yeah we just did it by zoom
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that's so crazy we saw him in Alaska
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uh we talked him about the cancer that he had
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we told him what medication to get
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and he never even made a trip to us
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we did the whole thing wow
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over zoom
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that's incredible
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okay so I have a question
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you mentioned like obviously that you
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you prefer to see new patients in the office
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so in the scope of ocular melanoma
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like I mean we
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I know this is kind of maybe dumbing a point
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like I know you know this
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but just for our listeners
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like you get diagnosed a treatment plan is set forth
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whatever that looks like for the patient
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they have their treatment
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but then almost every well
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not even almost
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every ocular melanoma patient has follow up care
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is that correct
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like there's some level of follow up that happens
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that is absolutely correct
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and we generally immediately after we do the treatment
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we see them every four months
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but after two years we go to once a year
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cause if they're stable by two years
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chances are they're gonna always be stable
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yeah so this kind of hybrid satellite clinic
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this allows you guys
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to be able to follow up with patients virtually or
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you know in this hybrid setting
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instead of necessitating the get to Wills eye
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have the the entire experience
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that is the Philadelphia Wills eye experience
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which I mean you know
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everybody's got to do it at least once right
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if you're coming there right
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right so they
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they'll go to our hybrid telehealth offices
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and many times they just show up in flip flops
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cut off pants they get their imaging
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we zoom in with them because most of the time
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the patients we see in these offices are very stable
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like they've had a melanoma
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it's already been treated or they have a nevus
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it hasn't changed or they have a conjunctival
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lesion that we already removed
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so we can minimize their trips downtown
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and trust me I
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I come to work every morning at 5:00am
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and traveling the Schuylkill to work
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even at 5:00am there's lots of cars on the road
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and you know I can imagine when our patients come in
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it's gonna be even more congested
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and more of a challenge
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because if they're more elderly people
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it just makes it so much more difficult
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yeah no
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I absolutely believe that
