It’s not just about seeing yourself through a cold screen – interview with Arnaldo Andreoli, Luigi Sacco Hospital

The ‘Luigi Sacco’ Hospital is a Milan university polyclinic that particularly distinguished itself during the COVID-19 pandemic emergency. In the months of the pandemic, the Specialist Rehabilitation Operative Unit directed by Dr. Arnaldo Andreoli was among the first to activate a telemedicine and telerehabilitation service dedicated to patients with COVID-19, but also to patients with neurological pathologies, neurodegenerative diseases, severe disabilities or rare diseases already followed by the rehabilitation team.

The staff of the Sacco Hospital Rehabilitation Unit is collaborating with the Istud Foundation project “Telemedicine between effectiveness, efficiency and humanization of care”, contributing with the experience developed during these hard months of emergency. In this interview, Dr Andreoli talks about his experience with telemedicine, exploring its opportunities and limitations and highlighting how it will be possible to achieve an increasingly effective and humane treatment pathway for patients.

What are the possible advantages and disadvantages of the use of digital healthcare and, in particular, telemedicine in daily clinical practice?

At the “Luigi Sacco” Hospital – ASST Fatebenefratelli Sacco in Milan, thanks to telemedicine, we have been able to contact, visit and rehabilitate a larger number of people, often at unthinkable distances from our facility. In fact, we have been able to follow patients from our city, but also patients from Piedmont, Veneto and even Sicily during their rehabilitation. In this way, we have also been able to support all those families who find it difficult to accompany their relatives on visits. In addition, caregivers have avoided having to take days off work or holidays. It is therefore possible to do healthcare at a distance. It is obvious, however, that the caregiver must be trained in telemedicine. You can’t improvise because it’s not just a matter of seeing each other through a video. You have to be trained and know how to do it because there are limits: a face-to-face visit allows you to objectify things that you cannot detect in telemedicine. There are pros and cons, which is why staff need to be informed and aware of the limitations of this tool and what it does not allow them to detect.

During the pandemic period, access to care has changed, encouraging the use of Digital Medicine and Telemedicine solutions. What do you think is the scenario?

It is useful to encourage more and more the possibility of a distance relationship. It is not always possible to visit patients in person, and telemedicine can be useful for minor symptoms.
Telemedicine also requires ‘time’, so an appropriate and defined amount of time should be set aside, possibly even setting up outpatient clinics dedicated to this service.

What can we learn from the experience of remote care during the COVID-19 pandemic and what cannot be transferred online?

Digital Medicine was an opportunity during the pandemic period, which made it possible to carry out ‘remote’ assessments even for patients in isolation due to acute infection with SARS-CoV-2, the virus responsible for COVID-19. In those cases, it was not possible to approach the patient continuously without wearing the necessary Personal Protective Equipment (PPE). Thanks to telemedicine, we were able to give continuity of care and contact to these patients, and also save money in terms of medical devices and equipment. This experience allows us to understand how telemedicine and telerehabilitation can be an opportunity to be considered not only for patients far away from the hospital, but also to ensure continuity of care to patients closer to (or even hospitalised), who cannot benefit from frequent contact with health personnel.
What is difficult to transfer online is the relationship with the patient. Many times, a face-to-face visit allows us to objectify many aspects that may be missed during a remote assessment.

What do telerehabilitation solutions for patients with post-COVID syndrome look like? How do you imagine the new patient’s journey?

Telemedicine is very useful and lends itself very well to telerehabilitation. After the in-patient visit, which is in any case a pivotal moment in the treatment pathway, the physiatrist issues an Individual Rehabilitation Project (I.R.P.), which can then be delivered by a physiotherapist trained using devices and platforms dedicated to telerehabilitation. During the rehabilitation session, the physiotherapist guides the patient, defines the type of exercise and verifies its correctness during execution.
This is also healthcare time that must be dedicated to the patient. In many cases, in fact, patients give up performing rehabilitation treatments because of the difficulty of accessing treatment facilities or because of the time it takes to travel to the hospital. Telemedicine overcomes this problem, bringing these patients “closer” to the hospital. Indirectly, therefore, there is also a “saving” in terms of public mobility, pollution and vehicle traffic. Why not, it is an important thing that can also be considered in the city.

Empathy at a distance during treatment: is it an oxymoron or a feasible goal?

This is a feasible goal, but telerehabilitation personnel must be trained. It is necessary to know and know how to implement procedures and empathy modalities that allow for a taking care of the patient in the same way as in the presence of the patient. It is necessary to develop new languages and new ways to familiarize with the patient. In fact, Digital Medicine has different times and methods from those of in-patient examinations and rehabilitation treatments. The health worker and the patient communicate through a screen, a seemingly “cold” tool, but it is necessary to be sufficiently trained to make it “warm”. Training for this purpose should be offered and provided by communication professionals, health communication experts, telemedicine and telerehabilitation experts, who have been practising it for some time. These figures will be able to offer advice to ensure that it is not a “cold” and “dry” tool, but that emotions and empathy can still be conveyed through this modality. In this way it will not be a “saving” intervention, but a more effective and immediate one.

The team of the Specialistic Rehabilitation Operative Unit of the “Luigi Sacco” Hospital in Milan is collaborating with the Istud Foundation Project “Telemedicine between effectiveness, efficiency and humanisation of care”: this important issue must therefore be tackled in a cooperative manner by several stakeholders given the need to reorganise care pathways in an effective, efficient and humane manner?

Absolutely. Collaboration is essential: the more centres that provide telemedicine, the more opportunities there will be to collect ideas and advice, highlighting limits and criticalities. In this way it will be possible to improve, making Digital Medicine more effective, appropriate and human. Telemedicine must be extended and studied, collecting all possible contributions, in order to improve day by day, offering a further opportunity of Care for our patients.

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