COMMENTARY

No-Visitor Policies Are Bad Medicine

John L. Marshall, MD

Disclosures

August 24, 2020

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This transcript has been edited for clarity.

This is John Marshall for Medscape. I've been thinking a lot about the impact of COVID-19 on our division, our patients, our processes, and our cancer care.

Cancer care is not elective; it has to keep going. One of the worst policies for our patients right now is this no-visitor policy. You are coming for a treatment, a clinic visit, or, worse yet, admitted to the hospital for end-of-life care or for some complex medical procedure related to your cancer, and yet you can't have a caregiver, an advocate, sitting next to you in your room.

As much as we say they may irritate us, we all rely on them. They don't irritate us. They help quarterback and navigate us as we see our patients. They help us coordinate care and they help us understand what that patient's life is really like. Sure, technology bridges that to some degree, but it's just not the same. We all know that.

As a consequence, I think the quality of our care is falling a bit because no caregivers are around. I've been watching patients make really interesting decisions. Nowadays it's not uncommon for somebody to say, "I'm not going to go to the hospital to see what is wrong. I'm going to sit at home. I don't want to go in there and be lonely, even if it means my life will be shorter. I'm not going to take another round of fourth-line therapy for metastatic disease because I don't want to risk ending up in a hospital by myself, particularly at end of life." [I think we are doing] hospice sooner rather than trying to extend people's lives with some intervention or "Band-Aid."

Because of the terribleness of being by yourself in the hospital — maybe the loneliest place on Earth — patients are making different medical decisions.

I also wonder how much of this is going to stick around when we loosen up. In Washington, DC, we have started to do some elective procedures and fill back up within the hospital. Maybe soon we will start to allow visitors and caregivers physically back into the hospital. I wonder if we will slip back to where we were before or if we will reflect on this and incorporate more heavily the importance of being at home with family.

This loneliest place on Earth that we have created in our hospitals is teaching us all a lesson for the future.

Just a thought as COVID-19 continues to wreck our days. John Marshall for WebMD/Medscape.

John L. Marshall, MD, is a leader in the research and development of drugs for colon cancer and other gastrointestinal cancers, and he has been the principal investigator of more than 150 clinical trials. Marshall is the founding director of the Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer, chief of the Division of Hematology-Oncology at Georgetown University, and the clinical director of oncology for Georgetown University Hospital.

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