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and I think this is so monumentally um
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life changing for those patients to I mean
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I just I just know that that's something that patients
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especially those who have to travel from rural
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like out of you know out of the city areas this
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this makes for an entire
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loss of a work day for most people
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and or or for a caregiver right
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because sometimes you're dilated and you're
13:53
you're just not confident driving whatever the reason
13:57
this sounds like it simplifies a lot of things
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yeah so one other thing I'm gonna say is
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you know this is so new in the field of ocular oncology
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that there's not been much written about it
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there was the first report to come out on telehealth uh
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in oncology an assessment of patient satisfaction
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was actually written by our daughter Nelly
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who is a second year resident at Wills and she did a
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a summary on telehealth in ocular oncology
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that was published
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in the Canadian Journal of ophthalmology two years ago
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and basically you know
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not everyone's satisfied with telehealth so that
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you know we
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I think it's more of the older patients
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who aren't that comfortable with zoom
14:43
and they really want to see the doctor in person
14:47
but we had about 90% uh patient satisfaction
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and 86% of patients said
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they would recommend it to a friend
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to do telehealth
14:58
rather than go downtown to see the doctor
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so I mean I think the days of waiting
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long hours in a doctor's office
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for something that's not so serious
15:09
I think those days are gonna be you know over
15:13
I think patients who have
15:15
not so serious things are gonna be fast tracked
15:18
into telehealth and they're in and out of
15:22
a remote office within an hour
15:25
that's incredible yeah
15:26
and a another study just came out in again
15:29
in the Canadian Journal of opthamology from Vancouver
15:33
where they wrote their experience
15:35
with telehealth and patient satisfaction
15:38
and they actually did a psychologically approved uh
15:44
test where they asked 10
15:47
standardized questions to the patients
15:50
to see if they really were satisfied with telehealth
15:53
and it came out very positive
15:55
the patients were definitely satisfied
15:58
you know
15:58
I know this from personal experience when you know
16:02
I had to take my husband Jerry for certain checkups
16:05
I always wished wow
16:06
I wish we could do this at home you know
16:09
just talk to the doctor from home well
16:11
I think that time has pretty much arrived
16:15
yeah
16:15
I think that you're so right and and as a physician
16:18
I can only imagine that telehealth
16:20
and having this kind of a setting where you have this
16:22
you know this hybrid opportunity
16:24
for patients who don't need that um
16:27
they don't necessarily need to be
16:29
in office in order to get
16:30
you know equal care
16:32
um I can imagine as a physician
16:34
this allows you to have way more time in your office
16:38
for those patients who do have to be there in person
16:40
and who you do kind of have to handhold through
16:43
like an ocular melanoma diagnosis or whatever it is
16:46
like your team then of of people is much more able to
16:51
um focus on them right and um
16:53
their experience there
16:54
and just making sure that they're okay
16:56
um as opposed
16:57
you know just because it's so much more efficient
16:59
like to see all these other patients correct
17:01
so what we do is um
17:03
on days when we see patients in the clinic
17:06
we always run telehealth cause the telehealth
17:09
patients don't need a lot of hand holding
17:12
they just need you know
17:14
check you look good everything's fine
17:16
don't worry about it whereas
17:18
the patients we bring into the office
17:20
might need a little more explanation
17:22
they might need uh
17:24
you know some of them still need injections
17:26
