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Let’s compile important stuff here
Let’s compile important stuff here
This "paper" can be also titled: "How we should have been conducting breast RT if we were not thinking about earning money all the time"...
Well yeah you’re in Europe. Tell that to most of the posters here, they won’t like it.
Keeping 6 ft distance from everyone, using surgical masks, conserving precious n95s for encounters with symptomatic pts. Apparently many are doing telephone OTVs, not sure that is kosher or great for pt care. Can't do things like skin checks etc.On a practical front, what are you guys using to protect yourselves in clinic? Surgical masks? N95 masks?
I'm also washing my hands regularly and meticulously and wiping down common areas.
Keeping 6 ft distance from everyone, using surgical masks. Apparently many are doing telephone OTVs, not sure that is kosher or great for pt care. Can't do things like skin checks etc.
We are debating screening at the front door with temps, however our only thermometers are under tongue/axilla.
I’m telling admins to get infrared or forehead. Would you guys want your nursing doing oral temp screens? I really don’t.
Let’s compile important stuff here
A paper saying that RT "doesn't matter at all" for many breast patients, so skip it? Heaven forfend. But thanks for the shout out @radoncgrad2019Are you on that side or the Side of scarb who posts here on a daily basis that what we do doesn’t matter at all?
"Boost radiotherapy has more limited applications..."Scarb, is there literally anything that you do that falls in line with what is generally accepted as normal practice? I have the sense that you just like to debate, but you seem to almost always take a contrarian view. You don't treat nodes, you don't boost...
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FWIW Whelan has said himself that he typically boosts, despite the lack of a mandated boost on his trial.
Boost!
Routine boosting will make you more money vs silly arguments about technological technicalities. But I wouldn't say people made the argument so much as CMS did FWIW.Palex actually does real IMRT (VMAT) for breast cancer!
In the US, we actually still have people trying to make the argument that 3D tangents with field-in-field is IMRT based on a nonsensical semantics argument. It's pretty shameful.
We are debating screening at the front door with temps, however our only thermometers are under tongue/axilla.
I’m telling admins to get infrared or forehead. Would you guys want your nursing doing oral temp screens? I really don’t.
Surgical masks mainly. FFP3 masks are reserved only when encountering patients tested positive as well as for those undertaking procedures which produce aerosols, such as bronchoscopy for instance.On a practical front, what are you guys using to protect yourselves in clinic? Surgical masks? N95 masks?
Good luck getting infrared thermometers. I am being told it's impossible to order them.
Regarding OTVs over the phone, I don't understand how you would bill for this and hence this is verboten to admin. The vast majority of my OTV time is spent with chit-chat with asymptomatic patients who just want someone to talk to. In this case, I have been making it clear that we are sticking to business and asymptomatic OTVs are taking < 1 minute.
We did this all weekWe are debating screening at the front door with temps, however our only thermometers are under tongue/axilla.
I’m telling admins to get infrared or forehead. Would you guys want your nursing doing oral temp screens? I really don’t.
At least in theory as the code was written and first envisioned the majority of the "OTV time" actually happens from "overseeing the chart." It's a code that happens over a 5 day (or fx) tx time period. It's not officially called a "visit" by Medicare; it's "weekly treatment management." It includes many other things besides just a visit, things that happen when the patient is home and/or without the doctor actually seeing or touching the patient: "review of port images, dosimetry, dose delivery, treatment parameters and patient set-up, among other professional services as clinically indicated." Also, when the code was developed ~20 years ago, it being an E+M type code (suggesting face-to-face necessary) was expressly rejected by CMS in a description of the code. Many have tied verbal knots to explain the necessity of face-to-faceness, and of course that's what we all do. But was a face-to-face totally legally mandated? It's never quite been tested. But now's a time where I think face-to-face doesn't have to happen and a phone call, along with the "weekly tx management" activities as ASTRO describes them happening over a 5-7 day stretch, could suffice. YMMV of course!Good luck getting infrared thermometers. I am being told it's impossible to order them.
Regarding OTVs over the phone, I don't understand how you would bill for this and hence this is verboten to admin. The vast majority of my OTV time is spent with chit-chat with asymptomatic patients who just want someone to talk to. In this case, I have been making it clear that we are sticking to business and asymptomatic OTVs are taking < 1 minute.
How do you skin check a pt over the phone? I think social distancing would be a reasonable compromise, so you can still do skin checksAt least in theory as the code was written and first envisioned the majority of the "OTV time" actually happens from "overseeing the chart." It's a code that happens over a 5 day (or fx) tx time period. It's not officially called a "visit" by Medicare; it's "weekly treatment management." It includes many other things besides just a visit, things that happen when the patient is home and/or without the doctor actually seeing or touching the patient: "review of port images, dosimetry, dose delivery, treatment parameters and patient set-up, among other professional services as clinically indicated." Also, when the code was developed ~20 years ago, it being an E+M type code (suggesting face-to-face necessary) was expressly rejected by CMS in a description of the code. Many have tied verbal knots to explain the necessity of face-to-faceness, and of course that's what we all do. But was a face-to-face totally legally mandated? It's never quite been tested. But now's a time where I think face-to-face doesn't have to happen and a phone call, along with the "weekly tx management" activities as ASTRO describes them happening over a 5-7 day stretch, could suffice. YMMV of course!
Scarbs voice is like Jon Hamm? Or Ralph Wiggum?
No, Jon Snow.
We did this all week
ForeheadOral temp or forehead?
May not resemble him vocally but probably in other ways? But speaking of Hamm, watch 'Richard Jewell.' An underappreciated movie gem from last year. Usually Clint does his own music but he picked the great Arturo Sandoval for the score for this one. My favorite line of the movie, spoken by Sam what's his name's Russian secretary: "In my country, if the government says you're guilty that's how we know someone is innocent." Zing!Scarbs voice is like Jon Hamm? Or Ralph Wiggum?
Facetime!How do you skin check a pt over the phone? I think social distancing would be a reasonable compromise, so you can still do skin checks
Yup, mine are on hiatus for awhileGoes without saying but no ties and white coats.
On a practical front, what are you guys using to protect yourselves in clinic? Surgical masks? N95 masks?
I'm also washing my hands regularly and meticulously and wiping down common areas.