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.
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
Until recently, there were several barriers preventing widespread adoption of telemedicine. The two broad themes were:
Providers, health systems, and payers were slow to embrace change
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.
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.
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!
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The BMJ’s new podcast aims to help doctors feel more connected, heard, and supported
“Deep breath in … and out. Again, deep breath in … and out.”
We tune in to patients’ breath sounds, seeking confirmation of a diagnosis—one more supporting piece of evidence to reassure anxious patients or to narrow the differential.
But since the SARS-CoV-2 pandemic arrived, saying “deep breath in” has been replaced by the need to take one ourselves: before looking at the morning news, before venturing out (or logging on) to work each morning, and before ringing the next patient on your list with the ominous note alongside their name: “fever and cough for a week, now feeling breathless.” Although chosen in what seems like a different era, the name for The BMJ’s new podcast for general practitioners—Deep Breath In—seems fitting for our troubled times.
Rebooting general practice
Before anyone in Wuhan fell ill, GPs had already been feeling the strain. In the UK, despite government promises of 5000 new practising GPs by 2020, there were 6.2% fewer full time equivalent GPs in 2019 than in 2015.1 Similarly, physicians in the US have been compensating for an estimated shortfall of some 14 500 primary care doctors since 2017.2 Recent attempts to take the strain off GPs in England by funding allied health professionals have faltered because of onerous new demands on fledgling primary care networks.3 Turning it off and switching it back on again is often the only thing that works when your computer grinds to a halt. Perhaps coronavirus will do the same for primary care.
Primary Care Physicians are a vanishing species . This is unfortunate, since PCPs are the only doctors who attend the whole field of Medicine (have you ever asked an orthopedist about your cough?).
However, some of the slack is being taken up by Nurse Practitioners  and Physicians Assistants .
If you know a retired Internist or Family Practice Physician, be sure to cultivate a friendly relationship (and give them a hug when the Covid 19 epidemic cools off). They might be inclined to be that greatest of all Medical Resources- the Patient Advocate .
Empowering Patients Through Education And Telemedicine