and they need to be in the office
17:28
so when we have gaps in time in the office
17:32
that's when we'll go and do our telehealth
17:34
it works yeah
17:36
no I think this is such an incredible way
17:38
and such an innovative way to approach um ocular
17:42
you know
17:42
ocular melanoma care specifically for our community
17:44
but I'm sure like I know
17:45
Wills eye
17:45
doesn't just cover the realm of ocular melanoma um
17:48
so I think this is like you said
17:50
I think this is cutting edge
17:51
like this is the future of medicine as we
17:53
as we have it now and
17:55
why not use the 21st century technology that we have
17:58
correct yeah
17:59
I mean I have to admit
18:01
Covid kind of plopped us into telehealth
18:06
but we were starting it already before Covid
18:10
just realizing
18:12
that not all patients need to wait all day to see us
18:15
not all patients need to drive into the city
18:19
or pay for expensive parking or stay overnight
18:22
so they can be first on the list
18:24
they can actually access this closer to home
18:27
so this our telehealth practice services uh
18:33
upstate New York eastern Pennsylvania
18:35
New Jersey Washington DC
18:39
Virginia even West Virginia
18:41
Delaware Maryland
18:43
they all use telehealth offices and
18:47
you know for the most part
18:49
it's a positive experience
18:51
um oh
18:52
and the last thing that we do at telehealth is
18:55
believe it or not we have a QR code
18:58
so we give the patient the QR
19:00
code at the end of their visit
19:02
so that they can make their next appointment
19:05
so
19:06
they don't even have to call in to make an appointment
19:09
now I have to admit
19:10
I got this idea from my little Muffies
19:14
who's my pet dog
19:17
Muffies Vet does the same thing
19:20
she doesn't do a QR code but she sends a
19:23
a reminder to check in and make the appointments
19:27
and we choose our own appointments
19:29
so via this QR code uh
19:32
patients will choose their appointment
19:34
and the QR code takes them either to
19:38
the western satellite the eastern satellite
19:41
or the southern the Wilmington satellite
19:44
and it allows them to make their appointments there
19:47
on their own without ever having to
19:50
I mean I'm a fan
19:51
yeah or sit on the phone for
19:53
you know
19:53
20 minutes waiting for someone to pick up again
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we're really trying to use
20:17
you know we're using iPad photographs
20:21
um uploading to the internet
20:24
uh zoom calling and in specific times
20:28
we do Facetime calling QR codes
20:31
this is all like cutting edge technology
20:33
it's it is a lot
20:35
a lot of fun to be a part of it
20:38
yeah no
20:39
I think it's so incredible
20:40
and I just really um
20:42
I just admire any and all of the physicians
20:44
that we have in our community
20:46
who try to utilize technology like this
20:48
because I do agree with you
20:49
I think it
20:50
I think it absolutely improves patient experience
20:53
and patient care in so many cases
20:55
and yeah
20:55
um and I
20:56
and I have to say I think that
20:58
you know even for
20:59
maybe the demographic of people
21:00
who aren't as confident with technology right
21:03
if they see their entire doctor's staff showing them
21:06
look it is possible
21:07
we're all doing it we all Learned how to do it
21:10
I feel like that as a patient
21:11
that just instills that extra layer in your physician
21:14
team but also
21:15
you know just shows them like okay
21:17
if they can do it maybe I can too
21:19
or at at minimum
21:20
they can really help me to be able to do this
21:23
and to handle this well and
21:24
you know to adapt
21:25
uh
21:26
because I think that's really what we're having to do
21:28
this day and age is
21:28
we have to learn to adapt
21:30
and use technology in the most innovative ways we can
21:34
right and I think
21:35
hanging around young people
21:36
makes it a little bit easier
21:37
too'cause they they show me a lot of little tricks
21:40
on the phone we do all of our dictation to the phone
21:44
which goes into our electronic medical records
21:47
which is so great we then print
21:50
we print out a letter
21:51
but we always put that in our chart
21:53
but we uh
21:55
e FAX the letter to the doctor
21:58
I mean this is like
21:59
it's kind of beyond belief what goes on
22:02
and if I ever get
22:03
like on the weekends sometimes or even in the evenings
22:06
I might get an email from one of our referring doctors
22:08
who says hey
22:10
we saw so and so she had a little bit of swelling here
22:14
can you check your chart
22:16
and let me know if that's new or old
22:18
and so what I do is I go into our electronic chart
22:22
or I go into our images
22:24
and I can check it immediately and answer immediately
22:27
back in the old days
22:28
I would have to talk to a secretary
22:31
pull the chart have the chart put on my desk
22:34
and flip through the chart
22:36
now it's like immediate
22:38
so it's it's really
22:40
it's uh exciting
22:42
yeah I love it
22:43
I absolutely I mean
22:45
I'm just I'm thrilled to hear you talk about this
22:47
and to hear just how excited you guys are as a team
22:50
to have been able to bring this from
22:52
you know it's idea
22:53
like it's inception all the way to okay
22:55
now we've got this well oiled machine
22:57
