All posts by doctorswithoutwaitingrooms

EMPOWERING PATIENTS THROUGH EDUCATION AND TELEMEDICINE

TELEMEDICINE: STANFORD MEDICINE UTILIZES IPADS IN EMERGENCY DEPARTMENT

From a Stanford Medicine article (April 27, 2020):

“Far from separating us from our patients, it is actually expanding on what we can do,” said Ryan Ribeira, MD, clinical assistant professor of emergency medicine at the Stanford School.

An iPad in a patient room at Stanford Health Care’s emergency department. Photo by Susan Coppa

Caring for patients remotely greatly reduces the use of protective equipment — an estimated 80-120 sets per day. The risk of exposure has also been minimized for physicians, nurses and other caregivers, particularly those who are pregnant, immune-compromised or otherwise at high risk of complications from COVID-19. 

When the staff at Stanford Health Care’s Marc and Laura Andreessen Emergency Department started connecting with patients in isolation via iPad, they found an unexpected benefit: The approach offered a more personal, human-centered experience. 

The iPad project moved from conception to implementation in just eight days, starting with a drive-through program in a Stanford Health Care garage: Patients remained in their cars while a physician assessed them by video from inside the emergency department. 

To bring the program into patient rooms, technology specialists at Stanford Health Care ensured the tablets had necessary features, such as the ability to auto-answer calls. When a caregiver calls to check in, the patient receives a few rings as advance notice, then the iPad answers itself. 

The iPad has also been paired with portable handheld ultrasound scanners that quickly plug in, eliminating the need for a bulky ultrasound cart that requires decontamination after every use. And patients participating in clinical research can consent via iPad.

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ENDOCRINOLOGY: BENEFITS OF TELEMEDICINE IN DIABETES MANAGEMENT

From an EndocrinologyAdvisor online article (April 27, 2020):

In the diabetes world where data from meter, pump, and sensor downloads are critical to management, telemedicine is an ideal way to interact with patients. The missing pieces are vital signs, especially blood pressure and weight, but often the patient can monitor these at home and provide trends. Diabetes experts can manage the majority of patients using the HbA1c test and other data the patient has recorded and downloaded to a website. These are easily accessible. I have had patients write down their glucose readings and fax the results as well.” Mark H. Schutta, MD, medical director of the Penn Rodebaugh Diabetes Center

In perhaps one of the most significant changes to occur in health care as a result of the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has suddenly reached the widespread adoption many proponents have championed for years. Recognizing the necessity of telemedicine in light of the current crisis — both to address increased treatment needs and to prevent unnecessary in-person contact — some payors and state legislators have loosened certain restrictions regarding its use across clinical specialties.

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HHS Website: “Telehealth – Health Care From The Safety Of Our Homes”

For patients

Wondering how to get started with telehealth? Check out the information below to better understand your options.

Patient standing and looking at a huge phone screen (larger than life) that has a doctor inside of it. Waving to each other.

Finding telehealth options

If screening tools and self-checkers do not lead you to the care or information you are seeking, you can reach out directly to your doctor or health insurance company for options that can help connect you to a provider online. Understanding telehealth

Find out what it is, what to expect during a visit, and what kinds of care may be available. Telehealth during the COVID-19 emergency

Whether you’re looking for health care related to COVID-19 or something else, find out more about how to prepare for the visit. Preparing for a video visit

WEBSITE

TELEMEDICINE: TRANSITION TO WIDESPREAD ADOPTION

APRIL 8, 2020

Until recently, there were several barriers preventing widespread adoption of telemedicine. The two broad themes were:

  1. Providers, health systems, and payers were slow to embrace change
  2. A failure to appreciate that telemedicine is not a new type of medicine, but rather simply a care delivery mechanism that can be utilized with some patients, some of the time, to provide high-quality care

Addressing the Telemedicine Myths

Myth 1: Telemedicine is “too hard.”

This was not true before Covid-19 and we have further demonstrated that it is not true now. Almost every provider and the great majority of patients in the U.S. already possess the technology needed to conduct a telemedicine visit — a smartphone, tablet, or computer. 

