Navigating the Work-From-Home Waters as a New Genetic Counselor

Transitioning to working from home as a new genetic counselor and the learning curve that came with it –

By Alexa Rosenblum, MS, CGC

March 2020 marked the beginning of the COVID-19 pandemic, which created an immediate need for non-essential workers to be furloughed or begin working from home as a way to prevent the spread of the virus. In most clinical environments, many genetic counselors were sent home to their couches to see patients via telemedicine as a way to continue helping patients access genetic testing and understand their genetic testing results. However, the switch from office to home was fairly immediate, without much preparation or planning on the genetic counselors’ end. As a cancer genetic counselor, I began working from home in order to help patients stay on track with their cancer care plans. However, I have less than a year of experience under my belt due to having graduated in May 2019. I was still learning a lot on the job, and moving to working from home only created the need to learn more.

What does working from home mean for a genetic counselor who has never had to use telemedicine before? 

I am part of a genetic counseling team made up of two genetic counselors. That’s right- me, and one more genetic counselor. I am lucky to not have to navigate these waters alone, but my facility has never given patients the option to use telemedicine, so we were really trying to feel out the situation for the first time. To begin with, we didn’t have the resources to begin seeing patients via video chat, unlike a lot of other facilities. In order to see a patient via video chat (ie Skype, Zoom, FaceTime, etc), the platform must be HIPAA compliant. So, we decided on using our phones (yes, our personal cell phones) to call the patients for their appointments. This meant not being able to see our patients, which is typically a huge part of our psychosocial assessment of the patient. I had at least 4 patients who seemed emotional, but it was really hard to tell just by listening to their voice and their words. Additionally, I haven’t had a large amount of time to build my psychosocial skills/confidence in psychosocial counseling, so I definitely felt like these new telephone sessions were leaving the patient without getting the full experience of a genetic counseling session that they are entitled to. Of course, there is always going to be billing road bumps and issues of figuring out how to get reports and forms to the scanners, but in terms of patient care, I really felt that the transition to telemedicine left our patients without the complete “counseling” part of genetic counseling.

Finding a Routine Was Key

Getting my bearings didn’t come easily, but I decided to stick to a routine that would be helpful for me. While that included going to bed and waking up at the same time as I did pre-COVID, it also included clinical routines that would help me stay on track. I made sure to create separate folders on my desktop that included filled out test requisitions, signed informed consent documents, pedigrees, and summary sheets. I also created a tracking sheet that was separate from my regular clinical tracking sheet so I could remember which patients wanted home blood draws, which patients wanted a saliva kit shipped to them, and which patients would be coming to the cancer center to have their blood drawn on a specific date (and what that date is). All of this organization helped to keep me sane, which bled into my counseling skills as well. I was able to deviate from my normal “shpiel” that I gave patients when in the education portion of the session. I made sure the flow of the information made more sense without the photos that I usually include via my flipbook that I have used as a crutch since graduate school. Not having my flipbook has taught me that I can teach a patient all of the information they need to know without having visual representations with me each time. I also made sure to be more direct in my questioning, which helped me develop some psychosocial skills that I could use in the clinic. Having a routine in the questions that I asked and information that I gave was the best way that I dealt with working with patients from my couch instead of the clinic.

Take-Away Points

• Mental Health:  It’s perfectly acceptable to figure out ways to improve your mental health during this time. There are a lot of scary things about a pandemic, and added stress from figuring out how to transition your work from office to your house can weigh heavily on you. Take steps to decrease stress; for me, organization helped me stay on top of things and focus on what I needed to.
• Routine-Finding: Finding a rhythm that works for you is another important piece of the puzzle. Getting into a routine helps keep you on track and will act as a checklist so that you don’t leave anything out.
• Speak Up: If you need help or are feeling overworked, it’s okay to ask your coworker or your boss for help taking things off of your plate or changing around your clinic schedule so that you can handle your workload.

For Patients

• Even though genetic counseling is different via telephone than it is in person, make sure you let your genetic counselor know how you’re feeling during the session and what your thoughts are throughout.
• Genetic testing can be time sensitive, so if you need results sooner rather than later, let your genetic counselor know as soon as possible so that unexpected road bumps due to COVID-19 can be factored in.
• Can’t find a genetic counselor in your area? Check out Grey Genetics for a consult. 

Further Reading:

• Bruder, Katie. “Genetic Counseling in the Time of COVID-19.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 22 May 2020.
• “Cancer Genetic Counseling in the Time of COVID-19.” Georgetown University Medical Center, 28 May 2020.