that is really working in our favor
22:59
um so just kind of out of curiosity
23:01
I know Wills Eye is absolutely
23:03
one of the most popular eye
23:04
cancer centers or eye health centers in the world
23:07
um how many patients
23:08
are you guys able to see through telehealth
23:11
do you have like a rough idea
23:12
yeah maybe every week
23:14
oh every week we see patients via telehealth
23:17
and we are scheduling
23:19
anytime we see a new patient in our office
23:22
uh the technicians and I
23:24
they'll say satellite and
23:27
or they'll say Cherry Hill
23:28
that's one of our satellites
23:30
and I'll say yes so
23:32
we make the judgment the day we see the patient
23:35
for satellite or not
23:36
so I would say every Monday we see on average
23:41
uh 20 patients
23:42
every Tuesday on average maybe 10 to 20
23:46
and every Wednesday
23:47
we see on average 30 patients by telehealth okay
23:52
so you guys are definitely seeing
23:53
you know
23:53
upwards of 50 patients a week just in telehealth alone
23:56
absolutely
23:57
and you know we're going to various meetings this year
24:01
um some of our more junior doctors
24:04
will be going to the International Society of Ocular Oncology
24:07
in Brazil
24:08
and one of them's giving a talk on telehealth
24:11
I told her I said
24:12
you need to tell the rest of the ocular oncology community
24:16
how we do it how they can do it
24:19
what some of the cost will be to the doctor
24:23
what some of the cost savings will be to the patient
24:27
and how you know beneficial it is no
24:30
that was what I was gonna ask too is
24:31
you know would you suggest this for other clinics
24:34
around the world oh absolutely
24:35
to just implement this
24:37
I'm going to Stanford in November
24:40
uh to give several talks at a big meeting they
24:43
they host there
24:43
and it's called Innovate Ocular Oncology
24:47
and one of my talks is on how to do virtual telehealth
24:51
you know just to explain to them
24:54
you're gonna need dedicated technicians
24:58
you're gonna need dedicated ophthalmic photographers
25:02
and you're gonna need a
25:04
kind of an electronic wizard in your office
25:08
who's gonna be able to troubleshoot
25:10
every time the zoom goes down
25:12
or troubleshoot when the internet signal is weak
25:15
and we're lucky we already have that
25:18
and we flipped into telehealth it
25:21
it's probably been uh
25:23
five years now that we've been doing telehealth
25:26
but now we are pretty much telehealth
25:30
four or sometimes five days a week
25:33
we'll do it
25:34
you know once a month we go down to Wilmington
25:36
but that's gonna build
25:38
to the point that we'll be going down
25:39
you know we say go down
25:41
but we're we're just doing telehealth going down yeah
25:44
I know I I get what you mean
25:45
one technician goes down
25:47
and one photographer goes down
25:50
well and and I think as far as staffing goes
25:53
the ability for you guys to kind of have people who
25:56
can then travel like just briefly
25:58
you know like you said 30
25:59
40 minutes
26:00
like it's not like they're going states away
26:02
like they're right
26:03
they're just going kind of branching out
26:05
and we've made all the telehealth
26:08
so that it gets done by noon um
26:11
so it's always morning
26:12
and that allows them to come back to wills
26:16
if they have anything extra to get done at wills
26:19
just to get caught up on emails or whatever or to
26:23
you know just talk to us about whatever they
26:25
they did during the day um
26:27
so we don't want to overwhelm them with
26:29
really heavy duty telehealth and um
26:33
that works fine too um
26:36
I think our busiest telehealth is
26:40
actually in Cherry Hill or in Blue Bell um
26:44
east and west um
26:46
we have a lot of patients
26:47
who love going to the Blue Bell office
26:49
cause it saves them
26:50
even touching the Schuylkill Expressway
26:53
that's the big road that leads into Philadelphia
26:55
and that's always um
26:58
a dangerous road to ride on
27:00
so we will catch
27:03
like a lot of the patients from Rochester Syracuse
27:06
Albany Scranton
27:08
Reading Allentown
27:10
and they'll go to Blue Bell
27:12
and it just saves them a whole hour driving in
27:15
parking and then waiting in the office
27:18
and then the whole hour
27:19
getting back to that office site
27:23
well I think it's absolutely admirable
27:25
how well you guys have implemented this
27:27
and how um
27:28
and just how well you're able to show that it works
27:30
right
27:30
and I look forward to hearing more from ISOO and IOO
27:34
um and just hearing how we
27:36
you know I
27:37
I really look forward to seeing how more offices
27:39
could implement this um
27:40
I I think that it will be absolutely
27:43
life changing for so many patients around the world
27:45
and I just want to thank you for being so dedicated to
27:48
using the innovative technology
27:50
in your practice as well as
27:52
you know proving that it works through research
27:54
yeah you know
27:55
if we if we were back on old fashioned
27:58
you know paper charts with slides and whatever you
28:03
it would have been nearly impossible to do telehealth
28:06
but now that we're you know
28:08
completely digital with all of our images
28:11
completely digital with our chart
28:15
and we even have something that we call a living grid
28:18
this is important