It turns out that when fear of catching a potentially fatal disease strikes, telemedicine is no longer too hard.

Myth 2: Patients prioritize existing relationships with their provider over transactional episodic care.

Data argues otherwise: The majority of times, patients just want care. Falling primary care visits rates, coupled with growing emergency department and urgent care visit rates, suggests convenience as more important than an established relationship.

Myth 3. You cannot do a physical examination.

It turns out you can. A new 21st-century physical exam utilizing telemedicine emphasizes the importance of general appearance (sick or not sick, weight, distress), respiratory effort, and environmental factors including a visual assessment of the home that is not something that can be accomplished at an office visit. 

The majority of times, patients just want care.

Myth 4: Virtual visits are less effective than in-person visits.

Focusing on the comparison in diagnostic accuracy between virtual and in-person visits sets up a false dichotomy. Focusing on actionable information is more important than diagnostic accuracy.2 Actionable information recognizes providers might not always make a diagnosis within a single visit, whether in-person or telemedicine. 

Like every other new challenge, you have to try telemedicine to get comfortable with it.

Myth 5. There is not a payment model supporting telemedicine.

While it is true that the Centers for Medicare & Medicaid Services (pre-Covid-19) had limited reimbursement based upon site of service and geography, since the Covid-19 outbreak, to the credit of the federal government and commercial payers, telemedicine is now covered.

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Health & Aging: The Importance Of Exercise (Scientific American)

Health journalist Judy Foreman talks about her new book Exercise Is Medicine: How Physical Activity Boosts Health and Slows Aging

This is Scientific American’s Science Talk, posted on April 24th, 2020. I’m Steve Mirsky. And under our current, often locked-down situation, it’s still really important to try to get some exercise. Judy Foreman is the author of the new book Exercise is Medicine: How Physical Activity Boosts Health and Slows Aging. She’s a former nationally syndicated health columnist for the Boston Globe, LA times, Baltimore Sun and other places, and an author for the Oxford University Press. We spoke by phone.

Website

COMMENTARY

This Podcast is worth listening to in full. It will introduce some of the upcoming themes of DWWR.

Exercise is one of the 4 pillars of health, thriving and longevity, along with Diet, Sleep, and Intellectual Stimulation.  We look forward to highlighting and reveling in these subjects.

Judy Foreman’s thesis “ exercise is medicine” is true in many dimensions, including industries desire to capture the many beneficial biological effects of exercise in a pill; it requires effort to get off your duff, and you need to budget the time to work out.

My preference is WALKING and WATER EXERCISE. I make passing the time PLEASANT by listening to BBC “in our time”, recorded on a water-proof mp-3 player. EXERCISE is both VALUABLE and ENJOYABLE!

—Dr. C.

Artworks: “The Doctor” – Sir Luke Fildes (1891)

The Doctor exhibited 1891 Sir Luke Fildes 1843-1927 Presented by Sir Henry Tate 1894 http://www.tate.org.uk/art/work/N01522

From an article in MedPage Today by Michael C. Luciano, MD:

You often hear about the practice of medicine which, by definition, is the repetition of a skill set to gain proficiency. All the education, hard work, and countless patient visits are part of this practice.

The art of medicine is the application of all this information and skills we learn and relaying this in a humane way to this one patient in front of you, which is the only thing that matters at this moment. I am here for you is what each patient deserves to feel. This, in my opinion, is what separates the good doctor from the great doctor. That skill is innate. Those going into the field for the right reasons have this within them.

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ABOUT THE PAINTING

In 1890 Sir Henry Tate (1819-98) commissioned a painting from Luke Fildes, the subject of which was left to his own discretion. The artist chose to recall a personal tragedy of his own, when in 1877 his first son, Philip, had died at the age of one in his Kensington home. Fildes’ son and biographer wrote: ‘The character and bearing of their doctor throughout the time of their anxiety, made a deep impression on my parents. Dr. Murray became a symbol of professional devotion which would day inspire the painting of The Doctor’ (Fildes, p.46). Fildes invented a new setting and characters for his painting, and in 1890 he made several sketches.

