Craig at his telemedicine visit with his surgeon, Dr. Guzzo
Craig Loundas, Penn Medicine's Associate Vice President for Patient Experience, has heard it all when it comes to patient care in the health system. He and his team coordinate post-visit surveys that help health care providers, staff and facilities deliver the best possible experience to each Penn patient.
But, during the COVID-19 pandemic, Craig found himself on the other side of the survey – experiencing Penn Medicine as an inpatient at the Hospital of the University of Pennsylvania (HUP).
From Routine Care to Cancer Screening
During a routine physical earlier this year, Craig's doctors noticed an elevated amount of blood in his urine. After additional testing, his doctor referred him to a urologist who ordered a CAT scan in early March 2020.
That scan showed a small tumor on Craig's bladder, and further investigation was needed to determine whether the tumor was cancerous.
Craig had an outpatient cystoscopy on March 18 at the Perelman Center for Advanced Medicine SurgiCentre, during which doctors examined his bladder and did a bladder biopsy.
Penn Medicine had rescheduled many patient appointments to help ensure physical distancing in response to the COVID-19 pandemic, so Craig was one of only a handful patients that day. On an average day before the pandemic, the bustling SurgiCentre would see dozens of patients.
"People are sensitive that this is a different time for patients," Craig said. "They're following the protocols to keep us safe."
Preparing for Surgery During the Surge
The cystoscopy and biopsy confirmed that the tumor on Craig's bladder was malignant, but thankfully, the cancer was in its earliest stages and could be removed through surgery.
"I've always been pretty diligent in getting an annual physical and am thankful that my PCP [primary care provider] caught the increased levels and referred me to a urologist immediately," Craig noted.
Craig began preparing for surgery to remove the tumor with Thomas J. Guzzo, MD, MPH, Chief of the Division of Urology at Penn Medicine. They did their first visit via telemedicine on March 25 and planned Craig's course of treatment.
Surgery was scheduled for April 15, during the height of the COVID-19 pandemic in Philadelphia.
A Collaborative Decision Rooted in Trust
"I did ask Dr. Guzzo at the end of March, 'Would you recommend delaying the surgery until after COVID-19 passes?'" Craig said.
Dr. Guzzo told Craig that while his tumor was not life-threatening, it was still a serious concern. The surgeon was certain he would be safe throughout his procedure and recovery in the hospital.
"Bladder cancer can be highly aggressive and progress over short periods of time," Dr. Guzzo said. "Craig and I discussed the risks and benefits of moving forward with surgery during the pandemic versus deferring surgery to a later date and we both felt the risks of delaying outweighed the risks of coming into the hospital during the pandemic.
"Fortunately for Craig, I believe we made the right decision -- and I expect him to do very well."
Craig's trust in Dr. Guzzo never wavered and inspired confidence in the decision they made together.
"Trusting the voice of your doctor is really important, and it was good to hear him say 'come in,'" he said. "I trust him in terms of what happened. I never felt unsafe."
The day before surgery, Craig had a pre-operative visit with the Periop team to fully prepare him for what to expect upon arrival the next day.
On the day of this surgery, Craig was greeted at HUP's entrance by nurses who were fully dressed in personal protective equipment. He was immediately escorted to his pre-operative room, bypassing the waiting room entirely.
"Everyone was wearing face masks. There was very little waiting in public areas," Craig said. "You aren't sitting with people. When my wife had surgery a few years ago, there may have been 40 to 45 people in the waiting room. That isn't the case now."
Different Processes, Same High Standards
The surgery to remove the tumor on Craig's bladder was done laparoscopically through seven small incisions in his abdomen.
While in non-pandemic times, Dr. Guzzo would have met with Craig's wife in-person to discuss the surgery; he instead called her to let her know it had been a success.
"We were kept informed. The same points of communication that reassure people's families are still done," Craig said. "They're just done telephonically."
After one night recovering in the hospital, Craig was discharged. He was given notice earlier in the day, so he could arrange for his wife to pick him up without needing to wait in public areas at the hospital.
"I have not been hospitalized a whole lot, but it didn't seem like anything changed in terms of my care. Everyone had PPE [personal protective equipment] while taking care of me," he said, noting that he also wore a face mask each time he encountered another person in the hospital. "There is the same sense of clinical protocols, but they are done with PPE to make me feel safe, and the doctors and nurses feel safe, too."
Recovery via Telemedicine
As Craig recovered from his surgery at home, his care team constantly communicated with him via phone call and text message.
"I have no doubt we will come out of the pandemic stronger and better than we went into it," Dr. Guzzo said. "Not only from an organizational standpoint but also in the manner that we deliver care to individual patients.
"We have learned the value of telemedicine, and I think this will be a big patient satisfier moving forward even once the pandemic is over. The pandemic has forced us to reconsider how we deliver care to our patients and over the long run this will allow for more efficient delivery of health care services."
In the days after Craig's surgery, Dr. Guzzo and his team checked to see how Craig was feeling, how his incisions were healing, and if his medications were working for him – all without additional visits to the hospital or doctor's office.
"There's all kinds of cool technology that's being used here," Craig said. "There was a lot of communication before and after surgery to set me up for what would be different. I always felt safe."
Nine days after surgery, Craig returned to HUP for his final follow-up. Again he was greeted by PPE-clad nurses at the hospital's entrance.
"There were the same levels of safety protocols, and people were abundantly prepared for guests coming in," Craig said. "People have the supplies they need – from environmental services and food workers to doctors and nurses."
And, because the front-line staff at Penn Medicine are protected, they are better able to ensure the excellent patient care they've been providing for years.
"We've been through the AIDS crisis, we made it through Ebola, this is what we do," he said. "Our thousands of employees are doing what they've always done. The patients may be different, but these are solid, everyday behaviors that our employees have."
When asked how he would rate his own patient experience, Crag answered, "I'd give it five stars!"