28:20
a living grid is a summary of a patient's course
28:25
so that we know what what we saw at each visit
28:29
but they
28:30
we only get one line to put it in for each visit
28:34
and it's a quick summary on when they had their plaque
28:38
when they were diagnosed uh
28:40
when they develop macular edema etcetera etcetera
28:43
so it's really a and we have that all digitized
28:47
and that's also kept
28:49
so that we can access it at any satellite
28:52
and in our office and it's hipaa protected
28:55
everything is hipaa protected
28:57
and that's something very important
28:59
when you do telehealth
29:00
you have to make sure that all that you're doing is
29:04
approved for patient privacy
29:08
yeah that's absolutely so important
29:10
and I I imagine that's something that
29:11
you know some patients
29:12
that's maybe one of their questions of well
29:14
if I have this this hybrid visit
29:16
is my data gonna be protected right
29:18
we're talking across the internet
29:19
is that going to be safe so
29:21
it sounds like you
29:22
guys have some incredible safeguards in place
29:24
to make sure that hipaa is always protected
29:26
across the internet because the internet is big
29:29
it is vast it is
29:30
and you know
29:31
you wanna protect yourself from hackers
29:33
you wanna protect yourself from
29:35
you know leakage of information and
29:38
and very private information
29:40
so we we take care to always
29:42
you know obey the hipaa rules
29:44
and all of our imaging when it's uploaded
29:47
it's uploaded to a hipaa protected
29:51
uh software called continuum
29:54
so we have everything organized in that continuum
29:58
no that's absolutely so reassuring to hear
30:01
I'm sure um
30:02
but I am wondering for some of our listeners
30:04
maybe if they're they're listening
30:06
they might be wondering okay
30:07
like is this gonna be something my insurance will cover
30:09
um what do you have to say to that question
30:11
if you get that you know
30:12
at all in the office yeah
30:14
so thanks to Covid insurance covers uh
30:18
telehealth visits so for us
30:21
um if we do a standard uh visit
30:24
uh insurance will pay a standard payment
30:28
uh the only thing we're not doing is
30:31
we're not putting on the indirect
30:33
to look at the patient's fundus
30:36
we get wide angle images of the fundus
30:39
so we can see everything sometimes actually
30:43
we see even better on the wide angle images um
30:47
but we get
30:48
all the other imaging is standardized imaging
30:51
um yeah
30:52
and insurance covers this uh
30:54
so not only does the patient save in personal cost
30:58
but you know
30:59
parking cost but their insurance still covers it
31:03
yeah no
31:04
absolutely that's
31:04
that's obviously gonna be a big
31:06
a big factor for some people who
31:07
if they just have questions
31:08
so thank you for addressing that
31:11
well it sounds like you guys have a really
31:12
incredible system in place
31:14
and I look forward to hearing from
31:15
you know I mean
31:16
it would be so fun to hear from a panel of patients
31:18
who maybe been part of the telehealth
31:20
so if you're one of those people listening
31:22
and you guys want to chat on our podcast
31:24
please reach out
31:26
um you know
31:26
please reach out I don't know Doctor Shields
31:28
do you want them to reach out to us directly
31:30
or do you want them to reach out through your office
31:32
yeah either way
31:33
either way it would be fun to actually have a
31:37
a panel of patients talk about what they liked
31:40
what they didn't like
31:41
and suggestions for how to improve yeah
31:44
that would be fun no
31:45
I think that'd be amazing okay
31:46
well I'm gonna put that on my to do list of you know
31:48
find those patients I'm gonna put some feelers out
31:52
um and then
31:53
my only other question for you to wrap up is just
31:55
you know where do you as an ocular oncologist
31:58
want to see telehealth and these kind of satellite
32:01
this hybrid visit idea
32:02
taken in the wider world of ocular oncology
32:06
yeah so the whole
32:08
I think the biggest future benefit of telehealth
32:12
will be early detection
32:15
of diseases that we previously couldn't detect
32:20
because it was too far for the patient to come
32:23
or too much trouble for the patient to come in
32:26
to see us or their son couldn't take off the day
32:29
or they didn't want to stay overnight
32:31
now we go out to them and we set up a
32:35
a whole office filled with cameras and stuff
32:38
and we can monitor for example
32:41
this week I was doing my telehealth on Monday
32:45
and I saw one patient that had a freckle in the back of
32:50
her eye and it had shown growth
32:53
now had she not come to our telehealth office
32:57
had she gone to her regular ophthalmologist
33:01
or to somebody else it might not have been detected
33:05
so it allows us to still provide good care for patients
33:10
who have potentially
33:11
really serious problems even for our children
33:15
we see a lot of children with eye cancers
33:18
namely retinoblastoma and it allows us for that
33:22
to monitor them even into their teens
33:25
into their 20s they can still go to telehealth offices
33:30
and get in and out and still go to work
33:32
same day
33:34
Seeing a doctor does not need to be a whole day lost to the office it could be a
33:42