One year after Tate’s commission, The Doctor was exhibited at the Royal Academy. Agnews immediately published an engraving of it which sold over one million copies in the United States alone and became one of the most profitable prints made by the firm. The popularity of the painting confirms the popularity of social realism in art at this time, and Fildes was one of a number of artists, including Frank Holl (1845-88) and Hubert von Herkomer (1849-1914), whose paintings of the hardships of working class life were widely reproduced in The Graphic magazine. The Doctor was one of the fifty-seven pictures offered by Henry Tate as a gift to the nation in 1897.

Read more at Tate Museum website

Coronavirus : The Race To Expand Antibody Testing, Public Health Investment

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the role of antibody tests in controlling the pandemic, and how public-health spending could curtail an economic crisis. Also on the show, the open hardware community’s efforts to produce medical equipment.

In this episode:

02:08 Betting on antibodies

Antibody tests could play a key role in understanding how the virus has spread through populations, and in ending lockdowns. We discuss concerns over their reliability, how they could be used, and the tantalising possibility of immunity.

News: The researchers taking a gamble with antibody tests for coronavirus

10:25 Economy vs public health, a false dichotomy

Jim Yong Kim, former president of the World Bank, argues that strong investment in public health is crucial to halt the ongoing pandemic and to prevent a global financial crisis. We discuss his work with US governors to massively increase contact tracing, and his thoughts on how researchers can help steer political thinking.

News Q&A: Why the World Bank ex-chief is on a mission to end coronavirus transmission

19:00 One good thing this week

Our hosts talk about staying positive, and pick a few things that have made them smile in the last 7 days, including a tiny addition to the team, a newspaper produced by children in lockdown, and a gardening update.

Six Feet of Separation, the newspaper staffed by kids

22:51 Open hardware

Researchers are stepping up efforts to design and produce ventilators and personal protective equipment for frontline medical staff. We hear how the open hardware movement is aiding these efforts, and the regulations that teams need to consider if their designs are to make it into use.

Technology Feature: Open science takes on the coronavirus pandemic

COMMENTARY

Coronavirus Testing and Tracking (1) are the two pillars of surveillance which will hopefully replace the “shotgun” method of universal distancing that America has tried so far. Quarantining only those who are contagious makes much more social and economic sense than quarantining everybody, and it seemed to work in South Korea (2) and Taiwan (3).

There are problems both with testing-accuracy and availability- and tracking, which is in tension with individuality and freedom.
Still we have no choice but to try, because people and businesses need to socialize and make some money.

Some epidemiologists predict that Covid 19 will smolder on, hopefully not overtaxing our health system, until “herd immunity” gets to 60-70 percent of the population.

As a highly susceptible octogenarian, I plan to keep my distance and become one of the minority protected by herd. And maybe an effective immunization or drug will come along.

—Dr. C.

Podcasts: “The Usefulness of Telehealth and Digital Health During COVID-19 “

In the current times that we live in health care professionals are looking for ways to provide safe, quality care from a distance. Telehealth and Digital health are proving to be the perfect tools during this COVID-19 pandemic. 

PART I

In today’s episode Part I, we are joined with Dr. Amit Sachdev and Dr. Curtis Lowery. Dr. Sachdev is a physician most recently at the Brigham and Women’s Hospital, Harvard Medical School and he is currently working on the COVID response.

Dr. Curtis Lowery is the director of the UAMS Institute for Digital Health and Innovation. He also serves as a professor for the UAMS Department of Obstetrics and Gynecology. This episode is in two parts and it serves as an introduction to telehealth and digital health amidst the COVID-19 pandemic.

PART II

In part 2 of our conversation with Dr. Amit Sachdev and Dr. Curtis Lowery over the usefulness of telehealth and digital health during the COVID-19 pandemic. Dr. Sachdev is a physician most recently at the Brigham and Women’s Hospital, Harvard Medical School and he is currently working on the COVID response. Dr. Curtis Lowery is the director of the UAMS Institute for Digital Health and Innovation. He also serves as a professor for the UAMS Department of Obstetrics and Gynecology. Let’s continue the conversation.

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