Examples of significant changes prompted by the pandemic leading to shifts in clinical principles and practices of medical genetics
| Prepandemic genetic service delivery | Pandemic-related changes | Shifts in clinical principles and practices moving forward | |
| 1. Environment of practice | Patients physically seen in clinic based on geographic factors. | Increased use and availability of virtual care: many patients now able to be ‘seen’ in their home environments without the need to travel to clinic. | Coordination at the local or regional level could be considered to improve access to genetic care. |
| 2. Nature of consult | In-person, comprehensive history taking and dysmorphology examinations that often require measurements or specific manoeuvres and sensitive in-person discussions. | Increased use and availability of virtual care. Pandemic-related limitations in ancillary testing like physical examination, imaging or specialised laboratory testing. | Shifting from a ‘phenotype-first’ approach may allow for new models of in-person, virtual or hybrid care where genetic testing may be offered earlier than in traditional models. |
| 3. Patient factors | Patients had to take time off work to travel and pay for parking and childcare to attend in-person visits. | Public health guidelines to restrict non-essential visits. Increased use and availability of virtual care. Centring practices on protecting safety of patients. | Accommodation of patient preferences for the location and timing of care, particularly for individuals who may belong to a marginalised or disadvantaged group, may be increasingly important to consider. |
| 4. Provider factors | Physicians, genetic counsellors and laboratory personnel traditionally worked in hospitals without the ability to work from home. | Public health guidelines to restrict non-essential visits. Availability and support to work remotely. Centring practices on protecting safety of providers and preserving PPE. | Consideration of leveraging the use of virtual care and remote working environments may balance provider needs and safety. |
| 5. Laboratory factors | Molecular genetic testing primarily done on a blood sample. | Increased use of saliva and buccal swabs to decrease need to have physical contact for phlebotomy. | Incorporating more non-invasive and convenient sample collection may be a safe and welcome shift for some types of genetic testing. |
PPE, personal protective equipment.