just an hour of your time getting imaging
33:45
then you go to school or you go to work
33:48
or you don't bother your or your son goes to work
33:52
and then what we do is we either zoom with the patient
33:56
or we will have one of our technicians
33:59
call the patient afterwards
34:00
and just go through everything that we discussed
34:03
yeah so
34:04
I mean it really sounds like seeing more doctors right
34:07
more doctors not just your
34:09
guys'team utilizing this
34:10
will just be a larger benefit for everybody
34:13
seeking eye cancer care all across the world yes
34:16
so it hasn't caught on quite as much
34:19
in the world of opthamology
34:21
only because you have to
34:24
physically
34:25
send a person to the office to take the vision
34:28
there are ways you can do vision on zoom
34:32
I could hold up a vision card and I could tell you
34:36
get a tape measure and stand X number of feet back
34:41
and now you will read this card
34:43
but you can't you can't expect everybody to do that
34:48
so that's why we
34:49
we actually send a technician to do visions pressures
34:55
ultrasound
34:57
UBM ultrasound biomicroscopy
35:00
and then we send a photographer to do Clarus
35:03
wide angle images autofluorescence and OCT
35:08
that way we get all the information we need
35:10
and everything is done you know
35:13
everything is done within 15
35:16
20 minutes per patient and uh
35:20
you know theoretically
35:21
if we could see the patients right then and there
35:23
we could have them discharged right away uh
35:26
except for the few the few that show activity
35:30
what we do is we bring them into our office
35:34
so for the 98% that don't need anything
35:38
we tell them see you later you're doing great
35:40
don't worry
35:42
for the 2% that show evidence of some change
35:45
we have to bring them into the office
35:47
so if they do end up having to come into the office
35:50
does that end up being a same day or is it like
35:52
oh we gotta bring you in tomorrow
35:54
no it could be same day
35:55
and typically most of these offices are pretty close
36:00
to the point that we could
36:01
it's a 30 minute drive maybe in traffic
36:05
maybe a one hour drive but we could see them same day
36:08
and get things situated for them
36:11
oh I think this is
36:12
this is so good um
36:13
and like you said
36:14
I know we could talk for hours of this
36:15
but I definitely um
36:17
I definitely want to be respectful of your time
36:19
so you can get back to seeing patients
36:20
I'm sure um
36:21
but thank you so much for your time today
36:23
Doctor Shields and for just this incredible idea
36:25
and we just again want to offer our community
36:28
condolences for the loss of Doctor Jerry Shields
36:31
but we are grateful for the legacy that you guys
36:33
continue to carry on at Wills Eye
36:34
and for the amazing absolutely amazing
36:37
critical care that you guys give to ocular
36:39
melanoma patients so thank you
36:41
thank you thank you very much
36:43
and thanks for allowing me a little bit of time
36:45
to speak about Jerry
36:47
uh he was
36:48
he was a an educator not just to patients
36:53
but to doctors to ophthalmology worldwide
36:56
he was an organizer um
36:59
and you what you might not know uh
37:01
when he was younger
37:03
he actually was a butterfly collector
37:06
and he collected butterflies
37:09
to the point that he had the
37:10
second largest collection in the United States
37:14
and he named them all genus species
37:18
put them on cardboard poster boards
37:21
you know pin them up like they used to do
37:24
and he had
37:25
he used to exhibit it at many different places
37:28
and when he finally went to college
37:31
he gave it to the college that he attended
37:33
Murray State in Kentucky
37:36
so he was an organizer going way back
37:39
and he came into the field of ocular oncology
37:43
and organized it like
37:46
like nobody's business nothing
37:47
yeah that's amazing
37:49
he really did a great job
37:50
mention you didn't know how long we were together
37:52
we were together 41 years
37:55
so amazing it was a
37:56
it was a great 41 years we had so much fun
38:00
every day was an adventure
38:01
and I'm you know
38:03
kind of opening this new chapter
38:05
and I am working in his honor
38:07
I know he would want me to continue and um
38:11
I hope our daughter uh
38:13
joins us yeah
38:15
I loved hearing you talk about her
38:16
being in her residency
38:17
so I hope that she joins you as well
38:19
I think that it's
38:20
it's a really incredible family legacy um
38:23
no matter which direction it goes
38:25
but I really think that you
38:26
guys have done a phenomenal job
38:27
and I just applaud your efforts
38:29
thank you thank you so much
38:31
um I just want to
38:32
go ahead and just take a quick second
38:34
to thank our sponsors
38:35
those of you guys listening this podcast
38:36
is sponsored by Castle Bio Sciences
38:38
Immunocore Delcath Systems and Aura Bio Sciences
38:42
without their generous sponsorships
38:44
we would not be able to make this kind of uh
38:46
video content audio content
38:48
and just continue
38:49
helping you guys know what's out there
38:51
and what's new in ocular melanoma
38:52
so thanks again to our sponsors
38:54
and thank you hugely to our listeners
38:56
and finally to our guest Doctor Carol Shields
38:58
we'll see you guys next time